What Is Dental Extraction?

Tooth extraction is the removal of a tooth from its socket in the bone.

What It’s Used For

If a tooth has been broken or damaged by decay, your dentist will try to fix it with a filling, crown or other treatment. Sometimes, though, there’s too much damage for the tooth to be repaired. This is the most common reason for extracting a tooth.

Here are other reasons:

•  Some people have extra teeth that block other teeth from coming in.
• People getting braces may need teeth extracted to create room for the teeth that are being moved into place.
•  People receiving radiation to the head and neck may need to have teeth in the field of radiation extracted.
• People receiving cancer drugs may develop infected teeth. These drugs weaken the immune system, increasing the risk of infection. Infected teeth may need to be extracted.
•  People receiving an organ transplant may need some teeth extracted if the teeth could become sources of infection after the transplant. People with organ transplants have a high risk of infection because they must take drugs that decrease or suppress the immune system.
•  Wisdom teeth, also called third molars, are often extracted either before or after they come in. They commonly come in during the late teens or early 20s. These teeth often get stuck in the jaw (impacted) and do not come in. They need to be removed if they are decayed or cause pain. Some wisdom teeth are blocked by other teeth or may not have enough room to come in completely. This can irritate the gum, causing pain and swelling. In this case, the tooth must be removed.

Preparation

• Your dentist or oral surgeon will ask about your medical and dental histories. He or she will take an X-ray of the area to help plan the best way to remove the tooth.
• If you are having all of your wisdom teeth removed, you may have a panoramic X-ray. This X-ray takes a picture of all of your teeth at once. It can show several things that help to guide an extraction:
• The relationship of your wisdom teeth to your other teeth
• The upper teeth’s relationship to your sinuses
• The lower teeth’s relationship to a nerve in the jawbone that gives feeling to your lower jaw, lower teeth, lower lip and chin. This nerve is called the inferior alveolar nerve.
• Any infections, tumors or bone disease that may be present
• Some health care professionals prescribe antibiotics to be taken before and after surgery. This practice varies by the dentist or oral surgeon. Antibiotics are more likely to be given if:
• You have infection at the time of surgery
• You have a weakened immune system
• You will have a long surgery
• You have specific medical condition(s)

If you’re going to have conscious sedation or deeper anesthesia, wear clothing that has short sleeves or sleeves that can be rolled up easily. This allows easy access for an intravenous (IV) line to be placed in a vein.

You will be told not to eat or drink anything for six or eight hours before the procedure. You also should make sure you have someone available to drive you home after the surgery.

How It’s Done

There are two types of extractions:

• A simple extraction is performed on a tooth that can be seen in the mouth. General dentists commonly do simple extractions. Most of these can be done using just an injection (a local anesthetic), with or without anti-anxiety drugs. In a simple extraction, the dentist will grasp the tooth with forceps and loosen it by moving the forceps back and forth. Then the tooth will be pulled out. Sometimes the dentist will use a dental “elevator” to help loosen the tooth. This is an instrument that fits between the tooth and the gum.
• A surgical extraction involves teeth that cannot be seen easily in the mouth. They may have broken off at the gum line or they may not have come in yet. To see and remove the tooth, the dentist or oral surgeon must cut and pull back the gums. Pulling back the gum “flap” provides access to remove bone and/or a piece of the tooth.

Surgical extractions commonly are done by oral surgeons. They are done with injections (local anesthesia), and you can also have conscious sedation. Patients with special medical conditions and young children may be given general anesthesia. In a surgical extraction, the dentist will need to make a cut (incision) in your gum to reach the tooth. In some cases, the tooth will need to be cut into pieces to be removed.

If you are having teeth extracted and are receiving conscious sedation, you may be given steroids in your IV line to help reduce swelling after the procedure.

If you need all four wisdom teeth removed, they are usually taken out at the same time. The top teeth are usually easier to remove than the lower ones.

Here are the types of wisdom teeth, in order from easiest to remove to most complex to remove:

• Erupted (already in the mouth)
•  Soft-tissue impacted (just under the gum)
• Partial-bony impacted (partially stuck in the jaw)
• Full-bony impacted (completely stuck in the jaw)

Also, if your wisdom teeth are tilted sideways, they can be harder to remove than if they are vertical.