Dental Surgery

What teeth are to be removed?

The reasons for tooth extraction are various. Candidates for removal are severely decayed teeth, which cannot be restored by other methods.

– Teeth affected by periodontal disease (gum disease); since in severe cases teeth begin to loosen.

– Broken teeth that cannot be restored.

– Incorrectly located teeth in the tooth alignment.

If such teeth cannot be restored with conservative methods of treatment, the dentist extracts them. After teeth extraction defects are formed in the jaw, and the adjacent teeth begin to tilt towards the formed defect. The antagonist tooth from the opposite jaw begins to move toward the defect. This all can happen even if just one tooth is extracted. These phenomena lead to disturbance of the chewing process, and the chewing load sharply increases in the corresponding area. The habitual state of the jaws changes and the bite deforms. And this can greatly affect the overall condition of the teeth.

To avoid all these problems, in most cases the dentist recommends restoring the defect. Replacement of the extracted tooth by artificial one is carried out using bridge dentures, implants, removable partial dentures.

Therefore, when there is a possibility to restore the tooth by conservative methods, the dentist recommends the patient not to extract it. This approach is an alternative.

The process of tooth extraction

Before deciding on extraction, the dentist begins to carefully examine the oral cavity. He/she collects general medical and dental information, makes X-rays, with which the dentist assesses the condition of the tooth, its roots and the bone around it.

Anamnesis helps the dentist to collect all medical information about patient’s health, because the more the dentist will know not only about the tooth, but about the patient’s health as well, the better he/she will present the methods and the ways of the forthcoming treatment. To do this, the dentist asks questions to get from the patient the medical information he/she needs. The dentist should know whether the patient suffers from some other disease, what medications the patient uses. Some medications used by the patient can cause complications in the course of tooth extraction, for example, aspirin slows down blood clotting.

Pain relief of the tooth

The procedure of tooth extraction has an unimportant reputation as very painful one, but this is completely untrue.

Before the tooth is removed, the dentist also anesthetizes the tooth and the surrounding bone and gum. To ensure that during the anesthesia the patient does not feel discomfort associated with the needle injection, an anesthetic (pain relieving) gel of high concentration is applied on the place of needle insertion. After this, the patient does not feel the penetration of the needle into the mucosa, i.e. the process of anesthesia anesthetizes itself. After adequate anesthesia, the dentist proceeds to tooth extraction.

Tooth extraction

To remove the tooth, the dentist shall widen the tooth socket, because the bone in which the tooth is held, compresses. To do this, using tools, the dentist swings the tooth with some pressure back and forth.

These movements help to separate the tooth from the ligaments holding it in the socket. Once the socket is dilated, the dentist easily extracts the tooth.

Sometimes the tooth is so tightly seated in the socket or its roots are complex in shape, and the dentist cannot properly extend the socket in order to extract the tooth from it.

In such cases, the dentist dissects the tooth into parts and extracts each fragment separately. Since after extraction of the tooth blood can flow from the socket, the dentist shall stop bleeding. To do this, the dentist puts a swab on the empty tooth socket. The dentist puts the swab so that the patient can press it tightly with bite.

Post-surgical problems

After tooth extraction, the dentist gives some recommendations to patients to minimize possible post-surgical problems. In general and as a whole, these recommendations concern what can and cannot be done in the following terms.

What measures shall be taken when the socket swells

After extraction of the tooth, the patient may feel swelling in the area of ​​extraction associated with trauma caused during extraction. The more traumatic the extraction was, the larger the swelling is. To relieve swelling, the dentist recommends the patient to apply ice to the cheek from the opposite side of the extraction area. Ice shall be kept pressed to the cheek for 10 minutes, and then removed for 20 minutes and this procedure shall be repeated.

Dry sockets

After extraction of the tooth a blood clot is formed in the empty socket. The blood clot is an important part of the healing process of the socket. Therefore, precautionary measures are needed not to rip it off. To do this, during the first 24 hours after extraction, the patient shall not rinse his/her mouth and, if possible, shall not even spit, as a vacuum is formed in the mouth, which can lead to displacement of the clot. Hot food in the first day shall be avoided as it also dissolves the blood clot. Displacement of the blood clot leads to dry socket. If precautionary measures recommended by the dentist are followed, the risk of formation of dry socket  decreases.

Dry socket is one of the more frequent complications after tooth extraction. Formation of dry socket is caused by the fact that either the clot did not form at all at the place of extraction or, being formed it fell off under some external influence. Usually, dry sockets are formed after difficult extractions connected with significant injuries.

Often dry sockets appear as blunt, weak or acute pain for 3-4 days after tooth extraction. Sometimes it seems to patients that the pain spreads from the place of extraction towards the ear. In case of a dry socket, often an unpleasant taste or smell appears in the mouth. To treat a dry socket, the dentist applies a cotton swab with a drug that reduces and soothes the pain. The swab shall be changed every 24 hours until all the symptoms disappear. This procedure may take several days.

Healing of the socket

Therefore, after extraction of the tooth, an opening remains in the jaw, which, over time, is filled with bone. Studies have shown that fibrous tissue subsequently forms from the blood clot in the tooth socket after extraction.

Fibrous tissue in turn is formed into bone tissue.

Thus, the socket is filled with bone. It takes several months to fully form bone tissue. The healing process is affected by the degree of difficulty of tooth extraction: the easier extraction of the tooth was, the faster and easier the healing is.

Post-surgical care of the socket

By observing the precautionary measures of hygiene and care of the extraction area, the patient will significantly reduce the risk of formation of the aforementioned complications. For this purpose, the dentist will give the patients the following recommendations:

– After tooth extraction during 24 hours the patient shall avoid occupations that require considerable efforts and stress. After tooth extraction, food shall not be chewed with teeth located in the extraction area. If extraction was difficult, for the next 24 hours the patient shall eat liquid and soft foods. 24 hours after extraction hot food shall be avoided. Hot liquids can dissolve the blood clot formed in the socket.

– During 2 days after tooth extraction smoking and alcohol shall be avoided. During smoking a vacuum forms in the mouth, which can lead to displacement of the blood clot and we know that this can lead to dry socket and disturbed healing process.

– After tooth extraction the patient shall avoid during 24 hours brushing teeth in the immediate vicinity of the extraction area. The next day the patient can brush his/her teeth, but with soft brush.
– The more carefully the hygiene of the extraction area is monitored, the faster it will heal. It is recommended 24 hours after tooth extraction to gently rinse the socket with warm salt water. To do this, add in a cup of water a half of a teaspoon of salt and rinse the mouth after eating and before going to bed.

– Mouth cleaning solutions shall not be used in the following days as they can cause irritation in the extraction area.