Tooth Anatomy

A tooth consists of a crown and a root. The crown is the part of the tooth above the gum line, and the root is located within the jawbone. Each tooth is anchored in the jawbone in a tooth socket, or alveolus. The tooth is held in the socket by ligaments that attach the tooth to the bone, allowing the tooth to be securely held within the bone.

Which Teeth Need to Be Removed?

The reasons for tooth extraction can vary, and before deciding to remove a tooth, it is important to assess the tooth’s condition and the patient’s health. Candidates for extraction include teeth severely damaged by decay that cannot be restored by other methods.

1. Teeth Affected by Periodontal Disease (Gum Disease)

In advanced forms of the disease, such as chronic periodontitis or gingivitis, teeth begin to loosen due to inflammation and destruction of the gums and bone tissue.

• Example: A patient with chronic periodontitis, whose upper incisors have become mobile and painful when chewing.
• Example: A patient with severe gingivitis, where the lower molars lose stability due to inflammation and destruction of the gums and bone tissue.

2. Broken Teeth That Cannot Be Restored

If a tooth is broken due to an accident or severe decay, its restoration with fillings or crowns may be impossible.

• Example: A patient suffered an accident, resulting in a molar tooth breaking under the gum, and it cannot be restored with fillings or crowns.
• Example: A patient with a crack in the tooth crown that goes deep under the gum, making it impossible to use a crown or filling for restoration.

3. Improperly Positioned Teeth in the Dental Arch

Teeth that grow improperly can cause pain, displacement of adjacent teeth, and other issues. In such cases, the dentist may recommend removal.

• Example: A patient has a wisdom tooth that grows horizontally, causing pain and displacement of adjacent teeth.
• Example: A patient with a canine that has not fully erupted and grows at a sharp angle, creating problems for adjacent teeth and causing pain.

Preparation for Tooth Extraction

Before proceeding with tooth extraction, the dentist conducts a thorough preparation. This includes:

• Oral cavity examination: The dentist carefully examines the teeth and gums, assessing their condition.
• Patient history: Collecting medical information about the patient’s health helps the dentist choose the best approach. It is important to report any chronic diseases and medications the patient is taking, as some medications can affect the extraction process.
• X-rays: These are necessary to accurately assess the condition of the tooth, roots, and surrounding tissues, helping to avoid complications during extraction.

Tooth Anesthesia

Many patients fear pain during tooth extraction, but modern dentistry offers effective ways to anesthetize. The anesthesia procedure includes several stages:

• Anesthetic gel: First, the dentist applies an anesthetic gel to the gum to numb the area where the needle will be inserted.
• Local anesthesia: After the gum is anesthetized, the dentist injects a needle with an anesthetic that blocks pain sensations not only in the area of the tooth but also in the surrounding tissues.

Once the anesthesia takes effect, the patient does not feel pain, and the extraction can be safely performed.

Tooth Extraction

The tooth extraction process can vary depending on the complexity of the situation:

• Preparation of the socket: The dentist widens the socket to make the tooth easier to extract. This is done using a special instrument, with gentle back-and-forth movements.
• Extraction of the tooth: After the tooth is detached from the ligaments, the dentist carefully extracts it.
• Complex extractions: If the tooth is too tightly seated or has complex root shapes, the dentist may divide the tooth into parts and extract each fragment separately.

After the tooth is extracted, the dentist applies a gauze pad to the socket to stop the bleeding.

Healing Process of the Socket

After a tooth is extracted, a hole remains in the jaw that will heal over time. The healing process occurs in several stages:

1. Blood clot formation: A blood clot forms in the socket, which protects the extraction site and facilitates the beginning of healing.
2. Transformation of the clot into fibrous tissue: Within a few days, the blood clot transforms into fibrous tissue, which later forms bone tissue.
3. Filling of the socket with bone: Gradually, bone tissue fills the socket, and the healing process can take from several weeks to several months.

Healing depends on the complexity of the extraction — the simpler the procedure, the faster the recovery.

Postoperative Care of the Socket

Proper care of the socket after tooth extraction plays a key role in preventing complications and speeding up healing. Follow these recommendations:

• Avoid physical exertion on the first day. This helps prevent increased bleeding and speeds up healing.
• Do not chew food with the teeth in the extraction area and consume soft or liquid food. Hard food can damage the socket.
• Avoid hot drinks and food in the first 24 hours. Hot liquids can dissolve the blood clot in the socket.
• Do not smoke and avoid alcohol for 48 hours. Smoking can displace the blood clot, and alcohol slows healing.
• Brush your teeth with a soft brush, avoiding the extraction area. This helps maintain oral hygiene without damaging the socket.
• Rinse your mouth with warm salt water after 24 hours. Use half a teaspoon of salt per cup of water and rinse after meals and before bedtime.

By following these recommendations, you can reduce the risk of complications and accelerate the healing process.

Costs of tooth extraction and surgery services:

Services	Cost (MDL)
Anesthesia (conduction, infiltration)	200
Simple tooth extraction (mobility grade II-IV)	450
Complex tooth extraction (mobility grade I)	630
Wisdom tooth extraction	from 1150
Extraction of dystopic, retained teeth	from 2250