Tooth Extractions – Answers to Having Teeth Removed
It is common to have questions about why your family dentist may need to pull a tooth, or multiple teeth.
At some point in your life you will probably need a tooth extracted by a dentist or oral surgeon. I would guess that since you are reading this question and answer that you or someone you know has had the recommendation for a tooth extraction and you want some additional information. Smile Design Dentistry believes that the Q & A of this article can provide the information you are seeking, and offers some peace of mind. Tooth extractions are not as scary as you think! We’ll help you know what to expect.
Q. Why will a dentist recommend a tooth to be extracted?
A. Top reasons your dentist may recommend a tooth to be extracted:
1. Tooth extraction due to interference with permanent teeth. As a child we start losing our baby teeth and permanent teeth will come in after. The adult teeth are significantly larger than the baby teeth and in some cases this can create issues for the eruption of the adult teeth. If a baby tooth stays in place too long it can force the incoming permanent teeth to enter at incorrect positions possibly making more complex orthodontic (braces) issues. These tend to be very simple extractions to help permanent teeth come into the mouth in a more appropriate postion. They also tend to heal very quickly and with minimal discomfort.
2. Needing to remove a tooth due to overcrowding. As an adolescent it may be determined by your dentist that braces are needed to correct the positioning of teeth and correct bit issues that result from that. If your dentist or orthodontist feels the adolescent’s teeth are too crowded, they may recommend teeth be extracted to ease the overcrowding. While this is not as common as it was years ago, there are still instances where it is recommended that teeth come out to allow for adequate space for aligning the adult teeth. Again, these tend to be very simple extractions.
3. Recommended tooth extraction for proper dental arch alignment. As a young adult our wisdom teeth begin coming in. The position of 3rd molars, or wisdom teeth, can ruin the table in terms of alignment. The alignment of the dentition in the dental arches occurs as a result of complex multi-directional forces acting on the teeth during and after eruption. They can come in at very odd angles, may not erupt at all, or may erupt and appear to be in the right position in relation to your other teeth. These teeth are so far back in your mouth, that often times they have very poor gum tissue health around the tooth.
This poor tissues health and tone can cause problems like tooth decay and dental infections. Many times, the teeth are recommended to be extracted as a measure to prevent future complications and problems. (I will talk more about wisdom teeth in a bit since it very common, and a little scary for most of us.)
4. Tooth removal due to consistent pain. Finally, there are times when a tooth needs to be extracted due to a tooth that is causing pain, has been fractured, has an infection or large cavity. Sometimes the steps necessary to save a tooth can have very poor long term outcomes, may not be able to be done predictably or be cost prohibitive. If that is the case your dentist may recommend they be extracted so a dental implant or bridge can be placed to keep your teeth and mouth functioning as it should along with stopping the progression of infection or eliminating pain. The time of obtaining and cost of dental implants is more than taking care of needed tooth extractions early on.
A key aspect of dental pain management is knowing what needs fixing first.
Q. Will it hurt when they remove my tooth?
We understand that pain is a top concern and answer all your questions before extracting a tooth.
A. The short answer is NO, your extraction needn’t be a painful experience! Whew! I wanted to get that out of the way quickly to alleviate any dental anxiety you may have. Here are ways your dentist or oral surgeon will make your experience comfortable.
For most basic extractions you typically only need some sort of local anesthetic, something like Lidocaine may be used. This is the same anesthetic that is used when you are getting a filling done. You will have some anesthetic placed near where the tooth is being removed. This should take care of any pain you may experience during the extraction process. You will still be able to feel some pressure, but nothing should feel sharp or painful during the tooth removal. Even when applying the anesthetic you dentist has tricks so you don’t feel the needle. The may take a finger and massage your gums close by while applying the anesthetic to distract you and the next thing you know, the anesthetic is done!
For some pediatric extractions the dentist may only need to apply some numbing gel or spray to the area and get the desired numbing effect. This is usually the case for those teeth you see that are hanging on by a thread and the adult tooth is just not effectively getting the baby tooth out of the way.
Lastly, for the truly anxious patient, there are options to help lower the level of anxiety ranging from nitrous oxide (laughing gas) to Valium like medications. If you have questions about what is appropriate in your situation, ask your dentist. They should be able to help you make a good decision and what is best to keep you comfortable during your extraction.
Our dentists want to address this question early as it is probably the biggest question most denatal patients may have. A poor dental experiences as children may cause fear of the dentist. Many have heard horror stories from others or, the term extraction just “sounds” like it must be painful. Right? Our answers about possible tooth extractions can help to love your dentist who provides solutions.
So now that we’ve covered questions and answers about basic extractions, we’ll address complex extractions.
Q. What Happens when Tooth Extraction Become Complicated?
A. Great question but, similar to above, complex tooth extractions do NOT need to be an unpleasant experience. Depending on what is involved, in the anticipated process of removing the teeth, like for wisdom teeth or severely crooked teeth, your dentist may decide to do it themselves. They may refer you to someone who is a better fit for the particulars of your wisdom tooth removal procedure.
In either case, the majority of the process involves how to make you, the patient, as comfortable as possible during the entire procedure. A lot of the time, this involves some level of sedation when the procedure is more complicated.
While the discomfort of the procedure is still managed in the actual surgery with local anesthetic, your perception and memory of the surgery can be impacted significantly through the level of sedation you receive for the procedure. Sedation can be accomplished through a number of avenues, but the most common is IV sedation in dental surgery. This is performed by a licensed individual, either dentist or nurse anesthetist, that is in charge of keeping you comfortable and safe during your extraction procedure. Choosing to have sedation can have a substantial impact to turn your surgical procedure from one of anxiety and fear to comfort and simplicity.
Q. How do I Prepare Prior to a Tooth Extraction?
A.For a tooth extraction where you are not having any sedation, you really don’t need to do anything except to reassure yourself or a child that this is not a big deal or something to worry about. The lower your anxiety, the easier the procedure. Remember if you are having a lot of anxiety or worried about your child’s anxiety for the extraction, discuss your options with your dentist. There are easy ways to lower anxiety and require minimal preparation on your side.
For extractions that are more complicated and partial or full sedation has been recommended there are some preparatory instructions.
Taking care of complex tooth extractions involves:
- First, you will be sedated and the sedation can make you nauseous so your stomach needs to be empty for the procedure. You will be asked to abstain from food or drink 8 hours prior to the procedure. If the stomach has food It can be dangerous to vomit while sedated.
- Second, your doctor may ask you to have a pre-op physical done. This is to make sure that you are fit to have a sedation procedure done.
- Third, you will need to have a driver with you. It has to be someone who can stay during the procedure and can be responsible for safely getting you home. After the procedure you will be groggy and not in a condition to safely drive a vehicle, so this is very important.
With either type of extraction, or any type of dental procedure for that matter, be sure to give your dentist a complete list of medications you are taking. These can impact dental procedures and your overall health. Your dentist will first carefully review your health history and prescriptions to know how they may interact with any medications prescribed to you.
What can I expect After the Tooth Removal Procedure?
A.Your dentist and their team will review post tooth removal instructions with you either before or after your surgery. You should also be provided with a written form of these instructions, it can be helpful to have a printed resource to refer to if all the details aren’t clear in your mind a few hours after your surgery. Our gentle dentistry best practices take care of that for you.
Basic Tooth Extraction Rules to Follow:
- Please avoid smoking, spitting, drinking through straws or vigorously rinsing your mouth. It can cause the clot to come out of the extraction site and cause complications. If the clot comes out of the extraction site it can cause what is known as a dry socket. While not dangerous to you, dry sockets can be exceptionally painful so following these instructions is very important.
- After 24 hours, begin gentle warm salt water rinses several times a day, especially after eating. It helps to keep the mouth clean and foster the healing process. Our dental staff recommends rolling the salt water in your mouth rather than forcefully swishing. Also try to not forcefully spit the water out so as to limit the potential of a dry socket.
- Eat soft nourishing foods (basically anything you can cut through with a fork, avoid chips rice, anything harder or sharp) and drink plenty of fluids. The day of surgery, do not eat or drink anything too hot, lukewarm or cool is recommended. A hot beverage can cause the clot at the extraction site to dissolve.
- Some bleeding is normal from surgical area. We recommend firm pressure, usually by biting on damp gauze, to the surgical site until active bleeding has stopped. It is important that the gauze is in the proper position and pressure is kept on the area for 20-30 minutes to control the bleeding. Pink in your saliva is normal, but if active bleeding is happening reapply pressure. You can also try to hold pressure on a damp black tea bag. The tannins in the tea can aid in clot formation. If you are still having heavy bleeding contact your dentist.
- Some swelling and bruising may occur following oral tooth extraction surgery. This will usually reach its peak in 36-48 hours. We recommend an ice pack be placed on the outside of the face over the surgical area the day of the surgery. The ice should stay on for 20 minutes then off for a 20 minutes. The more you can minimize swelling, the more comfortable you will be. Avoid putting the ice directly on the skin to not cause frostbite.
- Please take pain medication shortly after you get home before local anesthetic (numbness) wears off. Please have something to eat or drink before taking medication. Anti-inflammatory medications are the workhouse for keeping you comfortable. Ibuprofen and similar medications, if you are able to take them, keep your swelling down and this keeps you more comfortable. Again, any pain you have is mostly from inflammation. The more you can do to keep swelling down the more comfortable you will be.
- When sleeping or resting, elevate your head on 2 pillows, it will help reduce swelling. If you had a more involved extraction, you may also want a towel or dark colored towel over your pillow to prevent staining from residual oozing from the sockets.
- It has been reported that if you are currently taking an oral contraceptive (birth control pill), antibiotics may decrease the effectiveness of the contraceptive. If you have been given a prescription for antibiotics, ie: Penicillin, Amoxicillin, Clindamycin, etc., please use an additional method of contraception and consult your gynecologist.
- If bleeding or pain persists, or if you have any questions, please call your doctor.
Our Plymouth, MN dental clinic knows that what most dental patients really want to know is whether or not they’ll be in pain afterward. Your pre dental visit and handouts will leave confident that it’s an easy enough procedure. Additionally, you can read our Frequently Asked Dental Questions to fell fully prepared.
If you follow instruction given by your dentist and try not to let preconceived misconceptions get into your head I’m certain you will be able to have any extraction done with out pain and/or fear. If you think you may need a tooth removal for orthodontic reasons or some other need, we are happy to see you and answer all of you questions.