Dental Extractions
A tooth extraction is the removal of a tooth.
Teeth are removed for various reasons:
dental caries
gum (periodontal) disease
dental infections
trauma or injury to the tooth or surrounding bone – dental fracture
wisdom teeth complications
preparation for a dental prosthesis
preparation for dental braces, if the teeth are very crowded
baby teeth not falling out at the proper age.
When the situation is more complicated as in many third molars or wisdom teeth extraction cases or if sedation is required as well as implant placement the we will refer the patient to a specialist – oral surgeon.
Consultation and Planning
A patient will have a consultation with us prior to the extraction. During the consultation, the we will ask for a thorough medical history as well as any medications that the patient is taking.
Some people need to stop or start taking certain medications in the days leading up to the surgery, depending on the medical conditions and the extent of the surgical procedure. Also, some patients may receive certain medications on the day of the surgery.
Blood thinners
Some patients take blood thinning medication to prevent the formation of blood clots in vessels. These medications can lead to more bleeding during surgery.
Most of the time, the bleeding can be control at the site of the extraction. Using gauze and applying pressure after the procedure, it’s one way to stop the bleeding.
However, anyone who takes blood thinners should let us know during the consultation. In order to tell whether the person should temporarily switch to a different blood thinner or stop taking this type of medication, we may ask for a medical clearance from the primary physician or may request to see the results of a recent blood test. Typically, people do not need to stop taking blood thinners prior to teeth extractions but if it is necessary it should be done only at the primary physician advice.
Pre-op antibiotics
In a few circumstances, we may prescribe antibiotics before a tooth extraction. One such example, they may do so to treat dental infections with widespread symptoms, such as a fever, along with local oral swelling.
A patient may need antibiotics if they have a high risk of infective endocarditis, an infection of the heart valves or the interior lining of the heart chambers. According to the American Heart Association (AHA), people with certain heart conditions have an increased risk of developing this infection following dental surgery. The AHA and American Dental Association recommend, therefore, that people with any of the following take antibiotics prior to dental surgery to reduce the risk of infection:
a prosthetic cardiac valve
a history of cardiac valve repair with prosthetic material
a cardiac transplant with structural abnormalities of the valve
congenital heart abnormalities
a history of infective endocarditis
Patients may also need to premedicate after hip or knee replacement surgery if the orthopedic surgeon will recommend it.
The Procedure
Before starting the extraction, we will take an X-ray of the person’s tooth. This imaging will help us evaluate the curvature and angle of the tooth’s root. We classify extractions as simple or surgical. A simple extraction involves a tooth that is visible above the gums and that can be removed in one piece. A surgical extraction is more complicated and involves the removal of gum tissue, bone, or both.
Once the local anesthetic has numbed the area, we will begin the extraction. A person should not feel pain, but they can expect to feel pressure against the tooth. They may also hear grinding and cracking of bone or teeth. Some people find the experience unpleasant and distressing.
If a patient does feel any pain, they should notify us immediately. More anesthetic will be administered.
After the extraction, stitches or additional procedures to control the bleeding may be necessary.
Post-op instructions
Below, find ways to help reduce discomfort and promote healing after a tooth extraction.
Biting on gauze
Following an extraction, we will ask you to bite down on a thick layer of gauze over the extraction site. Biting down on the gauze with firm, consistent pressure will help control bleeding.
The gauze must remain in place for at least 30-45 minutes. If blood is still oozing, the patient will then need to replace the gauze and bite for another 30 minutes.
Controlling pain
The numbness from the local anesthetic should only last for a few hours following an extraction. Contact us if the numbness persists.
If we find it necessary, we may prescribe medication to alleviate pain and after the procedure. Typically, though, over-the-counter medications such as acetaminophen or ibuprofen are sufficient to control the pain after a routine extraction.
Controlling swelling
People may experience mild facial swelling in the area of the extraction. This is normal. Applying ice to the face may help alleviate the swelling - 20 minutes on, 20 minutes off.
Avoiding disturbing the extraction site
The first 24 hours after an extraction are extremely important. Disturbing or irritating the area can keep blood clots from forming effectively and slow the healing process.
People should therefore avoid:
sucking on the extraction site
touching it with their tongue
using a straw
spitting
eating solid — especially crunchy — foods
rinsing the mouth vigorously
drinking alcoholic beverages or using mouthwash that contains alcohol
smoking
Eating
After a tooth extraction, drink plenty of fluids and eat soft, nutritious foods. When chewing becomes comfortable again, slowly reintroduce solid foods. We recommend chewing on the side opposite from the extraction site until the wound has fully healed.
Brushing and flossing
Don’t brush the day of the extraction. Brush and floss starting the day after the extraction, but be careful not to disturb the blood clotting. Also starting the day after surgery, people can also rinse with warm salt water, especially after meals. To make this, add half a teaspoon of salt to 1 cup of water.