Dental Extractions

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Reasons for Tooth Extraction

The most common reason for extraction is tooth damage due to breakage or decay. There are additional reasons for tooth extraction:

• Severe tooth decay or infection. Despite the reduction in worldwide prevalence of dental caries, still it is the most common reason for extraction of (non-third molar) teeth with up to two thirds of extractions.
• Extra teeth which are blocking other teeth from coming in.
• Severe gum disease which may affect the supporting tissues and bone structures of teeth.
• In preparation for orthodontic treatment (braces).
• Teeth in the fracture line
• Fractured teeth
• Insufficient space for wisdom teeth (impacted third molars). Although many dentists remove asymptomatic impacted third molars, American as well as British Health Authorities recommended against this routine procedure, unless there are evidences for disease in the impacted tooth or the near environment. The American Public Health Association, for example, adopted a policy, Opposition to Prophylactic Removal of Third Molars (Wisdom Teeth) because of the large number of injuries resulting from unnecessary extractions.
• Receiving radiation to the head and neck may require extraction of teeth in the field of radiation.

Types of Extraction

An extracted 3rd molar that was horizontally impacted. Extractions are often categorized as “simple” or “surgical”.

• Simple extractions are performed on teeth that are visible in the mouth, usually under local anaesthetic, and require only the use of instruments to elevate and/or grasp the visible portion of the tooth. Typically the tooth is lifted using an elevator, and using dental forceps, rocked back and forth until the Periodontal ligament has been sufficiently broken and the supporting alveolar bone has been adequately widened to make the tooth loose enough to remove. Typically, when teeth are removed with forceps, slow, steady pressure is applied with controlled force.
• Surgical extractions involve the removal of teeth that cannot be easily accessed, either because they have broken under the gum line or because they have not erupted fully. Surgical extractions almost always require an incision. In a surgical extraction the doctor may elevate the soft tissues covering the tooth and bone and may also remove some of the overlying and/or surrounding bone tissue with a drill or osteotome. Frequently, the tooth may be split into multiple pieces to facilitate its removal. Surgical extractions are usually performed under a general anaesthetic.

Post Extraction Healing

Following extraction of a tooth, a blood clot forms in the socket, usually within an hour. Bleeding is common in this first hour, but its likelihood decreases quickly as time passes, and is unusual after 24 hours. The raw open wound overlying the dental socket takes about 1 week to heal. Thereafter, the socket will gradually fill in with soft gum tissue over a period of about one to two months. Final closure of the socket with bony remodeling can take six months or more.