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Tooth Extraction

1) A tooth extraction might be indicated if repairing a damaged tooth is not practical.

  • Broken, cracked, or extensively decayed teeth can be extraction candidates.

Some teeth will have extensive decay (dental caries) or else will have broken or cracked in such an extreme manner that an extraction might be considered the best, or at least a reasonable, solution. Of course there will be a number of factors that will come into play with any specific situation. In some cases the obstacles that present themselves might be so formidable that a repair for the tooth is simply not possible. In other cases the cost of needed dental treatment or else a questionable long-term outlook for the success of the treatment may be the reason an extraction is chosen.

  • Teeth that are unsuitable candidates for root canal treatment should be extracted.

Some teeth may require treatment of the nerve space that lies within them (root canal treatment) in order to make a repair. While most teeth typically are candidates for root canal treatment there can be complicating factors that remove this option. If this is the case and needed root canal treatment cannot be performed then the extraction of the tooth is indicated.

  • Teeth associated with advanced periodontal disease (gum disease) may need to be pulled.

By definition, teeth that have experienced the effects of advanced periodontal disease (gum disease) are teeth whose supporting bone has been damaged. In general, as periodontal disease worsens, a tooth is supported by less and less surrounding bone, often to the point where the tooth becomes loose. In those cases where significant bone damage has occurred and a tooth has become excessively mobile extraction of the tooth may be the only option.

2) Malpositioned or nonfunctional teeth may need to be extracted.

Some teeth are extracted because they are malpositioned. As an example, sometimes when wisdom teeth come in they lie in a position that proves to be a constant source of irritation to the person’s cheek (by either rubbing against the cheek or causing the person to bite it). As a solution, a dentist may suggest that the offending wisdom teeth should be extracted.

Some teeth might be extracted because they provide very little service to the dental patient but do offer risk for becoming problematic. A common example is a wisdom tooth that has come in but has no matching tooth to bite against. Wisdom teeth are typically in a region of the mouth that is hard to clean, thus placing them and their neighboring tooth at greater risk for decay and periodontal disease. Depending on the precise circumstances that they find, a dentist may advise their patient that removing a nonfunctional tooth might be in that patient’s best long-term

interest in regards to maintaining good oral health.

Impacted teeth are often extracted. Impacted teeth are teeth whose positioning in the jaw bone is such that they cannot erupt into normal alignment. So by definition, impacted teeth are malpositioned and because they are malpositioned they are often nonfunctional. This combination of factors makes impacted teeth common candidates for extraction.

3) Tooth extractions may be required in preparation for orthodontic treatment (braces).

Whenorthodontictreatment is performed for a patient the dentist is trying to perfect the alignment of the patient’s teeth but they can only do so within the confines of the size of the person’s jaws. Especially in those cases where a large discrepancy exists between the size of the patient’s jaws and the needed space required for the improved alignment of their teeth, some strategically located teeth may need to be extracted.

When might a tooth extraction be a bad idea?

During their examination of your teeth and mouth it is possible that your dentist will be able to recommend one or more alternative treatments to having a tooth extraction. While extracting a tooth might be less expensive than the other treatment options your dentist proposes, it may not be the least expensive treatment in the long-run.

When a tooth is removed its neighboring teeth will tend to shift, sometimes significantly. Any alignment changes that do occur can have a major impact on your dental health. Removing even a single tooth can lead to problems associated with chewing ability or jaw joint function. Additionally, teeth whose alignment has changed can become traps for food or be harder to clean thoroughly, thus placing them at greater risk for tooth decay and gum disease.

So to avoid these types of complications, in most cases your dentist will probably recommend to you that you replace any tooth that has been extracted. Replacing a tooth after an extraction with an artificial one can easily cost more than the alternative of not extracting a tooth and instead rebuilding it.

Dry Socket

Introduction

One of the most common complications due to tooth extraction is dry socket and it is found that 3-5% of the tooth extractions are affected by it. The term “dry socket” is given because of the appearance of the wound. This FAQ gives details on the dry socket.

What is a Dry socket?

Dry socket is a temporary dental condition that sometimes develops during the first few days – 1-3 days – after the tooth extraction. This is alternately known as alveolar osteitis. This condition is extremely painful and has an extremely foul odor. The formation of dry sockets takes place if the blood clot fails to form or if the formed blood clot gets dislodged from the socket. The blood clot formation is necessary for healing of the bone and without blood clot the bone is exposed to air, food, and fluids and produces a foul odor. Further the process of healing gets delayed. This condition occurs because of complications that occur after extraction of tooth such as impacted Wisdom Tooth

What are the symptoms of dry socket?

The following are the symptoms of dry socket:

1. Acute pain in a few days after a tooth extraction
2. Bad breath or halitosis
3. Bad taste in the mouth
4. Bone in the socket is visible
5. Blood clot in the extracted area
6. Empty-looking dry socket
7. Lymph nodes around the jaw or neck get swollen
8. Pain radiating from the socket to your ear or eye

What causes Dry socket?

After extraction of teeth you will find that a blood clot forms at the site of tooth extraction. This clot protects the underlying bone and nerve endings in the empty tooth socket. This clot forms the foundation for the new tissue and bone growth.

There are certain cases wherein the formation of the clot is improper or the clot is dislodged from the socket much before healing. In the absence of this clot the bone and the nerves in the socket get exposed to food, fluids and air. This causes acute pain both in the socket and also along the nerves that radiate to your ear and eyes on the same side as the tooth.

It has been found that dry socket happens in about 3 to 5 percent of cases of all tooth extractions. This is common in wisdom teeth extraction and impacted wisdom teeth.

What are the risk factors for Dry socket?

The following are the risk factors for dry socket.

1. Oral contraceptives – this increases the level of estrogen that dissolves the blood clot thereby resulting in dry socket.
2. Past history – if you had dry socket earlier you are likely to get it again.
3. Post operative care – if you neglect the post operative instructions such as avoiding certain types of foods or not taking care of your wound dry socket could develop.
4. Smoking and use of tobacco – the wound site will get contaminated by chemicals in the cigarette or tobacco. Sucking the cigarette might dislodge the blood clot.
5. Tooth or gum infection – the risk for dry socket increases if there has been infections around the tooth to be extracted either now or in the past.

What complications occur due to Dry socket?

Dry socket results in the following complications.

1. Absenting from school/ work
2. Delayed healing after tooth extraction
3. Infection
4. Pain

What is the treatment for Dry socket?

The following methods are followed for treating dry socket; these methods are mainly aimed at reducing your pain.

1. Cleaning the socket – your dentist or oral surgeon removes the debris or food particles collected in the socket by flushing it out.
2. Medicated dressings – your dentist or oral surgeon will pack the socket with medicated dressings. Dressing has to be changed often depending on the severity of the tooth pain.
3. Pain killers – depending on the pain you have your surgeon will prescribe pain killers. If OTC pain medications are ineffective the surgeon might prescribe stronger pain medications for relieving your pain.
4. Self-care – it is also possible that your surgeon might train you to flush your socket using a specialized syringe, water, salt water, mouthwash or a prescription rinse.
Within a few hours of starting treatment you will get relief to certain extent. As days go by the pain will start reducing and the wound will heal within a fortnight.

How to prevent the occurrence of dry socket?

Occurrence of dry socket can be minimized by taking proper precautions both by the patient and the oral surgeon.

Prior to getting your tooth extracted you can use the following medications in consultation with your dentist.

1. Application of medicated dressings after surgery
2. Application of antiseptic solutions on the wound
3. Check with the surgeon whether your current medications will interfere with the surgery – mainly the ones that affect clotting of blood
4. Oral antibiotics
5. Stop smoking at least 24 hrs prior to surgery
6. Do not use other tobacco products 24 hrs prior to surgery
7. Time the surgery when your estrogen levels are lower
Use of antibacterial mouthwashes or gels before and after surgery once the tooth is extracted takes the following precautions for initial few days.

1. Avoid eating foods such as pasta, peanuts, popcorn etc. that are likely to embed pieces in the socket; eat only soft foods and foods that don’t have residuals
2. Avoid vigorous mouth rinsing
3. Brush gently around the site of extraction
4. Do not spit
5. Don’t drink with a straw
6. Don’t drink carbonated beverages
7. Do not touch the socket either by with fingers or by your tongue

What are the home remedies for Dry socket?

Dry socket does not normally cause any serious complications or infection. However it causes acute pain which has to be brought under control quickly. The following measure will be useful for reducing the pain and swelling.

1. Avoid taking any tobacco product
2. Keep yourself hydrated and void nausea by drinking clear fluids
3. Gently brush around the dry socket area
4. Mouth rinse often with warm salt water
5. Stop smoking
6. Take pain killers as prescribed by your doctor
7. Use cold packs – on the outside of your face.