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Who may need tooth extraction?
Your dentist will present to you with various alternative treatments instead of a tooth extraction. While having a tooth extracted may be less expensive than the other options proposed it may not be the least expensive in the long run. But some factors do necessitate the extraction of the tooth ----

What are the problems associated with tooth extraction?

To avoid these complications your dentist will probably recommend to you to replace the tooth which has been extracted. Replacing a tooth which has been extracted with an artificial one will cost more than the alternative of not having a tooth extraction. Hence it is always better to save the tooth (if possible) and have your own natural tooth in the mouth. Root canal treatment (RCT) can save most teeth from the jaws of defeat. Follow the Six Golden Rules to maintain a good oral health.

What are the preparations needed before an extraction?
If significant amount of infection is present your dentist may decide that you may need a course of antibiotic for several days before the tooth extraction procedure is performed. Any antibiotics prescribed should always be taken as directed. Failure to do so can lead to the development of bacterial resistance to the antibiotic. If you have had any problems related to taking antibiotics (allergic reactions etc) you should report them to your dentist. Communicate with your dentist any concerns or fears you may have related to the tooth extraction procedure.

Even if your dentist doesn't ask make sure you report any problems you had with any previous tooth extractions, or any bleeding problems, or medical conditions in general (cardiac, hypertension, diabetes mellitus, liver diseases, hyperthyroidism, epilepsy, asthma etc), or allergic reactions to local anesthetic etc. Make sure your dentist knows all of the medicines and supplements (steroids) you are taking for whatever reasons. Many common medications can cause complications with tooth extractions such as, aspirin. This is a common drug taken by cardiac patients and is know to retard the blood clotting process and hence may cause increased bleeding after extraction. Such persons may need to stop the aspirin 3 days before the extraction and restart after 2 days of extraction. If you have cardiac diseases like valvular defects or prosthesis you will require an antibiotic cover before and after the extraction. The dentist may refer you the treating physician or concerned doctor for a medical checkup and consultation.

What are the steps involved in an extraction of a tooth?
Local Anesthesia: Before extraction of the tooth the dentist will anesthetize (numb) the tooth and the area surrounding it (jaw bone and gums), using an local anesthetic, usually lignocaine with 2% adrenaline. It takes around 5 - 10 minutes for the local anesthesia to act and make the area numb. The numbness may last for 2 - 3 hours.

Some people place themselves in a position of creating a self fulfilling prophecy. They expect the injection to hurt and whatsoever the dentist says they are not ready to accept nor understand. They don't give the process a chance, thus making a guaranteed unpleasant experience for both themselves and the dentist. The more cooperative you are when the dentist performs the injection the better it will be for you. The discomfort of the injection is related to the rate at which the anesthetic solution is injected. Slower the rate, lesser the discomfort. If you are being a poor patient the dentist's natural instinct will be to speed up the injection process and to finish it off quickly. Additionally, when a dentist performs an injection they must place the anesthetic solution in the proper location. If the dentist is focused more on your behavior, as opposed to only on performing the injection, it will increase the likelihood that the injection will be slightly off target and additional injections will be required to numb the area properly. During the injection relax completely, do not exert or use force by tightening the muscles of your face, hands and legs. Concentrate on your breathing, and breathe in and out normally. Remember, the injections are never that painful. Surely you will feel a prick but nothing more. Do not fear the unknown. If you are uncooperative the pain will be 10 times more.

Reflecting the Gingival tissues: The dentist checks for the proper numbness around the surrounding tissues. If it is an lower tooth, part of your tongue will also feel numb. The gums around the tooth is separated from the tooth with the help of a periosteal elevator. If you feel any pain during this procedure communicate with your dentist and he may inject more local anesthetic to numb the area further.

Extraction of the tooth: When your dentist performs the extraction expect to feel a lot of pressure. The dentist needs to expand the socket (the bony hole which holds the tooth) and also separate the tooth from the ligament which binds it in place. Since the bone of the jaw is compressible, by firmly rocking a tooth back and forth, the dentist can widen the tooth's socket to a point where the tooth is free to come out. You feel this pressure, but no pain. The reason you feel pressure during the tooth extraction is because our body have different types of nerve fibers, each of which carry different types of sensations. The local anesthetic is very effective at blocking pain transmitting nerve fibers, but the nerve fibers which transmit pressure sensations are not so profoundly affected. Expect to feel a pressure during your tooth extraction but don't assume this indicates that you will soon be feeling pain, because it doesn't. If you do happen to feel pain during the extraction you should let your dentist know so they can numb the area some more. But more anesthetic injections will never decrease the pressure sensation you experience.

Sometimes a tooth is so firmly anchored in its socket, or else the tooth's roots are curved, that the dentist can't get the tooth's socket expanded enough to remove it. In these cases the dentist may cut the tooth into two sections and then remove each section on its own.

What care should be taken after extraction of a tooth? (Post-Extraction Recommendations)
BLEEDING is the most common complication seen after an tooth extraction. Bite on the cotton pressure pack the dentist have placed in the socket for one hour. It is normal for some bleeding to occur for some hours after tooth extraction. It may even take 6 - 8 hours for the bleeding to stop completely. Avoid the following ----

Most bleedings can be controlled by placing a piece of moist clean cotton ball over the empty tooth socket and then biting firmly on this for 45 - 60 minutes. Make sure that the cotton ball is positioned directly on the extraction site and not on the adjacent tooth. It is both the firm pressure and maintaining this pressure for a constant 45 minutes which are important factors in this technique. Don't open your mouth every 5 minutes to check if the bleeding have stopped. Give your body time to produce a good blood clot. If a small amount of bleeding persists after 45 minutes then repeat the procedure. If heavy bleeding is still present then contact your dentist, as you may require stitches.

SWELLING may be present after an extraction. The more difficult the extraction has been, the more likely a swelling will occur. Any swelling which does occur can be kept to a minimum by placing a ice-pack on your face in the area where the extraction took place. Position the ice on your face for 10 minutes and then leave it off for the next 10 minutes. Repeat this cycle up to 24 hours after the extraction but not beyond that. Swelling should reach its maximum by 24 hours. To bring the swelling down after the first 24 hours apply a warm moist towel to the swollen area for 20 minutes followed by 20 minutes of no heat application. Repeat this cycle as necessary.

MEDICATIONS prescribed by the dentist should be taken as directed by the dentist or the pharmacist. Make sure you follow the directions and precautions which accompany them. Failure to do so can lead to the development of bacterial resistance to the antibiotic prescribed. It is usually best to take them with or after food (unless directed otherwise) to prevent an upset stomach or acidity.

Keep the extraction site clean. The cleaner you keep the extraction site the quicker it will heal. After 24 hours of tooth extraction you can gently rinse the mouth with warm saline water (1/2 teaspoon of salt in a cup of water) twice daily (morning and night). Do not use commercial mouthwashes as they can have a tendency to irritate the extraction site. It is very important to maintain a good oral hygiene during the healing process. On the day of the extraction, brushing the area directly is best to be avoided. But the next day you should resume brushing in the normal manner.

Stitches may be placed if necessary in the extraction site. The dentist will want to remove stitches which don't resorb in about a week or so after the extraction. The process of removing stitches is usually very easy and quite painless. Some types of stitches will resorb (dissolve away) on their own, and may not require removal.

Sometimes small fragments of dead bone (sequestrum) come to the surface of the extraction site, as they are ejected by the body during the healing process. You may be able to painlessly remove these very small splinters of bone yourself, or ask your dentist's assistance in removing them.

What is a Dry Socket?
Dry socket is a common complications people experience after a tooth extraction. The formation of a blood clot is an important part of the healing of the extraction socket. Dry sockets occur when either a blood clot has failed to form in the socket, or else the blood clot which did form has been dislodged and lost. Dry sockets are most frequently associated with difficult tooth extractions or those extractions in which the surrounding bone had to be removed (surgical removal). Persons who follow their dentist's post-extraction recommendations properly will reduce their chances of developing a dry socket.

Dry socket manifest themselves as a dull throbbing pain which appear three to four days after the tooth extraction. The pain can be moderate to severe in intensity. Dry socket are usually associated with a foul odor or bad taste. The extraction site appears whitish because the bone is exposed to the outside. There will be no pus discharge.

TREATMENT: The dentist will place a medicated dressing of Zinc-oxide Eugenol (clove oil) into the socket. This will help to soothe the pain. The dressing is usually removed and replaced every 24 hours until the dry socket's symptoms subside (which can in some cases take up to 6 - 10 days).

* Know your teeth * Know your Gums (Gingiva) * Eruption Dates * Six Golden Rules * Brushing\Flossing Technique * Wisdom tooth * Tooth Decay * Extraction * Dental Implant * Surgical Extraction * Orthognathic Surgery * Asymmetry of the face * Gummy Smile * Prognathism{Long Jaw} * Beggs\Straight wire{Orthodontia} * Bleaching{Tooth Whitening} * Habit Breaking * Interceptive Orthodontics * Discolouration\Veneers * Composite\Amalgam Fillings * Root Canal Treatment{RCT} * Crown{Porcelain\Castmetal} * Flap Surgery/Splinting * Bridges{Porcelain\Castmetal} * TMJ (Joint) Disorders * Bell's Palsy {Facial Paralysis} * Ankylosis{Difficulty in mouth opening} * Cleft Lip and Palate * Trigeminal Neuralgia * In a Lighter vein

This site is produced, designed and maintained by
Dr Antony George, Trichur Institute of Head And Neck Surgery (TIHANS),
Shornur Road,Trichur,Kerala-680001,India.
Ph: 0091-0487-335145, 335185
email me
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copyright ŠAug 2000. No part of this website may be transmitted or reproduced in anyway. Every effort has been made to supply correct and accurate information, but I assume no responsibility for its use.

updated Aug2002.