Tooth Extraction | Teeth removal

A dental emergency means different things to different people. Most often it involves pain, but not always. For example, who would deny that a crown falling off a front tooth the day before a wedding was not an emergency.

We understand and cater for such unexpected events. We leave spaces in our schedule to accommodate for them without compromising regular patient treatment.

We also understand and can help with the stress and anxiety that’s often at the core of long term dental problems.

Before You begin

To keep you safe and provide you with the best possible outcome, we need to carefully plan for your procedure. This means we:

Asses your extraction difficulty.

Discuss your alternatives.

You should know the advantages and disadvantages of all of your options.

Look for signs of active infection in the area.

Local swelling, a fever, difficulty opening or pain when swallowing would all be indications to defer the extraction until the infection has settle a little. If we press on in these circumstances, you may be more likely to have the infection spread in the area after the extraction, the local anaesthetic may not be effective.

Organise an x-ray.

It may be taken in house, but there may be advantages to considering an OPG which is taken elsewhere.

Take a medical history.

Many conditions and medications can require special management. A clear idea of your relevant medical information will help us to provide you with a comfortable and safe outcome. There are certain conditions that may require pre-medication with antibiotics an hour before the procedure.

What to expect of the extraction procedure

An extraction can be classified as either a “simple” extraction, or a “surgical” extraction. The processes used for both types of extraction are similar – surgical extractions are a little more complex and take a little extra time.
The following are things you’d likely experience in both:

Local anaesthetic.

A gentle technique is used to keep your discomfort to an absolute minimum. This is where 30 years of experience shines through.
Most simple extractions can be done using only a local anaesthetic.
If you are overly stressed about the procedure, we may offer you further relaxation techniques like Nitrous Oxide (Laughing gas) or a light oral sedative.
If you feel you will need to be completely asleep during the procedure, we can refer you to an excellent Oral Surgeon. We have only ever received back positive reviews about Mr Peter Allan.

Test for numbness

There are a number of ways for us to test if our anaesthetic has been completely effective and we aim not to progress with the procedure until we can be sure that will be completely pain free.

Sectioning the tooth

As the use of implants to replace teeth has become more and more popular, extraction techniques have changes. It’s now very important to retain intact as much of the bone that surrounds the tooth as possible. For this reason, most teeth with multiple roots are divided into separate pieces before they’re removed. While this involves the use of a dental drill, and takes considerably more time and skill, it does reduce the force required for removal and usually causes less pain and swelling after the procedure. Of course, there will be no pain through this sectioning procedure.

Pushing rather than pulling.

During the extraction you should feel pressure but never pain. If you feel pain that can be described as sharp or pinching, then you should tell us straight away. Applying more anaesthetic will not take away the sensation of pressure.
We actually loosen the tooth by stretching the bone that surrounds it. Again, in an attempt to save as much healthy bone as possible, a pushing tool is used for much of the procedure rather than the pulling forceps you might imagine we’d use.

Cracking noises

There’s no hiding the fact that removing a tooth is a fairly physical process. Afterall there’s two fairly solid substances involved – tooth and bone. So snapping or breaking noises are completely normal during the procedure. This is generally the breaking of the membrane that attaches the tooth to the bone. But it can also be the tooth root fracturing, or even a minor bone break.

Cleaning up infection

After the tooth is removed, we take a careful look inside the socket. If any residual infected material remains, we carefully remove it and wash out the area. This will help you heal much more quickly and with less chance of complications afterwards.

Stitches.

Not always applied but if the procedure was not simple and required a surgical approach where the gum is reflected out of the way, then stitches will be required.

Gauze pack

The most common way that we stop the bleeding in the socket is by applying pressure to the area with a rolled-up piece of sterile gauze. This is left in place for 30 minutes after your tooth is removed.

When will the tooth be removed

Immediate removal

If this is your preference, and the levels of swelling surrounding the tooth are not excessive, we can often move the tooth right away. You could be on the road to recovery today!

Delayed removal

Antibiotics are prescribed to first settle the infection and painkillers are used to manage the pain in the short term.
Once the infection is settled (usually at the end of the course of antibiotics) the tooth is removed. This is carried out either in our practice with an effective local anaesthetic, or by referral to our excellent oral surgeon for removal under general anaesthetic or sedation.

Reasons for removing teeth

Gum disease

Gum disease is commonly a silent, destructive disease that erodes away the bone supporting the tooth. Once it progresses past a certain point it can be difficult or impossible to control. Gum disease is the leading cause of tooth loss in older adults and is the third most common disease in the world.

Deep infection in a tooth

If decay is left for long enough, it will advance towards the middle of the tooth, finally reaching the central nerves and blood vessels (dental pulp). Once there’s an infection in this space, there’s only two treatment alternatives – remove the infected pulp (Root Canal Treatment) or remove the tooth all together.

Excessive damage from trauma or decay.

To reliably restore, you need a certain amount of sound structure above the gumline so your rebuild gets a good grip on to the tooth. If this doesn’t exist, sometimes you may develop enough tooth to hold on to with a procedure called crown lengthening.

Crowding

If your mouth is crowded, you may need teeth removed before completing a straightening procedure Wisdom teeth are most often removed because of crowding – the jaw just isn’t long enough to allow the tooth to completely move into its correct position. So part, or all of the tooth remains submerged and this can result in infection, pain and swelling in the area.

Retained baby teeth

Sometimes baby teeth don’t fall out when they’re meant to and complicate the permanent successors arrival.

Radiation therapy

Sometimes the field of radiation applied in the head and neck region can involve some teeth. If these teeth are in any way compromised (particularly by gum disease)

Why replace a lost tooth

In almost all circumstances it is best to replace the tooth that is being removed. Investing in a high quality, long lasting tooth replacement can save you time, money and lots of pain in the future.

Without timely replacement, the following conditions may occur:

Your bite will collapse around the space
All surrounding teeth (including front teeth) will suffer overloading.
Missing teeth can affect your speech.
Poor appearance including loss of facial muscle tone
Poor digestion.
Bite and jaw joint problems can develop with bite collapse
Bone Shrinkage

Care after extractions

1. Keep the gauze swab in place, with biting pressure, for half an hour after leaving the surgery.
2. If bleeding persists after this swab is removed, make a thick clean swab from the gauze you have been given and bite on it until the bleeding stops.
3. If any blood has collected in your mouth, drop it out gently – forcible spitting may disturb the clot and cause persistent bleeding.
4. Do not drink alcohol, smoke cigarettes or take part in strenuous activity for 24 hours.
5. Do not have hot foods or liquids – only lukewarm, soft food for 24 hours.
6. Do not rinse your mouth today but begin rinsing with lukewarm salt and water in 24 hours. Do this as often as possible for the next three days, particularly after meals.
7. Rest or sleep with your head slightly raised.
8. A painkiller such as Nurofen or Panadeine may be taken as you begin to feel the anaesthetic wear off. These two painkillers actually work very well when taken together.
9. Remember that your lips and tongue are numb – be careful not to bite them.