Dental Extractions & Wisdom Teeth
Tooth extraction is the removal of a tooth from its socket in the bone. If a tooth has been broken or damaged by decay, we will try to fix it with a filling, crown or other treatment. Sometimes, though, there is too much damage for the tooth to be repaired. This is the most common reason for extracting a tooth. Here are other reasons:
We will ask about your medical and dental histories and take an X-ray of the area to help plan the best way to remove the tooth.
If you are having your wisdom teeth removed, your dentist may perform 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:
Antibiotics are more likely given if:
You will be told not to eat or drink anything for six to eight hours before the procedure. You should also make sure you have someone available to drive you home after the surgery.
There are two types of extractions:
Surgical extractions are commonly done by an oral surgeon. 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. When performing a surgical extraction we 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.
Because surgical extractions are more complicated, they generally cause more pain after the procedure. The level of discomfort and how long it lasts will depend on the difficulty of the extraction. We may prescribe pain medication 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 will be asked to bite on a piece of gauze for about 20 to 30 minutes. This will put pressure on the area and allow the blood to clot. It still may bleed a small amount for the next 24 hours and taper off after that. Do not disturb the clot that forms on the wound.
You can put ice packs on your face to reduce swelling after the operation. If your jaw is sore and stiff after the swelling goes away, try a warm compress. Eat soft and cool foods for a few days and then try other foods as you feel comfortable. A gentle rinse with warm salt water, started 24 hours after the surgery, can also help to keep the area clean. Use one-half teaspoon of salt in one cup of water. Initial healing takes at least two weeks.
If you need stitches, they usually disappear (dissolve) on their own. They should disappear within one to two weeks. Rinsing with warm salt water will help the stitches dissolve. Some stitches need to be removed by either our office or that of an oral 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. That causes more bleeding and can lead to a dry socket, which occurs in about 3% to 4% of all extractions. Dry socket occurs 20% to 30% of the time when impacted teeth are removed. It happens more often in smokers and women who take birth control pills. It is also more likely after difficult extractions.
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. 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 then the lower teeth.
Here are the types of wisdom teeth, in the order from easiest to remove to most complex to remove:
Also, if your wisdom teeth are tilted sideways, they can be harder to remove than if they are vertical. Most simple extractions do not cause much discomfort after the procedure. You may take an over-the-counter non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil, Motrin and other brand names) for several days. You may not need any pain medicine at all.