Have you ever asked yourself, what is a tooth extraction? In this article I am going to explain exactly what a tooth extraction is, how a tooth is actually extracted, and what typically happens after a tooth extraction.
A tooth extraction is the technical way of saying “pulling a tooth out”. It is just a more fancy way to say it.
Dentists don’t actually “pull” teeth out. It would be more accurate to say that we “push” teeth out. The method of removing a tooth is to expand the bone surrounding the tooth and we do this by applying a pushing pressure to the bone surrounding the tooth so that we can pick the tooth out of the mouth without damaging the bone around it.
When does a tooth need to be extracted?
The four main reasons a tooth may need to be extracted are:
- Severe tooth decay
- Severe gum disease
- To create space for dental braces
- Wisdom tooth problems
The most common reason to take out a tooth is when the tooth has developed an infection due to the decay travelling all the way to where the nerve and blood vessels are within the tooth. If there is enough tooth structure left it is possible to save the tooth with a root canal treatment instead. But if there is too little tooth structure to be able to restore the tooth, then the tooth will need to be extracted.
In severe gum disease the bone can be gradually eaten away. When most of the bone supporting the tooth is gone, the tooth can become infected and loose and will need to be taken out to treat disease and make the person comfortable.
If you have a small mouth and big teeth, the teeth become crowded and crooked because there is not enough room for them to be positioned correctly. In this situation your dentist or orthodontist will likely recommend you get some of your teeth removed to allow space to move your teeth into the correct alignment.
Often wisdom teeth come through tilted and only partially pop out from the gum. there is a space between the gum and the tooth when this happens that allows food particles to become trapped. This trapped, festering food can cause a painful infection and the wisdom tooth may need to be removed because of this.
What are the alternatives to a tooth extraction?
The only alternative to an extraction is root canal treatment. This is only an option if there is enough tooth structure left for the tooth to be restored though.
Simply placing a filling without doing a root canal treatment first is not an option once the decay gets all the way to the tooth’s nerve and blood supply.
If a filling is placed on top of the decay without taking the nerve and blood vessels out first the bacteria will remain in the tooth and create an abscess in the bone under the tooth. This abscess may spread to other areas of the body and make you very sick. It is possible to die from a dental abscess. Hugo Boss, the famous fashion designer, died from a dental abscess!
Make no mistake, a dental abscess needs to be treated to avoid serious illness and even death. The tooth either needs to be extracted or root canal treated.
If a tooth is so broken down that the tooth can’t be restored it is sometimes possible to avoid extracting the tooth. Unfortunately, this is usually only an option when the tooth has had a prior root canal treatment because once this much tooth is lost the bacteria is usually deep inside the tooth and a dental abscess will develop if not removed.
If the tooth has been root canal treated and is too broken down to restore, the tooth can be trimmed down to the gum level and be sealed over with a dental filling material . This will avoid the bone loss that occurs when the root is no longer present. This way the bone is preserved and will allow a dental implant to be placed more easily in the future without needing a bone graft first.
What is involved with having a tooth extracted?
Once a decision has been made to remove your tooth the first step is to thoroughly numb the tooth up so you don’t feel any discomfort during the extraction.
It’s normal to hear clicking and cracking noises as a tooth is extracted. It’s also normal to feel a lot of pressure. It’s not normal to feel pain and your dentist will stop if you feel any pain whatsoever and will numb you up some more.
Once you are numb, a tool called a luxator or elevator is used to loosen the tooth within the bone it is contained within. This tool looks a lot like a flat head screwdriver. The luxator/elevator is wedged between the bone and the tooth which creates a space between them, loosening the tooth and allows for easy removal.
Now that the tooth is loose a tool called a dental forcep is used to grip the tooth, loosen it even more by moving the tooth around in the bone and finally pick the tooth out of the mouth when it is totally loose.
If the tooth roots are very long, thin or curved or if the tooth has erupted into a very tilted position, the tooth may need to be surgically removed. This is not a big deal and is not painful because you are already totally numb in the area of that tooth.
A surgical extraction is usually done with the patient still awake and you can expect to need a few stitches after the tooth has been taken out. In some cases (usually for very anxious patients) the dentist may sedate you with a drug similar to Valium or they may even put you under using general anaesthetic.
Keep in mind if general anaesthetic is used the cost of the procedure will be much more expensive because a trained anaesthetist needs to be there during the procedure to put you under and keep you safe.
What to expect following a tooth extraction
When the tooth is out you need to apply pressure on the tooth socket to stop the bleeding. After about 5 to 20 minutes most of the bleeding will have stopped and a blood clot will be forming.
For the next 24 hours this clot needs to be left alone as much as possible to allow it to not be dislodged. If it becomes dislodged the tooth socket can become dry and this can be quite uncomfortable. This is termed a dry socket and I will discuss this again within this article.
After 24 hours the clot is not easily dislodged and you should start warm salty water rinses for a few days. Do this about five times a day – when you wake up, after meals, and before bed. The salty water helps prevent infections and allows the socket to heal faster by keeping it clear of food debris. Just add half a teaspoon of table salt to a cup of warm water.
It’s common to get some pain and a little bleeding for a few days following the extraction. However if simple pain relievers like Advil and Tylenol aren’t helping with the pain or you are bleeding heavily, then you need to get back in touch with your dentist.
After 1 to 2 weeks the gum will heal over and it will feel normal. The bone underneath can take up to 6 months to completely heal over but is not something that you will notice and will not cause any problems.
What are the possible problems from a tooth extraction?
Usually teeth are extracted without any major problems. However, there are some possible problems that may occur during and after the extraction.
During the tooth extraction
Although your dentist will take care not to damage the next door teeth while they are extracting the tooth, it is common for a dental filling or crown on the next door tooth to be damaged. If this happens the dentist can usually repair the filling or crown.
Sometimes a root can be pushed into one of the sinuses in your cheek bone. If this happens the root will have to be surgically removed and is usually performed by an oral surgeon rather than a general dentist. Again, this is not painful as you are totally numbed up.
Rarely if a lower tooth is taken out, particularly a lower wisdom tooth, the nerve that supplies the teeth and your lower lip can be damaged. This will result in numbness in the lower lip. This is almost always a temporary numbness that gets better slowly. However, on VERY rare occasions the nerve is so badly damaged that the loss of feeling in the lower lip will be permanent. Again, this is a very rare event and you shouldn’t be overly concerned about this happening to you.
After the tooth extraction
The most likely problem is to develop a painful condition called a dry socket. A dry socket is pretty much what it sounds like. The clot is lost from the socket and the socket becomes dry and painful. This can happen to anyone, but is much more common in smokers.
If you develop a dry socket, you need to go back to the dentist and the dentist will put something in the socket that makes it feel better. You can also take over the counter pain relievers like tylenol and advil.
The socket can become infected. If this happens the socket will not heal and will likely be quite painful. You need to go back to your dentist. The dentist will need to check the socket for any foreign objects and will likely prescribe you an antibiotic.
It’s common for a bit of bone to come out along with the tooth during an extraction. This will not cause any more pain than normal because there are no nerves within the bone itself.
The pain you get when a tooth is taken out is from the gum, the ligament around the tooth and the membrane around the bone, but not from the bone itself. I was quite surprised when I discovered this fact because I remember my old PE teacher at high school telling us that bone has nerves in it. You were wrong Mr T!
But I digress, if a bit of bone breaks off during the extraction some fragments can come loose in the socket and these bone fragments slowly come out of the clot and can get stuck in the healing gum. This will feel sharp to your tongue. Don’t worry, your dentist will easily and painlessly take these fragments out for you.
What do I do about the missing tooth?
Now that the tooth is no longer in your mouth, there will obviously be a space showing from where the tooth was.
Most people will want to do something about the missing tooth if it is at the front of their mouth because it’s unattractive missing a front tooth. However, a lot of people aren’t too concerned about a space at the back of the mouth. After all, nobody can really see it.
If the space is just left without replacing with a denture, a bridge, or an implant, the teeth either side of the missing tooth will tip in towards the space in the same way as books in a bookcase do when a book is taken out from the middle. Also, the opposite tooth that normally bites into the missing tooth will now grow into the space where the tooth was. The remaining teeth will have to work harder and will be more susceptible to breaking when a tooth is lost. If any of this concerns you, then you need to look at your missing tooth replacement options.
The main complaint I get from people who have lost a back tooth is foods like potato chips cutting into the gum and not being able to eat as easily as they did when they had the tooth.
Most people aren’t too affected if they have only lost one or two back teeth. If they lose more than that, then they start noticing it’s harder to chew their food and that their face looks sunken in from the tooth and bone not supporting their cheeks as well.
If you lose more than two or three back teeth and you want to chew food properly and not have your appearance affected, I recommend replacing the teeth.
That’s pretty much all you need to know about tooth extractions, so I will finish here. You now know what a tooth extraction is and what to expect during and after a tooth extraction.
If you have had a tooth extraction and would like to share your experience or if you have any questions about tooth extractions, please do so in the comments section and I will get back to you.