Tooth Removal

Overview
If a tooth has been broken or damaged by decay, your dentist will try to fix it with a filling, crown or other dental treatment. But when there’s too much damage for the tooth to be repaired, the tooth may need to be extracted — or removed — from its socket in the bone.

TOOTH REMOVAL Procedures
There are two types of extractions:

  • A simple extraction – this procedure is on a tooth that can be seen in the mouth. For a simple extraction, the dentist loosens the tooth with an instrument called an elevator. Then the dentist uses forceps to remove the tooth.
  • A surgical extraction – this is a more complex procedure, which is used if a tooth may have broken off at the gum line or has not erupted in the mouth. The oral surgeon will make a small incision into your gum to surgically remove the broken tooth or impacted wisdom tooth.

Tips for Pain Management After TOOTH REMOVAL

Here are a few tips to help minimize your discomfort and speed recovery:

  • You can put ice packs on your face to reduce swelling. Alternate 20 minute on and 20 minutes off.
  • Eat soft and cool foods for a few days.
  • Starting 24 hours after surgery, swish with warm salt water. Use one-half teaspoon of salt in a cup of water.
  • You should not smoke, use a straw or spit after surgery. These actions can pull the blood clot out of the hole where the tooth was.

What Is It?

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. In this case, the tooth needs to be extracted. A very loose tooth also will require extraction if it can’t be saved, even with bone replacement surgery (bone graft).

Here are other reasons:

  • Some people have extra teeth that block other teeth from coming in.
  • Sometimes baby teeth don’t fall out in time to allow the permanent teeth to come 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 because these drugs weaken the immune system. Infected teeth may need to be extracted.
  • Some teeth may need to be extracted if they could become a source of infection after an organ 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. They need to be removed if they are decayed, cause pain or have a cyst or infection. These teeth often get stuck in the jaw (impacted) and do not come in. This can irritate the gum, causing pain and swelling. In this case, the tooth must be removed. If you need all four wisdom teeth removed, they are usually taken out at the same time.

If you expect to have treatment with intravenous drugs called bisphosphonates for a medical condition, be sure to see your dentist first. If any teeth need to be extracted, this should be done before your drug treatment begins. Having a tooth extraction after bisphosphonate treatment increases the risk of osteonecrosis (death of bone) in the jaw.

Preparation

Your dentist or oral surgeon will take an X-ray of the area to help plan the best way to remove the tooth. Be sure to provide your full medical and dental history and a list of all medicines you take. This should include both prescription and over-the-counter drugs, vitamins and supplements.

If you are having 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 doctors 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 medicine

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. In a simple extraction, the dentist loosens the tooth with an instrument called an elevator. Then the dentist uses an instrument called a forceps to remove the tooth.
  • A surgical extraction is a more complex procedure. It is used if a tooth may have broken off at the gum line or has not come into the mouth yet. Surgical extractions commonly are done by oral surgeons. However, they are also done by general dentists. The doctor makes a small incision (cut) into your gum. Sometimes it’s necessary to remove some of the bone around the tooth or to cut the tooth in half in order to extract it.

Most simple extractions can be done using just an injection (a local anesthetic). You may or may not receive drugs to help you relax. For a surgical extraction, you will receive a local anesthetic, and you may also have anesthesia through a vein (intravenous). Some people may need general anesthesia. They include patients with specific medical or behavioral conditions and young children.

If you are receiving conscious sedation, you may be given steroids as well as other medicines in your IV line. The steroids help to reduce swelling and keep you pain-free after the procedure.

During a tooth extraction, you can expect to feel pressure, but no pain. If you feel any pain or pinching, tell your doctor.

Follow-Up

Your doctor will give you detailed instructions on what to do and what to expect after your surgery. If you have any questions, make sure to ask them before you leave the office.

Having a tooth taken out is surgery. You can expect some discomfort after even simple extractions. Usually it is mild. Research has shown that taking nonsteroidal anti-inflammatory drugs (NSAIDs) can greatly decrease pain after a tooth extraction. These drugs include ibuprofen, such as Advil, Motrin and others. Take the dose your doctor recommends, 3 to 4 times a day. Take the first pills before the local anesthesia wears off. Continue taking them for 3 days. Ask your doctor for complete instructions.

Surgical extractions generally cause more pain after the procedure than simple extractions. The level of discomfort and how long it lasts will depend on how difficult it was to remove the tooth. Your dentist may prescribe pain medicine for a few days and then suggest an NSAID. Most pain disappears after a couple of days.

A cut in the mouth tends to bleed more than a cut on the skin because it cannot dry out and form a scab. After an extraction, you’ll be asked to bite on a piece of gauze for 20 to 30 minutes. This pressure will allow the blood to clot. You will still have a small amount of bleeding for the next 24 hours or so. It should taper off after that. Don’t disturb the clot that forms on the wound.

You can put ice packs on your face to reduce swelling. Typically, they are left on for 20 minutes at a time and removed for 20 minutes. If your jaw is sore and stiff after the swelling goes away, try warm compresses.

Eat soft and cool foods for a few days. Then try other food as you feel comfortable.

A gentle rinse with warm salt water, started 24 hours after the surgery, can help to keep the area clean. Use one-half teaspoon of salt in a cup of water. Most swelling and bleeding end within a day or two after the surgery. Initial healing takes at least two weeks.

If you need stitches, your doctor may use the kind that dissolve on their own. This usually takes one to two weeks. Rinsing with warm salt water will help the stitches to dissolve. Some stitches need to be removed by the dentist or surgeon.

You should not smoke, use a straw or spit after surgery. These actions can pull the blood clot out of the hole where the tooth was. Do not smoke on the day of surgery. Do not smoke for 24 to 72 hours after having a tooth extracted.

Safe and Effective Infant Oral Care

It’s crucial that you have the right information early on when it comes to infant oral care. Even though your child’s first teeth are temporary, they are still susceptible to decay and infection, and mothers can actually transfer damaging bacteria to their infants, according to the American Dental Association’s (ADA) Mouth Healthy site. Knowing the correct approach to oral care for each stage of your baby’s development will ensure you’re providing the best care possible.

Infant Care Is Your Dental Care

Good oral care for your baby starts with your own dental health. Disease-causing bacteria called “streptococcus mutans” can transfer from mothers to infants easily, according to the American Academy of Pediatrics, and can result in infant dental decay. Poor dietary habits can increase bacteria production and the risk of transfer to your infant, so keep an eye on your diet and practice good oral hygiene yourself.

The Centers for Disease Control and Prevention notes that early childhood caries, or dental decay that leads to cavities, is a widespread infectious disease for infants in the U.S. It’s also one of the most avoidable, and taking the right steps at every stage can prevent it and improve oral health.

The Most Effective Care at Every Stage

Follow these four steps to ensure proper oral care for your child:

  1. Schedule your own dental cleaning and exam in the second trimester of your pregnancy. Basic cleaning and care is safe for your baby, and decreases risk of bacteria transmission and infection. Avoid any cosmetic procedures until after your child is born, and limit or delay emergency procedures, such as extractions, if possible.
  2. Schedule your baby’s first dental health and oral exam no later than one year of age, or when the first tooth erupts, according to both the ADA and The American Academy of Pediatric Dentistry. The goals of this first visit are:
  • Risk assessment: Your pediatrician will relay whether any additional steps must be taken based on the exam.
  • Education: Pediatricians and pediatric dentists recommend dental wellness visits every six months for the first five years.
  • Referrals: This means choosing a pediatric dentist who will provide comprehensive, consistent care over the next five years.
  1. In the first year, clean your infant’s gums at least twice a day, in the morning and evening, and after feedings, to prevent bacteria and food buildup. The best technique is to wrap a clean, damp gauze around your clean index finger and gently wipe your baby’s gums.

What to Avoid

Avoid overexposure to fluoride, whether in toothpaste or through bottled water. You should consult with your dentist or pediatrician for information about fluoride usage with your infant. Don’t let your baby fall asleep nursing or with a bottle in his mouth; this will minimize bacteria development. And don’t share your utensils, drinking straws or cups. Remember your bacteria is transferable and can cause infections.

Putting all these practices into place, from when to start care to what specific steps to take or to avoid, will ensure your newborn has the safest and most effective oral care. That’s great peace of mind for any parent.

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