Tooth Extractions

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Tooth Extractions

What is a tooth extraction?

A tooth extraction is a dental procedure that involves loosening your tooth and then removing it from its socket in the bone. Tooth extraction is typically a last resort treatment option when other dental treatments, such as fillings or root canals, are not possible or would be ineffective in treating a tooth.

Here are some common reasons for tooth extractions:

Severe decay or damage: If a tooth is severely decayed or damaged beyond repair, it may need to be extracted.
Infection: If a tooth is infected and cannot be treated with antibiotics or a root canal, it may need to be extracted to prevent the infection from spreading.
Advanced gum/periodontal disease: If a tooth has suffered from gum disease and lost too much of its supporting bone, it may need to be extracted
Impacted wisdom teeth with associated dental disease: If the wisdom teeth do not have enough room to emerge properly, they may become impacted (trapped beneath the gum line) and may lead to issues such as pain and infection. In such cases, they will need to be extracted.
Orthodontic treatment: If a patient is undergoing orthodontic treatment, such as braces, some teeth may need to be extracted when there is crowding to make room for the other teeth to move into proper alignment.

What does a tooth extraction involve?

Consultation with the dentist to discuss your troubled tooth or your concern. The dentist will diagnose your dental condition and advise with the options available. If extraction is decided, it can be done on the same day or sometimes require a special arrangement for complex cases, depending on it being standard extraction or surgical extraction.
Before an extraction, the area around the tooth will be sufficiently numbed with local anaesthesia to minimise discomfort during the procedure. Your dentist will only proceed once the area is fully numb. Please feel free to tell your dentist if you are not fully numb, even in the middle of the procedure. In some cases, sedation or general anaesthesia may be used to make the procedure more comfortable.
There are two main types of extraction techniques

Intra-alveolar / Standard extraction

This is performed when the tooth to be taken out is easy to access and not covered by bone
Your dentist will loosen the teeth and help you to remove it
Once the tooth is removed, the wound will be cleaned with saline
We will check for bleeding to stop
Post-op care will then be given and explained to you

Transalveolar / Surgical extraction

This is performed when the tooth is impacted (obstructed). Impaction can be caused by gum tissues, jaw bone, or other tooth blocking access to the tooth
In cases where a tooth has a complex root form or is badly broken down, surgical extraction may also be required.
This might require a minor surgery involving a small cut along the gum and some bone removal (if necessary) and separating tooth into pieces to allow easier removal if required.
The tooth or each division will then be loosened and removed carefully.
The wound will be cleaned with saline
Small stitch(es) will be placed to allow healing
Post-op care will be given and explained to you. You will be given medications like painkillers if required.
Review healing

What are the benefits of an extraction?

It eliminates the disease (such as decay, infection, or gum disease) along with the diseased tooth. In severe cases of infection, extraction is important to prevent the spread of infection to other parts of the body
It eliminates the pain or discomfort that you might have been experiencing. Although some mild discomfort may be expected during the healing after an extraction, this will resolve very soon and you will feel much better than before

What are the risks associated with an extraction?

There are general risks for extractions and some specific risks for certain teeth.

General risks:

Following an extraction, the healing process will involve some discomfort, bleeding, bruising, and swelling. These are commonly expected but there are instances where patients report no occurrence of any of these.
Dry socket (bony inflammation) can happen when the blood clot is dislodged from the wound after extraction. This condition can arise around the third day after an extraction is carried out. You may suspect a dry socket if you initially feel better after the extraction but encounter a sudden severe pain happens on the third day.
There is a risk of post-op infection following an extraction. It is important to follow your dentist’s advice to keep the area clean. Inform your dentist if you experience worsening pain associated with the extraction site, particularly after 5 days from the extraction
Prolonged bleeding. This can usually be due to secondary trauma to the wound or due to underlying medical history. Your dentist should check your medical history before starting the procedure to allow proper management.

Tooth-specific risks:

For some lower back teeth especially the wisdom teeth, there is the potential of nerve disturbance or damage during extraction. If this risk is pertinent to your situation, your dentist will discuss the issue in-depth
For some upper back teeth, especially those with long roots, there is a small risk for exposure of your sinus cavity lining to your mouth (an oroantral communication). If this risk is pertinent to your situation, your dentist will discuss the issue in-depth

Other risks should be discussed by your dentist if relevant to your planned procedure.

What should I expect after an extraction?

Post-operative care

Your dentist will provide you with the relevant post-operative care instructions specifically based on the procedure you had.

In general:

1. Bleeding from the site of extraction.

Your dentist will ensure the bleeding is controlled before letting you leave the clinic.
Biting down firmly on a piece of gauze for 30 minutes after the extraction will help stop the bleeding and form a blod clot
It is important to ensure you do not disturb this blood clot. Do not rinse your mouth for the first 24 hours after the extraction. Try to chew away from that area, avoid the use of drinking straws, and avoid vigorous rinsing/brushing or strenuous activity.
Bleeding can happen in cases of secondary trauma or during extreme activity or exercise during the day of procedure. Hence, it is generally recommended to avoid any exercise after a tooth extraction.
Slight oozing of blood can be expected and is nothing to be concerned about.
If there is a steady stream of blood, fold up a new piece of gauze and bite down firmly on it. Reduce your physical activity, staying seated for 30 minutes. Bleeding should usually stop after applying local pressure for adequate time.
If bleeding persists or becomes severe, it is important that you contact your dentist, failing which you should seek emergency dental management.

2. Following a routine extraction, it is expected that you might experience some discomfort

This can be managed with over-the-counter painkillers, common ones include paracetamol and ibuprofen. Please consult your dentist or medical practitioner for the types of recommended analgesics (painkiller) based on your medical condition and procedure carried out.
You can consider sticking to soft foods for the first few days after the extraction
It is best to avoid smoking for at least 24h after the extraction as smoking can slow down the healing process and increase the risk of complications

3. Bruising/swelling

Swelling will increase across 48 hours after surgery. Following this, you should start to notice the reduction from the 4th or 5th day.
Ice packs can be used over your cheek during the first 24 hours. Hold it in place for 20 minutes and remove it for 10 minutes. You can repeat this as often as you want. Beyond the 24 hour point, the effect of icing is greatly reduced.
- Elevate your head with pillows while you sleep

4. Diet

Immediately after extraction and while your mouth is still numb, be very careful that you do not hurt yourself while eating
Once the numbing has worn off, you are quite free to eat and drink most of whatever you are comfortable with. If there is discomfort associated with eating after the extraction, you can consider limiting your diet to fluids and softer foods.
You should try to avoid anything too hot or too spicy, as this might cause a bit more bleedingRinsing of the area to reduce risk of infection

5. The risk of infection is present for all surgical procedures including extractions. However, dentists should not routinely prescribe antibiotics for straightforward extractions due to the risk of antibiotic resistance.

In order to reduce the risk of infection
- Your dentist will give you an antibacterial mouthwash to begin using after the 24 hour mark. Follow the instructions for use, and gently hold the solution in your mouth without vigorous swishing. Use this mouthwash after meals and before bed for at least the next 5 days.

If you notice that the pain you experience is getting more severe, particularly after the 5th day, it might be a sign of infection. Inform your dentist so that they can assist with further management

6. Oral hygiene

You can begin brushing your teeth after an extraction but avoid the extraction site with the bristles.
After brushing, be gentle with rinsing and do not actively spit.

It is important to attend any follow up or review appointments that your dentist might have arranged after the extraction. This allows them to continue to monitor the situation and ensure you are recovering well.

Tooth Extractions