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The Toothful Truth: What is Tooth Extraction?

March 25, 2024

Introduction: To smile or not to smile, that's the question! Especially when a toothache has you down. Tooth extraction, often seen as a last resort in dental care, is a solution many have come across but few fully understand. Dive deep into the world of dentistry as we explore the ins and outs of the procedure.


What is Tooth Extraction? Ah, the million-dollar question! Tooth extraction is simply the removal of a tooth from its socket in the bone. It's like uprooting a tree, but don't worry, it's not as terrifying as it sounds.

Extraction is “The painless removal of the whole tooth/root with minimum trauma to the investing tissues (hard and soft) so that the wound heals uneventfully”. Removal of a tooth does not require a large amount of force, but fine and controlled force, so that the tooth is gently lifted from alveolar process and not pulled out .


Reasons for Going Under the Pliers (Or Forceps!)

  • Decay and Damage: Sometimes, a tooth is just past the point of no return. When decay reaches the core of a tooth, or when a tooth is broken beyond repair, it's adios amigo!

  • Overcrowding: It's a party in your mouth and everyone's invited! But sometimes, there's just not enough room. In preparation for orthodontics, a tooth might be removed to create space.

  • Infections: Ever heard the saying, "one bad apple spoils the bunch?" Infections that risk spreading might necessitate extraction.

Indications

  • Severe caries (49% of cases): Endodontic treatment not possible either due to technical or economic reasons
  • Severe periodontal disease (41% of cases): Not salvageable by periodontal therapy
  • Severe attrition, abrasion, erosion
  • Acute/chronic pulpitis/pulpal necrosis due to trauma/infection
  • Teeth with necrosed pulp and periapical lesion not treatable by endodontic treatment
  • Over-retained deciduous teeth blocking the eruption of permanent tooth: In case of missing permanent tooth, many times deciduous tooth is retained in a dental arch
  • Supernumerary teeth
  • Malposed teeth: Cause constant trauma to soft tissues, prone to caries due to noncleansing issue
  • Impacted teeth
  • Tooth in the fracture line: Current concept of extraction is done, only if the fractured tooth is a source of infection or root fracture or there is interference in fracture reduction or healing due to retaining such a tooth
  • Tooth directly involved in pathology: Cyst, tumor
  • Teeth with poor prognosis in the line of therapeutic radiation, (prior to radiation course given in case of oral malignancy) to prevent osteoradionecrosis or radiation caries. Due to newer methods of radiation, the problem is less common.
  • Teeth with a vertical fracture or cracked tooth syndrome, which is a very painful condition
  • Prophylactic extraction (tooth acting as septic focus): endocarditis, rheumatic fever, prior to cataract surgery
  • For orthodontic treatment consideration:
  • Therapeutic extractions, malposed teeth, crowding, serial extractions
  • For prosthetic purpose: Teeth interfering with stability/construction/design of full or partial denture
  • Supraerupted tooth: Vertical extrusion of a tooth due to missing counterpart in the opposite arch
  • Teeth causing chronic trauma to the soft tissues of the oral cavity: Constant cheek bite, ulceration on the lateral border of the tongue, etc.
  • For orthognathic surgical procedures: Upper third molars are extracted in LeFort I osteotomy, lower third molars are extracted in sagittal split osteotomy procedure, premolars are extracted in anterior subapical osteotomy procedures.

 

Contrindications

  • It is usually classified as due to systemic and local reasons: further divided as relative and absolute contraindications.
  • Relative contraindications suggest that the systemic or local conditions of the patient can be modified/improved by proper medication and following certain treatment protocols suggested by the physician, so that uneventful extraction procedure with proper healing is achieved.
Systemic Contraindications
  • Relative Contraindications
  • Cardiovascular system (cardiac patient): Rheumatic
  • heart disease, coronary heart disease, unstable angina
  • pectoris, myocardial infarction, congestive cardiac
  • failure (CCF)
  • Blood dyscrasias: Anemia, leukemia, agranulocytosis
  • Uncontrolled diabetes
  • Uncontrolled hypertension
  • Nephritis: End-stage renal disease with severe uremia
  • Toxic goiter
  • Jaundice, cirrhosis of liver
  • Bleeding disorders: Hemophilia
  • Acquired coagulopathies due to anticoagulants/antiplatelet drugs
  • Adrenal insufficiency
  • Neurological disorders: Epilepsy, stroke
  • Respiratory system: Asthma, pulmonary tuberculosis, chronic obstructive pulmonary disease (COPD), acute chest infection
  • Patient on long-term corticosteroids, immunosuppressive or chemotherapeutic medications

 

Physiologic Contraindications
  • Pregnancy: First and last trimester are more crucial period. During the first 3 months of pregnancy process of organogenesis/fetal development takes place. 3rd week to 8th week during differentiation, all the drugs should be avoided for the potential risk. All dental invasive procedures should be avoided, unless
  • severe infection warrants the emergency treatment. 3rd trimester patient may develop supine hypotension syndrome during dental treatment in a flat position.
  • Left lateral position will allow the venous return.
  • Extraction during menstruation period: Painful and stressful condition along with mood swings for many
  • women. High circulating estrogen levels may cause excessive bleeding. Not the best time to undertake extraction unless it is a must.
  • Extreme old age: Compromised body physiology as well as fragile physical and mental conditions should be handled with atmost care .
  • Absolute Contraindications
  • Teeth in recent irradiated area: Within 6 months to 1 year
  • Within 6 months of myocardial infarction (after bypass surgery or stents)
  • Teeth in the area of central hemangioma, arteriovenous (AV) malformation, aneurysm
  • Pregnancy: 1st and last trimester
  • Site of malignant tumor: Hasten's metastasis.
  • Relative Local Contraindications
  • Acute generalized periodontitis, acute necrotizing ulcerative gingivitis (ANUG)
  • Acute dentoalveolar abscess, acute cellulitis
  • Acute pericoronitis.

 


Types of Tooth Extractions

  • Simple Extraction: Pulled out using forceps. It’s a straightforward operation, no frills attached!

  • Surgical Extraction: For teeth that play hard to get! If a tooth is broken or hasn’t emerged fully, a small incision is made to remove it.


Procedure and Aftercare – From Start to Finish

  1. Preparation: Before the big day, your dentist will take X-rays. You might be prescribed antibiotics if you're under certain medical conditions.

  2. The Main Event: First, the area is numbed. Then, depending on the type, either a simple pull or a surgical procedure is carried out. You'll be awake, but you won't feel a thing!

  3. Post-procedure: After the procedure, you'll be given gauze to bite on to stop bleeding. Avoid certain foods, smoking, and vigorous mouth rinsing to prevent complications.


The Recovery Timeline: What to Expect

  • Day 1: Mild bleeding, swelling, and discomfort. Relax, keep your head elevated, and follow your dentist's guidelines.

  • Day 2-3: Swelling peaks. Use cold packs and take prescribed painkillers.

  • 1 week: The site should be healing well. If stitches were placed, they might be removed.

  • 2 weeks: Any residual stiffness or discomfort should be subsiding.

Post - Extraction Care

  • Inspect the socket: Remove the debris/bone/tooth fragments
  • Irrigate the site with saline
  • Compress the alveolar bone with firm finger pressure
  • Curette out the granulation tissue from the socket and excess granulation tissue around gingival cuff
  • Trim/smoothen any sharp edges from alveolar margin with bone file
  • Ensure hemostasis
  • Suture , if required
  • Medication : antibiotics , analgesics


Instructions to the Patient

  • Moist pressure pack to be held with gentle pressure for at least 30 minutes
  • No spitting/gargling/smoking
  • Avoid hot food/alcohol for at least 24 hours
  • Liquid/semisolid/soft diet

Complications: Watch Out!

If pain persists or swelling doesn't reduce, contact your dentist. Dry socket, infections, or other complications may have set in. But don’t lose sleep over it – these are rare!


Tooth Extraction Costs: Breaking the Bank?

Dental procedures aren’t notoriously cheap. Depending on your location, type of extraction, and dental professional, costs vary. Dental insurance often covers a portion. However, remember, quality care is worth every penny!


FAQs about Tooth Extraction

  1. Is tooth extraction painful? No, the procedure itself isn't painful because of anesthesia. However, some discomfort afterward is normal.

  2. How long does recovery typically take? Most people recover within a few days to two weeks, depending on the extraction type and personal healing rate.

  3. Can I eat normally after an extraction? It's best to stick to soft foods for a few days and avoid hot drinks.

  4. What is dry socket? It's a painful condition when the blood clot that forms after extraction is dislodged, exposing bone. Seek immediate dental advice if suspected.

  5. How can I prevent complications? Follow your dentist's aftercare advice, avoid smoking, and maintain oral hygiene.

  6. Will I need a replacement for the extracted tooth? Depending on the tooth's location and your preferences, you might consider implants, bridges, or dentures.


Conclusion: Whether it’s because of that sugary sweet tooth or just plain bad luck, tooth extraction can be a necessary procedure. By understanding the process, recovery, and aftercare, you can be better prepared and put your worries to bed. After all, as they say, "A smile is the best makeup anyone can wear."