Tooth
extraction is the removal of a tooth from its socket in the
bone.
Purpose
Extraction
is performed for positional, structural, or economic reasons.
Teeth are often removed because they are impacted. Teeth become
impacted when they are prevented from growing into their normal
position in the mouth by gum tissue, bone, or other teeth. Impaction
is a common reason for the extraction of wisdom teeth. Extraction
is the only known method that will prevent further problems.
Teeth may also be extracted to make more room in the mouth prior
to straightening the remaining teeth (orthodontic treatment),
or because they are so badly positioned that straightening is
impossible. Extraction may be used to remove teeth that are
so badly decayed or broken that they cannot be restored. In
addition, patients sometimes choose extraction as a less expensive
alternative to filling or placing a crown on a severely decayed
tooth.
In
some situations, tooth extractions may need to be postponed
temporarily. These situations include:
Infection that has progressed from the tooth into the bone.
Infections may make anesthesia difficult. They can be treated
with antibiotics before the tooth is extracted.
The patient's use of drugs that thin the blood (anticoagulants).
These medications include warfarin (Coumadin) and aspirin. The
patient should stop using these medications for three days prior
to extraction.
Patients who have had any of the following procedures in the
previous six months: heart valve replacement, open heart surgery,
prosthetic joint replacement, or placement of a medical shunt.
These patients may be given antibiotics to reduce the risk of
bacterial infection.
Tooth
extraction can be performed with local anesthesia if the tooth
is exposed and appears to be easily removable in one piece.
An instrument called an elevator is used to loosen (luxate)
the tooth, widen the space in the bone, and break the tiny elastic
fibers that attach the tooth to the bone. Once the tooth is
dislocated from the bone, it can be lifted and removed with
forceps.
If
the extraction is likely to be difficult, the dentist may refer
the patient to an oral surgeon. Oral surgeons are specialists
who are trained to give nitrous oxide, an intravenous sedative,
or a general anesthetic to relieve pain. Extracting an impacted
tooth or a tooth with curved roots typically requires cutting
through gum tissue to expose the tooth. It may also require
removing portions of bone to free the tooth. Some teeth must
be cut and removed in sections. The extraction site may or may
not require one or more stitches to close the cut (incision).
Before
an extraction, the dentist will take the patient's medical history,
noting allergies and prescription medications. A dental history
is also taken, with particular attention to previous extractions
and reactions to anesthetics. The dentist may then prescribe
antibiotics or recommend stopping certain medications prior
to the extraction. The tooth is x-rayed to determine its full
shape and position, especially if it is impacted.
If
the patient is going to have deep anesthesia, he or she should
wear loose clothing with sleeves that are easily rolled up to
allow for an intravenous line. The patient should not eat or
drink anything for at least six hours before the procedure.
Arrangements should be made for a friend or relative to drive
the patient home after the surgery.
An
important aspect of aftercare is encouraging a clot to form
at the extraction site. The patient should put pressure on the
area by biting gently on a roll or wad of gauze for several
hours after surgery. Once the clot is formed, it should not
be disturbed. The patient should not rinse, spit, drink with
a straw, or smoke for at least 24 hours after the extraction
and preferably longer. Vigorous exercise should not be done
for the first three to five days.
For
the first two days after the procedure, the patient should drink
liquids without using a straw, and eat soft foods. Any chewing
must be done on the side away from the extraction site. Hard
or sticky foods should be avoided. The mouth may be gently cleaned
with a toothbrush, but the extraction area should not be scrubbed.
Wrapped
ice packs can be applied to reduce facial swelling. Swelling
is a normal part of the healing process. It is most noticeable
in the first 48-72 hours. As the swelling subsides, the patient
may experience muscle stiffness. Moist heat and gentle exercise
will restore jaw movement. The dentist may prescribe medications
to relieve the postoperative pain.
Potential
complications of tooth extraction include postoperative infection,
temporary numbness from nerve irritation, jaw fracture, and
jaw joint pain. An additional complication is called dry socket.
When a blood clot does not properly form in the empty tooth
socket, the bone beneath the socket is painfully exposed to
air and food, and the extraction site heals more slowly.
After
an extraction, the wound usually closes in about two weeks.
It takes three to six months for the bone and soft tissue to
be restructured. Complications such as infection or dry socket
may prolong the healing time.
Dry socket
A painful condition following tooth extraction in which a blood
clot does not properly fill the empty socket. Dry socket leaves
the underlying bone exposed to air and food.
Extraction site
The empty tooth socket following removal of the tooth.
Impacted tooth
A tooth that is growing against another tooth, bone, or soft
tissue.
Luxate
To loosen or dislocate the tooth from the socket.
Nitrous oxide
A colorless, sweet-smelling gas used by dentists for mild anesthesia.
It is sometimes called laughing gas because it makes some patients
feel giddy or silly.
Oral surgeon
A dentist who specializes in surgical procedures of the mouth,
including extractions.
Orthodontic treatment
The process of straightening teeth to correct their appearance
and function.
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