Tooth Extractions

Why do I need an extraction?

The most common reason for tooth removal is decay; this can start as a small build up of plaque and bacteria, which then eats through the enamel to the deeper layers of the tooth. Once the decay has progressed far enough there is a serious risk of gum disease and, further on from that, infection of the jaw and tissues around it. In cases like this, the dentist will recommend one or more extractions to stop the infection spreading, and to make room for any kind of cosmetic surgery to replace the teeth. If you have reached the later stages of decay you will probably welcome the removal, as rotting teeth and gums can be very painful, embarrassing and difficult to live with.

Some orthodontic cases require extractions, but not for the same reasons as above. During the growth process teeth can crowd together or stop another tooth from coming through, several teeth may need to be removed so that the dentist can begin treatment. This is similar with wisdom teeth, if they don’t erupt properly and remain impacted below the gum line, they can push the other teeth out of place, leading to over crowding and damage to the surrounding roots, they can also cause infection because they are difficult to clean if only partially erupted. In the past, it has been seen as standard treatment to remove wisdom teeth as they break through, but in modern dentistry there are those who suggest that this causes more problems than it solves. If you have impacted wisdom teeth you may have no trouble with them at all, you dentist might prefer to leave them in place and just keeping a close watch for any signs of infection, a lot of surgeons favour this method because of the trauma and complications associated with extracting large molars.

How will my teeth be removed?

Dental phobia might cause people to imagine all sorts of horrible things that are about to happen to them in the surgery, but extractions are a routine part of dentistry and they aren’t nearly as scary as they are often made out to be. To prepare you for the operation you should have x-rays taken and a complete dental examination performed, to make sure an extraction is strictly necessary. At this point, your dentist will decided if further surgery is needed and may refer you to an oral surgeon to complete the procedure. The Pearl Dental Clinic in London employs several experienced oral surgeons who can help with even the most difficult operations; your dentist may transfer you into their care if he or she feels they are not qualified to carry out the treatment.

Before the extraction takes place you will have the area in question anaesthetised with an injection, if you’re worried about pain during the operation, be assured this is the worst it’s going to get – and it’s only a little pinch in your gums, after that you won’t feel a thing. When the dentist is sure you can’t feel anything, they can begin the procedure. Firstly, they will use a tool called an elevator to loosen the tooth; this involves pulling and pushing it gently but firmly from side to side until enough of the surrounding tissue has broken away so that it can be extracted using dental forceps. If it’s a particularly large tooth that has been removed there may be a lot of bleeding or severely ruptured gums, in this scenario the dentist can chose to stitch up the socket to help it heal if it isn’t going to be replaced. In truth, it’s not the most pleasant experience, but it’s preferable to letting your teeth rot away and fall out on their own.

What should I do after it’s been extracted?

Immediately after your operation your lips and mouth will feel numb, this is a strange sensation but should wear off after a few hours. Try to avoid eating or chewing until your mouth returns to normal, as you might not be aware how much pressure you are putting on the extraction site. After the anaesthetic has worn off it’s quite normal to feel some degree of discomfort, over-the-counter pain relief should be enough to alleviate it, NSAID’s such as Ibuprofen are your best option because they help with the swelling as well as the pain. If your gums are very swollen and tender, try an ice pack to cool and numb the area. For the next two days you need to be careful not to knock your teeth or to eat any hard foods, rinse your mouth out with warm salt solution several times a day, this cleanses the gums and helps dislodge any stray food particles.

Following an extraction, some patients often find that they suffer the most at night time, this is because when you lie on your back or in a horizontal position the blood and other fluids will pool in the back of your mouth, gathering in the tender socket and causing pain. The best way to deal with this is to try and sleep in an upright position, it might be uncomfortable for a few nights until the blood has clotted enough, but you will avoid a more painful recovery. When you feel that the discomfort has decreased and the gums have recovered sufficiently, you can begin your normal oral hygiene routine again, albeit with a gentler hand than normal.

What is dry socket?

This is an infection that can occur after an extraction, it develops when the blood in the vacated socket fails to clot. Clotting is an important part of the healing process because it promotes new tissue growth and protects the exposed flesh from infection, if this doesn’t happen then the socket is left open to bacteria and the tissue becomes inflamed. This type of complication arises in around five percent of tooth extractions, so dentists are usually quite familiar with it. In the first few days after your tooth has been removed you might not notice anything, but if dry socket occurs you will feel a constant pain in your mouth as well as an unpleasant taste, earache is another symptom associated with this problem. If you notice any of these things after your surgery, call the dentist right away and they can dress the socket to encourage normal healing, they may also provide you with antibiotics.