Tooth Extraction Health Article

Definition

Tooth extraction is the removal of a tooth from its socket in the bone. It is performed to control disease, improve function, or treat malocclusion.

Purpose

Tooth extraction is performed for many reasons. Teeth are often removed because they are impacted, that is, they cannot erupt normally on their own. Teeth become impacted when they are prevented from growing into their normal position in the mouth by gum tissue, bone, or other teeth. Wisdom teeth sometimes are impacted and require extraction. Teeth might also require extraction if they cause pain or cause crowding of other teeth.

Teeth may also be extracted to make more room in the mouth prior to straightening the remaining teeth (orthodontic treatment), or to make room for the placement of dental implants or dentures. Sometimes, teeth are extracted because they are so badly positioned that straightening is impossible. Extraction may be necessary because of severe gum disease or because the teeth are so badly decayed or broken that they cannot be restored. Patients also sometimes choose extraction as a less expensive alternative to filling or placing a crown on a severely decayed tooth.

Precautions

Tooth extractions may sometimes need to be postponed temporarily. Such situations include:

• When an infection has progressed from the tooth into the bone. Infections may make anesthesia difficult and can be treated with antibiotics before the tooth is extracted.
• When a patient takes blood-thinning medications (anticoagulants), such as warfarin (Coumadin) or aspirin. The patient may need to stop using these medications for three days prior to extraction if medically advisable.
• When patients have had any of the following procedures in the previous six months: heart valve replacement, open-heart surgery, prosthetic joint replacement, or placement of a medical shunt. Such patients may be given antibiotics to reduce the risk of bacterial infection.

Description

Once the area has been numbed with a local anesthetic, an instrument called an elevator is used to loosen (luxate) the tooth, widen the space in the bone, and break the tiny elastic fibers that attach the tooth to the bone. When the tooth is dislocated from the bone, it can be lifted and removed with forceps.

If the extraction is likely to be difficult, the dentist may refer the patient to an oral and maxillofacial surgeon, a specialist trained to give intravenous sedatives or general anesthesia to relieve pain. Examples of difficult procedures are extracting an impacted tooth or a tooth with curved roots. This typically requires cutting through gum tissue to expose the tooth and may also require removing portions of bone to free the tooth. Some teeth must be cut and removed in sections. The extraction site may require one or more stitches to close the incision.

Preparation

Before an extraction, the dentist takes the patient's medical history, noting allergies and prescription medications. A dental history is also taken, with particular attention to previous extractions and reactions to anesthetics. The dentist may then prescribe antibiotics, or consult with the physician and recommend stopping certain medications prior to the extraction. The tooth is x rayed to determine its full shape and position, especially if it is impacted.

If the patient is going to have deep anesthesia, loose clothing should be worn that allows access for an intravenous line. The patient should not eat or drink anything for at least six hours before the procedure. Arrangements should be made for a friend or relative to drive the patient home afterwards.

Women who take oral contraceptives are twice as likely to develop dry socket, a common complication in which a blood clot does not properly fill the empty socket after extraction. Women taking birth control pills should try to schedule their extractions during the last week of their cycle to coincide with low estrogen levels.