Tooth Extraction

 

Diagnosis and treatment

To determine if an extraction is right for your situation, we’ll perform a thorough exam, which typically includes x-rays.

If the tooth cannot be saved, it’s important to extract it as soon as possible to prevent infection in the tooth and jawbone. With modern dental techniques, the procedure should be a comfortable one for you. In many cases, we also recommend replacing an extracted tooth to preserve the jawbone and stabilize your bite, so we’ll talk with you about your replacement options.

Considering extraction for a decayed tooth

When a tooth is severely decayed and cannot be saved, extracting it can be the best choice for relieving pain and preventing the spread of infection.

Most decayed teeth can be saved

Most decayed teeth can be treated successfully with a filling or crown. But for these treatments to work, there must be enough healthy tooth structure above the jawbone to support the restoration.

For example, a crown is often used to cover, protect, and restore a tooth that’s been damaged by decay. The crown attaches to the part of the tooth that’s above the bone, so an adequate amount of tooth structure must remain to hold the crown securely.

Some teeth cannot be saved

Considering extraction due to periodontitis

When too much bone around a tooth has been lost due to severe periodontal disease (also called periodontitis), sometimes the best treatment is to remove the tooth to maintain the health of your mouth. 

Periodontal disease causes bone loss.

Teeth are held in place by the height and shape of the jawbone, but then teeth and gums and infected by the bacteria that cause periodontal disease, the disease process begins to destroy the bone that surrounds the teeth.

Left untreated, periodontal disease destroys so much bone that there’s not enough support for the teeth. In severe cases, the teeth become very loose and cannot be saved.

Diagnosis and treatment

To determine if an extraction is right for your situation, we’ll do a thorough examination, which typically includes x-rays. In advanced gum disease, sometimes called periodontitis, x-rays show us low and uneven bone levels around the teeth. The condition is especially obvious when compared to x-rays of a healthy mouth, in which the bone comes up high around the necks of the teeth.

Many times we can save teeth. Aggressive periodontal therapy, frequent periodontal maintenance appointments in our office, and a consistent home care can halt the progression of periodontal disease and stop the bone loss. Sometimes we also recommend periodontal surgery to save teeth.

However, if your teeth continue to loosen and the destruction persists, our only option will be to remove the affected tooth. It’s important to extract a tooth that cannot be saved as soon as possible to prevent the spread of infection.

We often recommend replacing an extracted tooth to preserve remaining jawbone and stabilize your bite, so we’ll talk with you about your replacement options.

If too much of your tooth has been damaged by decay, there isn’t enough healthy tooth structure left to hold a restoration. In this case, we may have no choice but to remove what remains of the tooth.

Bone grafting

When you’ve lost bone from your jaw, we can often restore it by performing a surgical procedure called bone grafting. Bone grafting techniques and technology enable us to restore the health and strength of the bone that supports your teeth.

Why is bone grafting used?

The area from which the bone was lost, often called a bony defect, may be a result of periodontal disease, removal of a tooth, trauma, a cyst, or long term tooth loss. Though your body can’t normally grow new bone on its own, with bone grafting, we can help your body replace lost or missing bone, fill in pocket of bone loss, and stimulate new bone and soft tissue growth.

The procedure

First we select the bone grafting material. We may use your own natural bone, bone tissue from another source, or artificial bone.

To place the bone graft, we begin by making sure the area is completely numb, and then we gently separate the gums from the bone or tooth. If a tooth is present in the grafting site, we’ll use a process called root planning to remove all of the plaque or tartar from the root surfaces of the tooth. This ensures that the area is free from harmful bacteria.

We then sculpt the surrounding bone to the desired shape and place the grafting material into the bony defect. Sometimes, we’ll take another step, called guided tissue regeneration. In this procedure, a special membrane is placed over the graft site to prevent unwanted tissue from growing into the graft site, and to enhance normal bone growth.

After the graft is placed, your gums are the repositioned over the graft site, and several sutures are placed.

Over the course of three to nine months, your body works to repair the grafted site, growing new soft tissue and bone. This new bone growth strengthens the area by connecting your existing bone with the bone material we placed during the procedure.

Patient instructions- extractions

Follow these instructions carefully to ensure the successful healing of your tooth extraction.

Before the procedure

Schedule some time off, so you can take it easy for several days after your tooth extraction.

If you are a woman taking birth control pills, schedule your appointment during the last week of your cycle.

Arrange to have a friend or family member to drive you home.

We may recommend that you take an anti-inflammatory medication before your appointment.

When to call us

It’s normal to experience some discomfort for several days after a tooth extraction, but call us right away if you have:

  •       Heavy or increased bleeding
  •       Pain or swelling that increases or continues beyond two or three days
  •       A bad taste or odor in your mouth
  •       A reaction to the medication

During the first 24 hours

It’s important that a blood clot forms on the extraction site to stop bleeding, reduce pain, and speed healing. To protect the clot and avoid the pain of dry socket:

  •       Bite on a gauze pad firmly for 45 to 60 minutes. If bleeding or oozing continues. Bite down on a clean pad or moist tea bag for 45 to 60 minutes.
  •       Don’t spit, and don’t suck on candies or through a straw.
  •       Don’t rinse your mouth, and don’t rinse or floss next to the site.
  •       Don’t smoke or use tobacco. Avoid tobacco for at least 72 hours because it slows healing.
  •       Don’t sneeze or cough, so have sinus or allergy medication on hand if necessary.
  •       Limit yourself to calm activities and elevate your head with pillows when you lie down to reduce bleeding.
  •       Don’t drink hot, carbonated, or alcoholic drinks, and avoid hot or spicy foods.

To control discomfort, take pain medication before the anesthetic has worn off or as recommended.

To keep swelling to a minimum, use an ice bag over the area, 20 minutes on and 20 minutes off.

When the numbness has worn off completely, drink lots of fluids and eat only soft nutritious foods, chewing on the opposite side.

After the first 24 hours

Begin to eat normally as soon as it’s comfortable.

Resume brushing and flossing, but clean gently around the site for about a week.

If antibiotics were prescribed, continue to take them  for the indicated length of time, even if all symptoms and signs of infection are gone.

Reduce soreness or swelling by applying moist heat. Swelling usually starts to go down after 48 hours.

Further reduce swelling by rinsing your mouth very gently with warm salt water. Use about one teaspoon of salt per glass of warm water. Rinse two to three times a day for the week following the extraction.