The process of teeth extraction dates back as far as the practice of dentistry. At one time, it was the only solution available for severe, chronic tooth pain. Fortunately, dentists today can make the extraction procedure less painful and replace the missing tooth with a realistic dental prosthetic afterward.
Reasons to Have a Tooth Pulled
A dentist may occasionally diagnose a patient's tooth decay or damage as too severe to adequately treat with a filling, crown, onlay or inlay. When this occurs, the patient may opt to take the tooth out completely instead of undergoing repeated attempts at restoration procedures that have little chance of success.
Dentists typically perform extractions of wisdom teeth to reduce oral discomfort or prevent damage to surrounding teeth. An impacted tooth is positioned in such a way that it cannot fully emerge. This can lead to pain and gum irritation. An impacted wisdom tooth located at an abnormal angle in the jaw may put pressure on the adjacent tooth leading to crowding. Extraction may reduce the risk of cavities in the adjacent molar by making proper brushing and flossing easier in that area of the patient's mouth.
Extensive bone loss from periodontal disease can cause teeth to loosen and eventually fall out on their own. A patient may choose extraction to avoid the ongoing discomfort of dealing with a loose tooth. Rarely, a dentist may recommend pulling a tooth for patients with excessively crowded teeth. The patient might choose to have this done in preparation for a fitting with orthodontics to correct severe misalignment problems.
Teeth Extraction Procedure Overview
A general dentist or oral surgeon does a complete patient workup including x-rays and a full medical and dental history. The dentist will use this information to identify the position of the teeth, sinuses, nerves and any underlying problems such as bone disease.
The dentist will provide local numbing, conscious sedation or full anesthesia depending on the complexity of the extraction process and the patient's tolerance for pain or anesthetic medications. A friend or family member must accompany patients who receive sedation or anesthesia to drive them home after the procedure. The patient may receive antibiotics before or after the extraction to limit the chances of infection.
A general dentist may perform a simple extraction on a tooth protruding vertically above the gum line. The patient receives an injection of a local anesthetic to numb the treatment area. The dentist will grasp the tooth firmly with forceps and rock it back and forth to loosen it before pulling it completely free. The patient may take over-the-counter pain medications to manage any post-procedure discomfort.
A dentist who specializes in oral surgery performs more complex extractions that entail cutting into the gums and underlying bone. The oral surgeon may have to drill into the patient's jaw and break up an impacted tooth to remove it in pieces. The patient receives a local anesthetic injection supplemented with conscious sedation if needed. The dentist may prescribe pain medication for the patient to take for several days after the extraction. The patient must follow post-operative instructions to reduce bleeding, promote the formation of a blood clot in the extraction site and reduce the risk of complications.
Potential Risks of Teeth Extraction
Dry socket occurs frequently in patients who have an impacted tooth extracted. This painful side effect happens when a blood clot fails to form or breaks free allowing air to come into contact with the underlying jaw bone. A dentist will place a medicated dressing on the wound site to help resolve dry socket. Less common complications include adverse reactions to anesthetics, infection, injuries to surrounding teeth, nerve damage, jaw fracture, long term soreness or a hole into the sinus cavity.
Restoration After Tooth Extraction
Dentists and patients often prefer using dental implants for restoration after a tooth extraction. Implants most closely emulate the function and look of real teeth and do not require grinding down adjacent teeth to support a traditional bridge. Dentists may fit patients who require extraction of multiple teeth with an implant-supported bridge or partial denture. A dental surgeon may need to perform bone grafting to support an implant if the patient has suffered bone loss in the treatment area due to advanced periodontal disease.
A dentist will recommend replacing a pulled tooth whenever feasible. Dental insurance typically covers simple extractions and some complex extractions; but the coverage may not extend to all restoration options. However, replacing a tooth rather than leaving a gap helps keep the surrounding teeth from shifting out of place and promotes better oral health over the patient's lifetime.