Tooth extraction is the painless removal of tooth or tooth roots with minimum trauma to the investing tissues so that the socket heals uneventfully without any post operative complications.
Extractions are done in cases of abscessed tooth, in tooth infections, for orthodontic purposes, for complete dentures, if there is some extra tooth present, people receiving radiation therapy, or in cases of severely decayed or fractured or impacted tooth.
The tooth is held in the socket by the periodontal ligament and in case of extraction, force is applied to break these ligaments and to extend the width of the socket which pulls out the tooth from the socket.
It may take few minutes to hours for the extraction procedure to complete.
Tooth Extraction Procedure
Before going for the extraction, the dentist will take an x-ray to know about the relation ship of the tooth to sinus in case of upper tooth extraction and the relation ship of tooth to the nerve (Inferior alveolar nerve) in case of lower tooth extraction. The shape of the roots of the tooth, Infections, tumors and bone diseases can also be seen in the radiographs. If the wisdom tooth needs to be removed, then panoramic x-rays are taken which will tell about the relation of wisdom tooth to the other teeth.
Wisdom tooth indicated for extraction
The dentist will first give several shots of local anesthesia to numb the extraction site area and so that no pain occurs during the procedure. Lignocaine with adrenaline is commonly used for numbing the area. In cases of difficult surgical extractions or in patients with dental anxiety, the procedure can be done after giving sedation such as IV conscious sedation or after giving general anesthesia. If conscious sedation or general anesthesia is given to the patient, then they should wear the clothing in which the sleeves can be rolled on or in clothing with short sleeves. This will allow an easy access for the intravenous line which is to be put in the vein.
Sedation given to the patient
Fear of pain from injection
Quite a lot of patients have a fear from the injections. They assume that the injection shot will cause pain and are very uncooperative during the procedure and will make the experience unpleasant for themselves as well as the dentist. The more cooperative the patient is when the dentist gives the shot; the better it will be for the patient.
The rate at which the anesthetic shot is given determines the level of discomfort caused to the patient by the injection. If the injection is injected at a slower rate, it will cause lesser of pain. The anesthetic should be given at a proper position for it to be effective. The shots don’t hurt much. You will just feel a prick there. While giving the injection, patients are advised not to exert much and not to tighten the face, hands or legs muscles and just concentrate on breathing and breathe in and out normally. The dentist may give topical anesthesia which is available in the form of spray or gel and is applied to the site of injection to reduce the pain due to injection.
Local anesthesia takes 5-10mins to make the area numb. By the action of local anesthesia, the numbness will be there for 2-3 hrs.
In cases of alcoholics or in cases of acute infections, the tooth may not respond to local anesthesia. In such cases, antibiotics and pain killers can be taken by the patient before the procedure. Antibiotics will reduce infection in the tooth. Antibiotics are also given in cases of long surgery or if a patient has weakened immune system.
Before performing the extraction, the dentist will check whether the area is numb around the surrounding tissues or not. Retraction of the gingival tissue is done first and then the tooth is extracted. The patient might feel a lot of pressure during the extraction but there is no pain. The pressure feeling is there during the tooth extraction because the local anesthetic effectively blocks the pain transmitting fibers but the nerves fibers which transmit pressure sensation are not much affected. If the patient experiences pain during the extraction, then the dentist should be told so that he can numb that area again.
Ways of tooth extraction
Simple extraction and
Surgical tooth extraction
Simple extractions don’t usually cause much of pain and discomfort and is performed in those teeth in which much of crown of the tooth is in good condition and the extraction is done with the forceps. It is also called as closed extraction.
Tooth Requiring Extraction Extraction Using Gentle Surgical
Surgical extractions are mainly performed by the oral surgeons and incision of the gum and/or bone cutting is required in these kinds of extractions. They are also called as open extractions. It is a more invasive procedure than the simple extractions. It is done in those teeth which don’t have much of tooth structure left and nothing much is visible above the gum line. There is comparatively more postoperative pain in cases of surgical extractions. Surgical procedures can be of 5types: Surgical, surgical root, soft tissue, partial bony and full bony.
If a person has any medical history like bleeding problem, hypertension, diabetes mellitus, epilepsy, asthma or liver diseases or allergy to the local anesthesia, then he should inform all this to the dentist. If a person is severe hypertensive, then the dentist may not even extract the tooth because the chances of bleeding are more in case of hypertensive patients. The blood pressure needs to be normal and then only the dentist pulls out the tooth. In case of diabetic patients, the healing of the socket takes longer time so the tooth is pulled out when the sugar level of the person is normal. Surgical extractions are avoided in patients with high sugar levels. If a person is taking aspirin, then there would be more bleeding postoperatively in such patient due to reduced blood clotting process. So it is advised not to take the medicine 3days before the surgery and 2days after the surgery in such a patient. The dentist should know about the medical as well as the drug history. The dentist may refer to the physician in case of serious medical ailment.
Pain and discomfort after tooth extraction-
Even after a simple tooth extraction, it is normal to feel pain for few days after the extraction. The pain and discomfort after the procedure depends on the procedure which is used for the extraction of the tooth. In case of surgical extraction, a patient experiences more pain than the simple closed extraction. Analgesics are given after the tooth extraction to relieve the pain. If the tooth is pulled out under sedation, then steroids may be given to reduce the swelling after the procedure. Aspirin should be avoided to avoid excessive bleeding. In cases of simple extraction, the extraction socket takes 7-10 days to heal completely whereas in case of surgical extraction, it may take weeks to months for the socket to heal depending on the degree of damage to the dental tissues. The pain is more in case of removal of the impacted tooth. The medications should be taken after consulting the dentist. The patient has to take soft and liquid diet after the extraction and has to do warm saline rinses 3-4 times a day 24hrs after extraction. Patient is advised not to smoke for minimum of 48hrs after the extraction and not to spit, suck, drink for minimum of 24hrs after the extraction. If the dentist’s instructions are followed and the medicaments are taken on time as prescribed by the dentist, the pain and discomfort will regress in some time.
To avoid any complications, the patient should know about the do’s and don’ts of tooth extraction
It is also common to have pain in the jaw after the extraction as the mouth is held open for long time during the tooth extraction. Massaging the muscles gently, hot compresses application and over the counter analgesics can reduce the soreness of the jaw. Allow relaxation of the muscles and the jaw joint and don’t take hard crusted foods.
If severe pain occurs 2-3 days after the extraction, it can be due to dry socket. Dry socket is a condition in which the blood clot dislodges or dissolves exposing the bone. In case of dry socket, the dentist will clean that area and will give a surgical dressing at the site which will provide relief. Dry socket delays the healing of the socket.
In very few cases, pain is felt by the patients at the site of extraction for a long time being afterwards. The patient feels that it is same as phantom pain which a person experiences after limp amputation.
To conclude, Dental anesthetics, conscious dental sedation and general anesthesia avoid any kind of tooth extraction pain. The pain which occurs after the extraction can be relieved with tooth pain medicaments. Dentist’s instructions should be followed carefully to avoid any complications after the tooth extraction.