Before and After Tooth Extraction

Need for tooth extraction

You may need tooth extraction for several reasons. 

Some of these include:

• Tooth decay that has extended deep into the tooth
• If infection destroys a large portion of the tooth or surrounding bone
• If the space in your mouth is  not for all the teeth
• If you have impacted teeth or tooth that has erupted partially. An impacted tooth may cause no problems or may become painful when it tries to erupt. The pain can radiate or may be felt in nearby teeth or the ear on the same side. A partially erupted tooth can cause other problems like gum swelling, tooth decay, change in bite (the way the teeth come together), and an infection (pericoronitis) due to collection of food and other debris under the gum. Impacted tooth can cause formation of a follicular (dentigerous) cyst as well. This can injure nearby teeth and even destroy the nearby bone. 

How are Teeth Removed?

Before extraction your dentist will take a complete medical and dental history and do a clinical examination. If required he or she will do X-rays. X-rays helps your dentist to assess the length, shape, position of the tooth and surrounding bone. This helps your dentist to assess probable difficulty he or she may have while doing the procedure and if to refer you to a specialist dentist called an oral surgeon. 

Your dentist will give you local anesthesia and numb the area in your mouth and then extract the tooth with dental forceps.

What can I Expect After an Extraction?

• After your tooth/teeth are removed maintain your oral hygiene to prevent infection in that area. 
• After removal you will have bleeding for sometime (30 to 45 minutes). Bite down gently on a piece of dry, sterile gauze, as advised by your dentist for 30 to 45 minutes to control bleeding and to let a clot form.
• Avoid smoking, 
• do not rinse your mouth briskly, or clean the teeth next to the extraction site for 24 hours after extraction. 
• You will be given simple analgesics such as acetaminophen or ibuprofen to relieve pain and discomfort which occurs after extraction. 
• If needed apply ice pack on the face for 15 minutes every three to four hours if you have pain. The pain and discomfort usually decrease within three days to two weeks. 
• Do not drink hot liquids and liquids through a straw. 
• Rinse your mouth gently with warm salt water
• Consult your dentist if you have - severe pain, persistent bleeding, fever, increasing swelling 

Common reasons for tooth extraction are:

• Tooth decay or fracture: Your tooth may need removal if the damage to the tooth by decay or a fracture is too extensive to be repaired by doing filling, crown or other treatment.
  
• Extra tooth - which may block the eruption of a normal tooth
  
• Orthodontic procedures - may need teeth extraction to make room for the teeth or the restoration (crown, bridge) that is being placed.
  
• Cancer patients who are going to receive radiation to the head and neck Cancer patients on chemotherapy may develop infection of teeth which may need to be extracted.
  
• Patients for an organ transplant may need some teeth extraction if the teeth may increases their risk of infection after the transplant, when they are given immunosuppressive medications.
• Wisdom teeth - if they cause problems like gum swelling, tooth decay, change in bite (the way the teeth come together), or infection (pericoronitis)
  

Preparation

Before extraction your dentist will take a complete medical and dental history and do a clinical examination. If required he or she will do X-rays. X-rays helps your dentist to assess the length, shape, position of the tooth and surrounding bone. Relationship of upper teeth to the sinuses and the lower teeth to the inferior alveolar nerve can also be evaluated in X-rays. You may be given antibiotics to be taken before and after surgery.You are more likely to receive antibiotics if you have infection at the time of surgery or have weak immune system, or are very young or elderly.

Your dentist will give you local anesthesia and numb the area in your mouth and then extract the tooth with dental forceps. Teeth extraction usually is a relatively routine procedure. But wisdom tooth/teeth extraction is not as simple as extracting other teeth. You may be given general anesthesia (to put you to sleep) if the wisdom teeth are being removed.

 How it is Done

Your tooth may be removed by simple extraction or by surgical extraction

Simple extraction: 

Teeth seen are the mouth extracted by simple extraction. Simple tooth extraction is usually a relatively routine procedure. Your dentist will do the extraction under local anesthesia with dental forceps.

Surgical extraction: 

This procedure is done by oral surgeons to extract teeth are not seen well in the mouth because they have broken off at the gum line or have not erupted completely. The oral surgeon will do the extraction under a local anesthesia or conscious sedation. Some people and young children may need general anesthesia. Your surgeon will make an incision in your gum to reach the tooth and then remove the teeth. If all your wisdom teeth need to be removed, they are usually taken out at the same time.Wisdom teeth are the most difficult to remove. An impacted or tilted wisdom tooth is more difficult to remove. 

Follow-Up

• Pain: Simple extractions are usually not very painful after the procedure. Simple analgesics such as acetaminophen or ibuprofen can control the pain well in a few days. Where as surgical extractions are more painful. The discomfort and pain usually last longer than after a simple extraction. You will need stronger analgesics to control the pain. The post surgical pain usually decreases and disappears in a few days. If needed apply ice pack on the face to reduce pain ad post-operative swelling.
• Bleeding: After extraction you will have bleeding for sometime. Bite down gently on a piece of dry, sterile gauze, as advised by your dentist for 30 to 45 minutes to control bleeding and to let a clot form. You can have mild bleeding for next 24 hours or so. Remember not to disturb the clot that forms on the gums after extraction. The area may still bleed minimally for the next 24 hours or so and taper off after that. Don’t disturb the clot that forms on the wound.
• Oral hygiene: Do not rinse your mouth briskly, or clean the teeth next to the extraction site for 24 hours after extraction. Rinse your mouth gently with warm salt water as this helps to clean the area.
• Foods: Avoid smoking and eat soft foods as advised by your dentist. You can slowly start eating as normal diet as you feel comfortable. Do not drink hot liquids and liquids through a straw. 

Risks

Some common complications that can occur after tooth extraction are

• Infection
• Dry socket: In this condition blood clot doesn’t form after extraction or blood clot prematurely breaks off or breaks down. This exposes the underlying bone to air and food and causes pain, bad odor or taste.Accidental trauma to adjacent teeth, such as fracture
• Incomplete extraction. In this condition the tooth root remains in the jaw.Fracture of the jaw. May occur in elderly with osteoporosis of the jaw due to pressure put on the jaw while extraction.
• Perforation of the sinus during removal of upper molar. It may heal by itself in a few weeks but if it does not additional surgery will needed.

When To Call a Professional

Consult your dentist or oral surgeon if the pain and swelling worsen instead of improving after 24-48 hours.You have fever, chills or redness in the area.You have persistent bleeding even if mild after 24 hours.