Tooth extractions are no fun, but sometimes they are unavoidable. If you've never experienced a tooth extraction, the process can seem tricky. What is tooth extraction and when is it necessary? Here we describe the procedure in more detail.
What is a tooth extraction?
"Tooth extraction is the removal of a tooth from its bony socket," says Kimberly Soleimani, D.D.S., a board-certified dentist in New York City. The procedure primarily involves the extraction of permanent teeth in adults, not the temporary teeth typical of children's teeth.
Tooth extractions can be performed by dentists or oral surgeons and may be necessary for a range of oral complications from infection to periodontal disease.
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What Happens During Tooth Extraction?
Tooth extraction begins with anesthesia and can take anywhere from 20 minutes to an hour, depending on the severity of the case, Dr. Soleimani says. "Each tooth has different nerves, so you need to know the anatomy of the teeth to know what innervates them [which nerves are attached to each tooth]," he says, adding that the location of the tooth also matters. "You have to know how to separate the root from the bone so as not to break the root."
After anesthesia, the oral surgeon makes a series of incisions in the gums to expose the root of the tooth and drill the area. Then the tooth is removed using a combination of tools.
After surgery, the incisions are sutured back into place. In more serious cases, Dr. Soleimani on the need for blood clotting, usually achieved by applying pressure to the extraction site. The dentist will most likely place gauze over the extraction area and ask you to bite down hard on the pad. This pressure will help create a blood clot in the socket. The absence or disruption of a blood clot can lead to dry cavities (exposure of the bones and nerves in the gums), which can cause severe pain and possible infection for the patient.
Patients who develop dry socket should seek medical attention from their dentist. Dry socket treatment may include cleaning the extraction site and placing medications in the socket, using a nonsteroidal anti-inflammatory medication to relieve the pain (aspirin and ibuprofen), or changing daily the extraction site with a medical bandage until it heals. Patients should also avoid smoking and other tobacco products that can delay healing.
Who may need a tooth extraction?
There are six main reasons why someone needs a tooth extraction.
affected tooth:"This is the most common reason for tooth extraction," says Dr. Soleimani. A tooth is retained when another tooth presses against it, causing sensitivity, bleeding gums, swelling and pain. The most common form of impaction is wisdom teeth - the third molars in the back of the mouth, which often appear between the ages of 17 and 21.
Periodontitis:Periodontitis is a serious gum disease, usually caused by poor brushing and flossing habits. It can start as gingivitis and progress to the most severe form of periodontal disease, which can result in bone loss. "If you don't have the right bone-tooth ratio, the tooth can come loose and move," says Dr. Soleimani. A patient suffering from periodontal disease may suffer from the gum tissue loosening from the teeth and creating pockets for bacteria, creating a risk of infection. If the removed tooth is important to activities such as eating, your dentist will likely do soTo replace.
Orthodontic extraction:If the mouth is overcrowded, it can lead to crooked teeth. To straighten your smile, the orthodontist will remove the teeth to make room for others to develop properly without or sometimes in combination with orthodontics. In this case, the removed teeth are not replaced.
Infection:If a cavity - the permanently damaged part of the tooth that creates a hole - turns into a root canal that is not properly treated, there is a risk of infection and extraction will be necessary. Teeth removed due to infections necessary for daily functioning are likely to be replaced with new ones.
Large cavities:If cavities are not diagnosed and treated in a timely manner, the decayed tooth can become irreparably damaged and must be removed.
Cracked or broken roots:In some cases, the tooth root may crack or even break, making the tooth irreversible and requiring extraction.
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Removal of wisdom teeth
A special case of tooth extraction is the removal of wisdom teeth. Wisdom teeth are the last four permanent adult teeth that grow in a person's mouth. They are located in the back, bottom and top corners of the mouth. If a wisdom tooth doesn't have enough room to grow, or is partially or completely impacted (growing in the wrong direction), it may need to be removed to prevent future infections and/or damage to surrounding teeth.
Additional reasons for wisdom teeth removal may include:
- Pain
- Cysts or tumors
- Damage to other teeth
- Irreversible tooth decay
- Gum disease
- Braces treatment and/or dental care
- Partial eruption leading to recurrent gingivitis
Wisdom tooth extraction is performed by an oral surgeon using local anesthesia and in some cases sedation. If several wisdom teeth are removed at the same time, the procedure can be performed in a hospital under general anesthesia, which allows the patient to sleep throughout the extraction. During the procedure, the oral surgeon removes and separates the gum and bone on the way to the wisdom tooth, then pulls out the tooth. After gum removal, sutures are placed and the incision site is covered with cotton gauze to promote blood clotting. The healing time for wisdom tooth extractions can be longer than for other extractions.
Recovery after tooth extraction
While recovering from a tooth extraction, you can expect some pain and bleeding due to cuts, trauma to the gums, and blood clotting at the extraction site. Edema is also common, says Dr. Soleimani. Paracetamol or ibuprofen can help with mild cases of pain, and in severe cases your dentist can prescribe a medication if necessary. Pain can be expected for up to three days after extraction. If you notice that the pain worsens, the swelling increases or if your blood does not clot after a few days, see your doctor.
If swelling occurs, Dr. Soleimani recommends applying ice to the outer cheek on the side of the face where the extraction was performed. Do not apply ice directly to the wound.
When it's time to eat and drink, Dr. Soleimani urges patients to avoid using straws. "You shouldn't [use a straw] because research shows [sucking] can cause dry sockets, which can cause severe pain," she says. "I suggest a soft diet, but it all depends on the patient."
When should you talk to the dentist?
In general, severe toothache is often accompanied by the need for extraction. “If pain is keeping you up at night, it's a root canal or an infection from the root canal not being properly treated and bacteria pushing through the bone. This means that an extraction will probably be necessary,” said Dr. Soleimani.
Risk of tooth extraction
Tooth extractions are generally safe. That said, you may be under anesthesia in some cases, so the oral surgeon should be aware of your medical history. "The extraction itself is basic surgery, but the more medically complex the patient is, the greater the risk associated with the procedure," says Dr. Soleimani. Particular caution is required, for example, in people with reduced immunity and people who are allergic to certain medicines and products. Chemotherapy patients should also consult their doctor first.
How to prevent tooth extraction
While tooth extraction may be necessary in some cases, there are some lifestyle habits that may prevent you from having to start the procedure.
Extractions caused by an infection, such as an infected mouth, can sometimes be avoided with good oral hygiene and a balanced diet. According to the Centers for Disease Control and Prevention (CDC), healthy habits include flossing daily, brushing twice daily, using fluoride toothpaste, drinking fluoride water and visiting the dentist annually. Not smoking can also help prevent extractions, as smoking can lead to bone loss, adds Dr. Soleimani.
And while periodontal disease is usually related to genetics, Dr. Soleimani recommends that people with the condition get regular checkups. "Normally you should see the dentist every six months, but if you have periodontal disease, I recommend going every three months," she says. "If you take good care of your gums and clean them more often, the problem should be manageable."
How much does tooth extraction cost?
The cost of tooth extraction varies depending on the severity of the case. A simple procedure, such as a straight-rooted wisdom tooth extracted, can cost as much as $250. More complicated procedures, such as removing a fully impacted wisdom tooth, under local anesthesia range from $225 to $600. Additional costs to consider may also include sedation, ranging from $500 to $800, and dental X-rays, which can cost anywhere from $20 to $150 per image, depending on the type of dental X-ray and the number of kits required .
Is tooth extraction covered by insurance?
Most insurance plans will probably cover a portion or percentage of your tooth extraction if this happenshave dental insurance, according to dr. Soleimani. If you are unsure whether your treatment will be covered, please check with your insurance company before booking the procedure. Dr. Soleimani adds that many jaw surgeries are covered by insurance services' usual fee schedules, which means location can matter because prices vary depending on typical costs in a particular geographic area.
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