Tooth Extractions -Your Options Explained
What is a dental extraction?
As most of you know a tooth extraction is simply the process of removing or ‘pulling’ a tooth. Since it is an irreversible procedure, and there’s no going back. It’s important to consider the alternatives and what you want to do with the space it leaves.
Why choose Dr Workman to look after you?
Not only is Dr Workman a very good dentist, he has genuine caring nature and always makes sure you feel truly looked after. This is why he has such a loyal following of, families, young professionals right through to our older generation. With over 12 years experience, he is young, passionate, great at what he does and has an excellent aesthetic eye. If you would like a dental professional you can really trust, who places your health, happiness and comfort as an absolute priority, then you would be hard pushed to look any further. If you have typed ‘dentist near me’ then our state of the art Maroubra dental practice won’t be far away.
Who will do it?
Dr Jamie is an experienced general practitioner who will remove most teeth under local anaesthetic in the chair.
However, if a tooth is heavily impacted, or there is a high risk of complication due to a complex medical history, or the proximity to important structures such as the ID nerve or maxiallry antrum then it may be necessary to refer you to an oral surgeon to have the tooth taken out.
Why would you need an extraction?
The main reason for needing an extraction is that a tooth cannot be saved in any other way… either because it’s actually not possible to do so or possibly, that the alternatives are so expensive.
An extraction may be required – rather than a root canal – if the nerve is dying or has died; if you have an abscess or infection; a huge cavity; severe toothache; or extreme sensitivity that won’t settle.
Other common circumstances include:
1. Wisdom teeth – often there’s not enough space for them to be a useful tooth, they can’t be cleaned properly, or they are impacted and risk future problems.
2. Periodontal disease – once all the bone has been lost around the tooth and it’s very loose, there’s little that can be done if the tooth becomes painful.
3. Failed root canal treatment- the tooth will either need a re-root canal treatment that may involve referral to a specialist or an extraction.
4. Orthodontic reasons- if you have lots of crowding and space is required to straighten your teeth.
5. Cracked teeth- that can’t be saved because the crack extends through the floor of the tooth and renders the prognosis very poor.
6. Baby teeth- may need to be removed if they aren’t falling out naturally, or if the adult tooth comes through in a different position.
7. Associated pathology – if teeth have cysts or other pathology, it may be necessary to remove them.
What are the signs and symptoms suggesting that you’d need an extraction?
A very painful tooth, a very loose tooth, a huge cavity, a fractured tooth, severe toothache, and a painful wisdom tooth- these are all situations in which an extraction may be necessary.
A root canal can often save teeth but not always, especially if the supporting bone has been lost.
You can read more about the signs and symptoms, as these are essentially the same as for an extraction. Should you choose, you can also check out jamiethedentist.com for further information.
What are the risks and potential complications?
There are a number of potential complications when it comes to having a tooth removed but the ‘vast’ majority of dental extractions are pretty simple and uneventful.
Despite this, you need to be aware of both the risks and possible complications.
Dr Jamie will discuss these with you at your consultation.
A detailed medical history is necessary, as certain conditions will predispose you to a higher risk – you may require specialised care, additional precautions, antibiotics or need an adjustment to your medication in consultation with your doctor.
If you have had any complications previously, then you should also make Dr Jamie aware of these.
He will also need to assess the tooth and root, both clinically in the mouth and also by x-ray in order to plan the approach to the extraction.
We can divide potential risks into:
1. Risks during the procedure:
-The tooth fractures- this may then require a different approach to remove, such as a surgical approach.
– Other fillings or teeth are damaged- they may become dislodged and need to be replaced.
– Nerve problems – if the roots lie close to certain important structures, the nerve that supplies sensation to your tongue and lip can be at risk from extractions. For example: wisdom teeth are one example where you will certainly be warned of this rare possibility.
Oro-antral communication- Upper 1st and 2nd molar roots can lie close or even extend into the antrum and on removal, this can cause a communication between the sinus and your mouth.
This requires special care afterwards; the wound should close spontaneously but occasionally if a fistula occurs this may require surgical closure or referral.
Risks after the procedure:
– Bleeding – this is normally managed by biting on a gauze, and getting a clot to form.
Sometimes bleeding continues due to medication such as anti-coagulants e.g. as warfarin, herpain, aspirin etc. These may need to be adjusted in consultation with your doctor (Do ‘NOT’ just stop taking your medication).
The bleeding may also be from the gum, from bone or from inflamed tissue.
Dr Jamie has various measures to help, so you should call if you have any concerns.
It is not uncommon for bleeding to start again a few hours after the extraction as the adrenalin in the local anaesthetic begins to wear off.
-Dry socket – clot doesn’t form and even though it is
•Self limiting, is very painful and it helps to have it redressed
•Infection, pain and continued soreness- antibiotics may be necessary or further cleaning of the wound
•Some bruising and swelling may occur- most commonly if this is a surgical extraction
•Pain and soreness- some is normal and to be expected.
What is the procedure for an extraction?
To remove a tooth, you need to break the ligament which is holding the tooth in place and then expand the bony socket just enough to be able to remove the tooth.
Dr Jamie will need to take an x ray of the tooth so he knows exactly what he is dealing with.
He will also talk to you upfront about the potential risks/ complications discussed above.
To begin with he will give you the appropriate anaesthetics as painlessly as he can and that’s pretty painless!
The type and position of the tooth being removed will dictate which injections and how much anaesthetic is needed.
Before even starting to move the tooth, he will perform some simple little checks to ensure you are numb… if you aren’t… a little more anaesthetic will be needed.
Dr Jamie will then remove the tooth using a combination of instruments called elevators, luxators and forceps.
Most of the time this is actually the quickest part of the procedure and only takes a few minutes. It’s the getting you numb and stopping the bleeding afterwards, which tends to take the majority of time.
The tooth is wiggled a little until it moves; it’s then held with a specially designed instrument for that particular tooth and root shape. With continued ‘wiggling,’ you’ll feel more movement
– a sort of ‘pushing’ sensation, but no pain or sharpness.
Occasionally you will hear some little noises: this is normal – though a bit disconcerting – it means the tooth is almost out.
Once removed, the socket will be squeezed back together and perhaps a stitch or two placed to hold the gum in place.
A gauze will be popped in for you to bite on and he’ll apply pressure until the bleeding stops.
You will have had your post-extraction instructions, so you’re good to go!
This is of course, a description of a simple extraction… needed in the majority of cases.
Sometimes he needs to take a different approach: if the tooth has a curved root; is below the gum or breaks whilst attempting to remove it.
If the tooth looks particularly difficult, it may be necessary to refer you to an oral surgeon.
What are the alternatives to having a tooth extraction?
Sometimes there is no alternative: the tooth may be unsaveable, too broken down or the prognosis suggests that an extraction would be the best course of action.
If the nerve in a tooth has been affected by decay, or a crack, or a deep filling or crown, the only options are either an extraction, or carrying out root canal treatment – that’s it.
“I’m an advocate for saving teeth wherever possible, since that’s what nature gave us and by the time you’ve removed a tooth, considered the time and expense of replacing it, a root canal largely outweighs having the alternatives – which may I say is not painful at all in 99% of cases”. [Dr Jamie]
Although an extraction is the cheapest and fastest way to fix the problem, the quick fix isn’t always the best option… so take a moment to discuss the options with Dr Jamie and make sure you take a proper informed decision.
A more detailed discussion of the ‘extraction versus root canal‘ dilemma can be found in our root canal series at jamiethedentist.com.
Once you start on the road of extracting teeth, it can become the slippery slope to a set of dentures – each time it becomes that little bit easier for you to say, ‘yes, just take it out.’
There are certain medial conditions for which extractions should be avoided wherever possible, or referred to be managed by a specialist oral surgeon in hospital or at least in liaison with your doctor.
Aftercare and recovery?
After an extraction there are certain things that you need to be careful of and simple procedures that you need to follow, in order to allow the best possible healing: please Click here to download our detailed instructions.
It’s going to be sore for a while and you will need to take pain killers… so you need to expect that; it is normal and ‘par’ for the course.
The general progression should be one of gradual improvement over the next week, not worsening pain, which may suggest a dry socket or infection.
If you are in any doubt then please don’t hesitate to give Dr Jamie a call, he will always see you.
Eat soft food on the day and be careful of the numbness: you don’t want to do anything that raises your blood pressure like exercise; avoid alcohol; don’t smoke or rinse your mouth but drinking will be fine.
If the area bleeds, just apply the gauze you were given and bite down with firm pressure for 15 minutes.
You can begin warm salt rinses a few times that day, and the following day – continue throughout the week.
What are the consequences of having a tooth out?
Initially, there is the healing period but within a week, or maximum two, the pain will have disappeared and then over the course of the next couple of months the hole will gradually fill until it’s completely covered by gum.
You may experience difficulty chewing, or not wish to smile. Additionally, if you don’t fill the space, a number subtle changes will begin to occur over time: such as shifting, tilting and over-eruption of teeth and alterations to your bite.
Check out a more detailed discussion of all these factors in – The consequences of having missing teeth.
How can I fill the space if I do have an extraction?
Your basic options for restoring a missing tooth or space are: a bridge, an implant or a partial denture.
There are different types of each and the decision is based on many factors. You can get a good overview by reading- The options for restoring missing teeth.
|Treatment time||Depends on difficulty 30 mins-60mins|
|Cost||$200 (simple) up to $450 (surgical)|
- Dr Jamie’s education site; Jamiethedentist.com where you can hear him speak and read about TOPIC in a lot more detail.
- These other excellent resources: