Surgical and Non Surgical Dentistry

SURGICAL AND NON-SURGICAL EXTRACTIONS

A dental extraction is the removal of a tooth from the mouth. Extractions are performed for a wide variety of reasons. Tooth decay that has destroyed enough tooth structure to prevent restoration is the most frequent indication for extraction of teeth. Extractions of impacted or problematic wisdom teeth are routinely performed, as are extractions of some permanent teeth to make space for orthodontic treatment

Smile 'n’ shine dental care centre is equipped with the most modern and high-end extraction instruments and expertise for atraumatic dental extractions. All work here is done under complete asepsis and it is a zero contamination zone.

Surgical extractions are done by a team of specialist oral surgeons.

Reasons for tooth extraction

The most common reason for extracting a tooth is tooth damage such as breakage or fracture. Some other possible reasons for tooth extraction are as follows:

Extra teeth which are blocking other teeth from coming in.
Severe gum disease which may affect the supporting tissues and bone structures of teeth.
Severe tooth decay or infection.
In preparation for orthodontic treatment (braces)
Insufficient space for wisdom teeth (impacted wisdom teeth).
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

An extracted 3 rd 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 anesthetics, 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 subsequently 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. 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. 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.

2 extracted teethfrom a 14 year old boy, compared against a £1 coin.

2 extracted teeth from a 14 year old boy.

Problems with dental extractions

A dental extraction, or having a tooth pulled, is one of the most frequently requested services by people who come to a dental office in pain.Although a root canal is often a more preferable option to relieve pain from an infected tooth, in some cases a dental extraction is the best or only choice available.Even though most dental extractions proceed without any complications, some can occur. The most likely problems include pain, bleeding, infection, swelling, broken root tips, and bone chips and fragments.

Most people who have had a tooth extracted know that a certain degree of pain and bleeding is normal.Pain that lasts for up to a week or so but is gradually improving and bleeding that continues for up to 12-24 hours but is slowing down should be considered typical and will most likely not require follow-up care. Pain that seems to be getting worse after two days should be considered abnormal and may require evaluation by the dentist. Pain that increases after a dental extraction might be due to a dry socket, usually treated by the dentist rinsing the socket with an antiseptic mouth rinse, packing the area with a medicated dressing and putting the patient on pain medication. Another problem is bleeding that lasts for more than twenty four hours or is increasing several hours after the extraction.This may point to a serious problem that requires prompt attention from the dentist.Prolonged bleeding may occur if there is damage to a blood vessel or other tissue during an extraction, if a patient is taking certain medications or has a predisposing medical condition.Excessive bleeding can also be caused by a patient rinsing, spitting, or smoking after a dental extraction.To stop the bleeding, a dentist can pack and stitch the socket closed.

An infection and swelling are also potential complications from a dental extraction.An infection can be caused if debris or bacteria gets into the socket.Swelling is usually due to the trauma of having the tooth extracted, or can occur from a spreading infection. Swelling can be reduced by salt water rinses (after 24 hours) and an ice compress. Infections and swelling are usually treated by the dentist with rinsing the socket, antibiotics, and in some cases draining the infection surgically.

Broken root tips, bone chips and fragments are fairly common complications following a dental extraction.A small uninfected root tip can sometimes be left inside the jaw after a dental extraction if its removal might be too difficult or cause too much trauma for the patient.Often root tips, bone chips and fragments will work their way out on their own, but may also need some help from the dentist to remove them completely. An infected root tip stuck in the jaw bone will require surgical removal. Problems with dental extractions are fairly common, but can be minimized and resolved by a dentist experienced in oral surgery.

What to do following an extraction

FREQUENTLY ASKED QUESTIONS POST EXTRACTION

I’ve had my tooth out – what should I do now?

Take it easy for the rest of the day. Take as little exercise as you can, and rest as much as you can. Keep your head up to avoid any bleeding.

What precautions should I take?

Avoid hot food or drinks until the anaesthetic wears off. This is important as you cannot feel pain properly and may burn or scald your mouth. Also be careful not to chew your cheek. This is quite a common problem, which can happen when there is no feeling.

If you do rest, try to keep your head higher for the first night using an extra pillow if possible. It is also a good idea to use an old pillowcase, or put a towel on the pillow, in case you bleed a little.

Should I rinse my mouth out ?

Do not be tempted to rinse the area for the first 24 hours. It is important to allow the socket to heal, and you must be careful not to damage the blood clot by eating on that side or letting your tongue disturb it. This can allow infection into the socket and affect healing.

Is there anything else I should avoid?

Avoid alcohol for at least 24 hours, as this can encourage bleeding and delay healing. Eat and drink lukewarm food as normal but avoid chewing on that area of your mouth.

When should I brush ?

It is just as important, if not more so, to keep your mouth clean after an extraction. However, you do need to be careful around the extraction site.

What do I do if it bleeds ?

The first thing to remember is that there may be some slight bleeding for the first day or so. Many people are concerned about the amount of bleeding. This is due to the fact that a small amount of blood is mixed with a larger amount of saliva, which looks more dramatic than it is.

If you do notice bleeding, do not rinse out, but apply pressure to the socket. Bite firmly on a folded piece of clean cotton material such as a handkerchief for at least 15 minutes. Make sure this is placed directly over the extraction site and that the pad is replaced if necessary.

If the bleeding has not stopped after an hour or two, contact your dentist.

How soon can I have a cigarette?

It is important not to do anything which will increase your blood pressure, as this can lead to further bleeding. We recommend that you avoid smoking for as long as you can after an extraction, but this should be at least for the rest of the day.

Is there anything I can do to help my mouth?

Different people heal at different speeds after an extraction. It is important to keep your mouth and the extraction site as clean as possible, making sure that the socket is kept clear of all food and debris. Don’t rinse for the first 24 hours, and this will help your mouth to start healing. After this time use a salt-water mouthwash, which helps to heal the socket. A teaspoon of salt in a glass of warm water gently rinsed around the socket twice a day can help to clean and heal the area. Keep this up for at least a week or for as long as your dentist tells you.

It is important to keep to a healthy diet; and take a Vitamin C supplement, which will help your mouth to heal.

I am in pain, what should I take?

There will usually be some tenderness in the area for the first few days, and in most cases some simple pain relief is enough to ease the discomfort. What you would normally take for a headache should be enough. However, always follow the manufacturer’s instructions and if in doubt check with your doctor first. Do not take aspirin, as this will make your mouth bleed.

Are there any medicines I should avoid?

As we have said, it is important not to use anything containing aspirin as this can cause further bleeding. This happens because aspirin can thin the blood slightly. Asthma sufferers should avoid Ibuprofen-based pain relief. Again check with your chemist or dentist if you are worried or feel you need something stronger.
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I am still in pain, what could it be?

Sometimes an infection can get in the socket, which can be very painful. This is where there is little or no blood clot in the tooth socket and the bony socket walls are exposed and become infected. This is called a dry socket and in some cases is worse than the original toothache! In this case, it is important to see your dentist, who may place a dressing in the socket and prescribe a course of antibiotics to help relieve the infection. You may also feel the sharp edge of the socket with your tongue and sometimes small pieces of bone may work their way to the surface of the socket. This is perfectly normal.
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Will my dentist need to see me again?

If it has been a particularly difficult extraction, the dentist will give you a follow-up appointment. This could be to remove any stitches that were needed, or simply to check the area is healing well.