Tooth Extraction

Your Guide to Tooth Extraction

A tooth extraction will be advised as a last resort option. Our dentist’s first choice will always be to save the tooth and restore it back to health.

They will always discuss all the advantages and disadvantages of all your options with you before any treatment is carried out.

Extraction will only occur with your full consent especially since this is an irreversible procedure.

The process can be straightforward or require a more advanced surgical technique.

There are a few reasons why a tooth may be advised to be extracted:

• Deep infection in the tooth may have rendered the tooth un-restorable.
• The patient may not want to incur the expense of Root Canal Treatment and then further restorative work like a Crown on the tooth.
• Root Canal Treatment is not possible.
• Excessive fracture on the tooth or trauma has left the remaining tooth un-restorable.
• Elective extraction is required as in with orthodontic treatments.
• Advanced periodontal disease exists around the tooth.

The Extraction Procedure

The aim of the extraction procedure is to minimise any bone damage and destruction. The extraction site will resorb anyhow after the extraction.

To minimise the amount of bone loss and damage that incurs, a careful extraction technique is required.

Excessive bone loss or retained roots that cannot be extracted mean that in the future this site may be difficult to restore with an artificial tooth like dental implants in the future. Replace my teeth.

Steps to extraction:

1. Medical and dental history assessment is first required to make sure that there are no contra-indications to extractions. In some complex cases, the patient may need to be referred to a hospital for the extraction.
2. The tooth to be extracted is first re-assessed for complexities and difficulty of extraction. The primary assessment will have been carried out beforehand in order to plan for the extraction technique.
3. We first make sure that you are sitting or lying in a comfortable position.
4. The tooth is anaesthetised with a local anaesthetic.
5. Once the tooth and surrounding area are numb for the patient, the extraction process begins.
6. Radiographic assessment is necessary to ensure a safe extraction preventing any damage to any nerves or important structures.
7. Various instruments are used to extract the tooth. These include retractors, extraction forceps, elevators and luxators. There are various techniques but the most careful of them involve cutting down the periodontal ligament (the attachments between bone and root) and best use of leverage forces.The elevator or luxator blade is driven down the space between the bony wall of the socket and the root of the tooth. The tooth is then gripped with the extraction forceps and pulled out. Tooth extraction should not require considerable strength- it’s all about the correct technique.
8. If a surgical technique is being used then a scalpel will be used to open a flap (or raise the gum). This provides better visibility for the surgeon.Sometimes a drill is also used on the bone to dissect the tooth for ease of extraction. In this type of technique, sutures may be required. The healing period is also longer.
9. Once the tooth has been removed, cotton wool pads are then compressed on the extraction site to stop any bleeding.
10. Once haemostasis (bleeding stopped) has occurred the dentist will check the extraction site and then provide you with a Post-operative pack and instructions to follow.

Post-Extraction Advice

• The anaesthetic typically leaves your lips, teeth and tongue feeling numb after the appointment. For this reason, you should avoid chewing for a few hours following surgery, or until the numbness has completely worn off.
• Some discomfort after the extraction is normal. An over-the-counter pain reliever, such as ibuprofen or paracetamol (not aspirin), is usually sufficient.  We can also give you a prescription for stronger pain relief if needed.
• It can usually take you from 1-7 days to recover from the extraction. This also depends upon the difficulty of the extraction.
• It usually takes 1-2 weeks for an extraction site to heal.
• You will already have been advised of all possible post-operative complications.
• If there is any swelling, apply an ice pack – 20 minutes on, 20 minutes off – for a few hours following the extraction.
• You will be given written instructions of post-operative care too.
• Do not rinse your mouth or eat and drink anything for a minimum of 24 hours after the extraction. This is because it will prevent the blood clot (which seals the site and starts the healing process) from forming over the extraction site.
• After 24 hours we recommend warm salty mouthwashes at least 3-4 times a day to help heal.
• When you feel up to eating we advise soft foods that do not require much chewing as your jaw joints and remainder teeth may be recovering. Once the numbness has worn off, you should eat, as nourishment is important to the healing process. Limit your diet to soft foods like yoghurt, soft soups, ice cream, or soft-cooked eggs for the first 48 hours.
• Make sure you brush and clean your teeth as normal after the initial 24 hours. Use of mouthwash is highly recommended.
• Smoking should be avoided until complete healing has occurred.
• If antibiotics were prescribed, continue to take them for the indicated length of time, even if all symptoms and signs of infection are gone.
• Relax as much as possible and avoid all strenuous activities for the first 24 hours following treatment.
• Stay hydrated so drink at least eight large glasses of water or fruit juice each day.
• It is important to consider replacing missing teeth to avoid adjacent teeth (if present) moving and impairing chewing function. We will advise you about suitable treatment options.

Complications after Tooth Extractions

• Postoperative Bleeding. This is usually controlled and stopped (haemostasis) in the surgery. This is called Immediate Bleeding. However, there can be residual bleeding approximately 48hrs after the extraction.This is called Reactionary Bleeding. This is due to a local blood vessel opening up. When you have an extraction, you will be supplied with a pack that will contain some cotton pads.You can use these to compress on the extraction site until the bleeding stops.If you have any bleeding problems subsequent to this you should contact the surgery for further investigation. This will be Secondary Bleeding and your dentist will know how to manage this.
• Pain and swelling. Non-steroidal anti-inflammatory drugs are the systemic analgesic of choice e.g. Ibuprofen. External cold ice packs can also help to reduce any swelling.
• Dry Socket. This is another term for inflammation of the bone lining the socket, also called Osteitis. It is quite common following tooth extraction and tends to occur mostly after wisdom teeth or molar extractions.It usually onsets as pain 3-4 days after the extraction. The socket appears inflamed and usually bone is visible. The treatment includes irrigation of the site followed by an antiseptic dressing placed in the socket.Non-steroidal anti-inflammatory drugs are the systemic analgesic of choice e.g. Ibuprofen. But if this is not possible then your dentist will advise the appropriate one for you.
• Post-operative Infection. Sometimes you can be infected with a superimposed infection. This can cause you pain and a rise in body temperature.If this happens you must notify the surgery immediately. In most cases, you will be supplied with antibiotics which will clear the infection up.
• An incomplete extraction. This can be due to a complex angulation of the tooth or “hooked” root tips. In most cases, the surface after a few weeks by themselves and then can be taken out with ease.In other cases, we may need to leave the parts of the tooth that cannot be extracted in the bone. These cases will need to be monitored closely. In some cases, you will be referred to an oral surgeon.
• Nerve damage. This is very rare. But you can get a tingling sensation or complete numbness for a few days. In most cases, there is nothing to worry about as your normal sensations should return as the site heals. If it persists please notify the dentist as it can mean extensive damage has occurred.
• Damage to neighbouring teeth. This can happen when access is restricted and there are much blood and saliva making the surfaces of the teeth “slippy”. But with careful leverage and skill of the dentist in the majority of cases will be able to avoid this.
• Stiffness or soreness of the jaw joints. This can happen when the extraction procedure takes some time. The constant opening of the mouth can lead to a stiff sore jaw joint afterwards. Painkillers and external cold packs can help.

For more further information or any questions about our tooth extraction procedure, contact us on 01992 552115 today. You can also visit a member of our team at our Hertford dental practice or in one of our London consulting rooms by booking an appointment.