Dr. Adams generally prefers to save a tooth rather than extracting it although there may be certain situations where an extraction is indicated. A tooth extraction is the removal of a tooth from its socket in the bone. Tooth extractions are becoming less common because of the trend for the smile makeover and beautiful natural smiles. It is usually more expensive in the long run to extract a tooth because in many cases, something would have to replace it such as an implant, bridge or denture. There are situations where an extraction is indicated if there is crowding or wisdom teeth that are causing pain. This is a simple dental procedure but it can often cause a lot of anxiety for some patients. Being better informed about the extraction procedure and what to expect afterwards can often relieve some of this anxiety and help you to be better prepared for the treatment. Dr. Adams provides this service for simple extractions but usually will refer complex cases such as wisdom teeth to an oral surgeon who specializes in this type of surgery.
Some of the reasons for extractions are:
- Trauma to the tooth following a knock to the jaw from a sporting injury or fall.
- Deep decay or severe gum disease in a tooth.
- Not enough space for the teeth.
In some cases, extraction may be the only treatment option available however in other cases, alternative treatment options may be available. Dr. Adams will discuss any alternative treatment options with you prior to any extraction.
TOOTH EXTRACTIONS CAN BE DIVIDED INTO TWO CATEGORIES: Simple Extractions and Surgical Extractions.
Simple extractions
What does the procedure involve?
It could be a simple and quick procedure while sitting in the chair after receiving anesthesia.Pressure is applied to the tooth to loosen it within its socket. Once it is loose, forceps are applied and the tooth is loosened further and removed. Sometimes these extractions can occur before the patient realizes the tooth is out. In more complex cases, the patient will be sent to an oral surgeon who may provide a sedative that will relax the patient enough to fall asleep while the procedure is completed. This is usually the case of impacted teeth and wisdom teeth removal.
In some cases, the tooth may fracture during the procedure in which case the dentist may need to remove the remaining fragment separately. This can sometimes be performed non-surgically, but at times a simple extraction may turn into a surgical extraction. In some circumstances, the dentist may choose to leave the fragment in place. Simple extractions may, on occasion, also involve the division of the tooth into parts prior to extraction to help the tooth come out more easily.
Does it hurt?
The patient feels a lot of pressure in the area as the tooth is being extracted but generally does not feel any pain. There may be some jaw discomfort from keeping the mouth open for a long period of time but frequent opportunities to rest the jaw during the procedure tends to minimise this discomfort.
What is the expected recovery time?
Recovery time following a simple extraction can vary widely but it generally takes a few days for patients to feel back to normal. Full healing will take several weeks. It is very important to follow the post operative instructions. Some things to remember:
- Your dentist will ask you not to rinse or spit on the day of the extraction as this can lead to early loss of the blood clot and delay the healing process.
- Smoking on the day of extractions and the days following can also lead to early loss of the blood clot and to a condition known as dry socket where normal healing is interrupted.
- A patient can generally eat normally on the day of the extraction but in some cases a soft diet may be required for 24-48 hours following the extraction.
- To help prevent infection, your dentist might also ask you to rinse with warm salt water several times a day for 4-5 days starting the day after your extraction.
Will my private health insurance cover the cost?
If you have private health insurance, it may cover some of the cost of your extraction but it is always best to contact your insurance company first.
Surgical Extractions
Surgical extractions are those that are performed on teeth that are not easily accessible, such as when teeth are broken under the gum line or only partially erupted. Wisdom teeth removal is also generally a surgical procedure as these are often removed if they are still below the gums.
How is the procedure performed?
Dr. Adams will refer his patients to an oral surgeon who has specially training in these kinds of surgical extractions. This procedure can be performed either under local anesthesia while the patient is awake or under general anaesthesia. Whether the procedure is performed under local anaesthesia or general anaesthesia will depend on patient and the doctor.
What does the procedure involve?
Surgical extractions involve an incision made to the gum and may or may not require the removal of bone surrounding the tooth to provide access to the tooth. The tooth is then removed in a procedure similar to a simple extraction. Sometimes the tooth may also need to be divided into parts to allow it to be removed more easily. Once the tooth is removed, the gum will require sutures to keep it in place as it heals.
What is the expected recovery time?
Recovery time following a surgical extraction can vary greatly but is generally longer than a simple extraction. There is more likely to be some swelling and you are more likely to need to limit your activities (eg take time off work) for at least the first 24 hours following the surgery. This can not be stressed enough. Patients oftentimes feel really good afterwards and end up causing complications because they didn't take it easy. Instructions for aftercare are generally the same as for simple extractions but a soft food diet and pain relief is more likely to be required for a few days following the extraction. Full healing is also likely to take longer, particularly if there has been bone removal. Remember, if you can avoid taking pain relievers or take them for the very least amount of time, your recovery will be faster.
Will the cost be covered by my private health insurance?
The cost of a surgical extraction can vary widely depending on whether it is performed under local or general anaesthesia and whether bone removal or tooth division is required.It is best to make your inquiries about insurances and the finances with the oral surgeon's office manager.
- Are there alternatives to extracting my tooth? Any dental extraction should be preceded by a discussion with your dentist about the possible alternatives to extracting the tooth.
- What will happen if I choose not to extract the tooth and decline any other treatment? The option to do nothing at all and the possible consequences of this should also be discussed. If the tooth is infected and causing pain, this is likely to persist and worsen and may lead to possible spread of the infection which may be life threatening. On the other hand, a tooth which is not infected but which is causing crowding may possibly be left in place. Each situation is unique and should be discussed with your dentist.
- What are the options for replacing the tooth following extraction? Once the tooth is removed, you may or may not choose to replace it with a prosthetic tooth. The choice not to replace it may have consequences and these should be discussed with your dentist. Furthermore, there is a range of replacement options, each with their own risks and benefits and these should be discussed.
- How much will the procedure cost? The expected cost of the extraction should be discussed.
- What are the risks of the procedure? Every extraction has risks including risks of bleeding, infection and tooth fracture. Additional risks may be present depending on the individual case and should be discussed with your dentist
Wisdom teeth extractions are a fairly common procedure. Wisdom teeth often cause problems as they are trying to protrude through the gums. When a wisdom tooth is impacted, it means the tooth is coming in at an angle and not straight through the gum line. This can cause pain, the tooth can come in unevenly, or the tooth may only emerge partially.
When a wisdom tooth only emerges partially a flap of skin, called an operculum, may form over the tooth. This can make the tooth hard to clean, and pieces of food may be caught under the skin. This makes it easy for an infection, called pericoronitis, to develop. It will usually go away on its own, but it causes swelling and pain in the area.
Impacted teeth and wisdom teeth that can potentially cause problems, like infections, need to be removed. Extractions can range from a single tooth, to removing all four wisdom teeth at once. Based on the preference of the doctor and/or the patient, a local anesthetic could be used to numb the areas where the teeth will be extracted. Others will prefer to go under a general anesthetic so that they will be sedated during the procedure.
The gum tissue around the wisdom tooth is cut open to reveal the tooth. The tooth is loosened by gripping it tightly and wiggling it back and forth until it can be lifted out of the gums. Sometimes a tooth may be impacted so tightly that it cannot be simply lifted out of the gums. In cases like this the tooth will be broken up into pieces first before being removed. Depending on the incision and extraction site, sutures may be needed to close the area. Soluble sutures are the best option, which will dissolve on their own.
After the surgery you will need to rest. You need to be driven home by a friend or family member because of the anesthesia. You can expect for the extraction site to bleed for a little while after the surgery. Gauze will be applied at the completion of the surgery, and you will need to change it when it becomes soaked. If bleeding continues for longer than 24 hours you should call your dentist. Rest when you return home, but do not lie flat. This could prolong the bleeding. Prop your head up on a pillow when lying down. Your dentist will prescribe you pain medication, so if you become sore take as directed. You can also use an ice pack for the pain. Your dentist might also provide you with a cleaning solution to clean the extraction site.
You will be limited to soft foods for a few days after your surgery. Some recommended foods are:
- Gelatin
- Pudding
- Yogurt
- Mashed Potatoes
- Ice Cream
- Thin Soups
- ...and other food you can eat without chewing.
When drinking, make sure you do not use a straw. The sucking motion can loosen your sutures and slow the clotting process. The same goes for smoking. If you have prolonged pain, bleeding, irritation, or don't feel that the extraction site is healing properly call your dentist for a follow up.
