Tooth extraction refers to painless removal of tooth or tooth roots with minimum trauma to the surrounding tissues so that the extraction socket wound heals uneventfully. It is a common procedure performed in the dentist’s office. Unrestorable decayed teeth, cracked tooth, impacted teeth are indicated for tooth extraction. Tooth extraction may be done for braces treatment or to give dentures to the patient. Simple tooth extraction is performed by general dentist mostly and surgical tooth extraction is performed by an oral surgeon. Tooth extraction procedure will remove the infected tooth from the oral cavity and will prevent the spread of infection or damage to the tooth.
Medical and Dental History of the patient before Tooth Extraction
Before doing the Tooth extraction, oral surgeon will take detailed medical history and dental history. If a patient is severe hypertensive or diabetic or suffering from some bleeding disorders, cardiac disorders or leukemia, then the tooth extraction procedure is not performed until the severity of problem has been resolved. Patient is also asked about medicaments he is taking and if he is allergic to any of the medicines.
Clinical Evaluation of Tooth to be Extracted
Oral surgeon will then evaluate the tooth clinically before removing it. He will examine the location and position of tooth, mobility of tooth, condition of the tooth and the adjacent tooth and assess to the tooth.
Radiographic Examination of Tooth for Removal
X-ray of tooth to be removed is taken. Periapical radiographs are mostly taken. In case of impacted teeth, panoramic radiographs are taken. X-rays give information about the tooth, its roots and the surrounding tissues.
If the patient doesn’t have any severe medical condition or any other contraindication for tooth extraction, then the oral surgeon or the dentist will proceed with the tooth extraction procedure. If the tooth can be saved, then it’s better to save the tooth than getting the tooth extracted. Tooth extraction should be the last mode of treatment.
Tooth Extraction Procedure Time
Time taken for tooth extraction will vary on the basis of procedure which is used for tooth extraction. Simple or closed tooth extraction will take lesser time then surgical or open tooth extraction. Time taken for tooth extraction will also vary on the basis of condition of the tooth, number of teeth which needs to be pulled out and efficiency of dental surgeon or the dentist. Simple tooth extraction procedure is completed by the dentist in 20-30 minutes.
Tooth extraction can be done by 2 major ways. They are:
1. Closed/ forceps/ Simple technique and
2. Open/ Surgical/ Flap technique
Simple Tooth Extraction or Non Surgical Tooth Extraction Procedure
Firstly chair position is adjusted by the dental assistant and patient is made comfortable. Armamentarium (Instruments) for tooth extraction is arranged and a sterile drape is put across the chest of patient to reduce the chances of contamination by the dental assistant. Patient should vigorously rinse the mouth with an antiseptic mouthwash to reduce the bacterial contamination which will further reduce the incidence of post-operative infection. Dentist will perform the procedure after wearing protective eyeglasses, mask and gloves.
Dentist will numb the tooth
Local anesthesia is given to the patient to prevent pain during tooth extraction procedure. Local anesthesia causes transient and reversible loss of sensation in circumscribed area of the body. Patient will just feel a prick sensation in the site of injection.
Dentist or the oral surgeon may give topical anesthesia onto the site of needle penetration before giving the local anesthetic injection.
Local anesthetic takes 5-10 minutes to make the area numb and the numbness will be there for 2-3 hours. Dentists will then confirm Local Anesthesia and will rule out local anesthetic associated complications. Dentist will check whether the tooth is anesthetized or not by pricking with a probe on the tissues adjacent to the tooth. There should be no local anesthetic associated complication like hematoma formation or an adverse drug reaction after giving the local anesthesia.
If the tooth is anesthetized, then the dentist or the oral surgeon will proceed with tooth extraction. If the local anesthetic is not effective, then local anesthetic injection might have to be given again.
Primary instruments to remove the tooth from the socket are the extraction forceps. Forceps will expand the socket by the use of wedge shaped beaks and will remove the tooth from the socket.
What happens during Simple Tooth Extraction
There are 5 general steps in simple or closed or forceps tooth extraction technique.
1. Loosening of soft tissue attachment from the tooth
It is the first step in removing the tooth from the extraction socket. Sharp instrument is used for it. It will push the soft tissue away from the tooth. A small pressure is felt by the patient at this step but there is no sensation of sharpness or discomfort.
2. Luxation of tooth with dental elevator
This is done for the expansion of the bony socket. Usually straight elevator is used for this. It is inserted perpendicular to the tooth and is then turned.
3. Adaptation of Dental forceps to the tooth
There are different forceps to be used for tooth extraction of different teeth. Proper forceps are chosen by the oral surgeon and forceps is adapted to the tooth which is to be removed.
4. Luxation of tooth with Dental forceps
By moving the tooth back and forth, dentist or oral surgeon will luxate the tooth. This will expand the tooth extraction socket and will facilitate the removal of the tooth from the socket.
5. Removal of the tooth from the socket
Once the bone expanded sufficiently and the tooth has been luxated, then the tooth is removed from the socket.
The patient will feel pressure during tooth extraction but will feel no pain.
After Tooth Extraction, Dentist or Oral Surgeon Will Do
Inspection of the Tooth
After the tooth is removed, the dentist or oral surgeon will examine the tooth to make sure that whole of the tooth is removed and no portion of tooth has remained in the tooth extraction socket.
Inspection of the Socket
Dentist will inspect the socket for presence of any bony spicules or any foreign body like calculus or any opening of the sinus or vital structures.
After this, he will do the extraction socket wound debridement and will give gauze pack to stop the bleeding and to achieve hemostasis. Post operative instructions are then given to the patient.
Benefits of Tooth Extraction
In case of tooth extraction for braces treatment, teeth crowding is relieved by the tooth removal. Tooth extraction removes damaged teeth from the oral cavity and further prevents spread of infection or damage to other teeth. In case of severe tooth mobility associated with gum disease, tooth extraction will remove the pain and infection from the mouth. Tooth extractions also make room for the dentures.
Who performs Tooth Extraction Procedure
If a simple tooth extraction is to be done, then a general dentist can do it. Simple tooth extraction is also known as closed tooth extraction or forceps tooth extraction. Surgical tooth extraction is commonly done by oral surgeons. In case of surgical tooth extraction, tooth can’t be easily seen in the mouth and the oral surgeon has to give incision (cut) to remove the tooth from the socket. Patient should make sure that the dentist or the oral surgeon who is going to do his tooth extraction is educated, trained and certified in that particular type of tooth extraction procedure. To ensure the credentials of the dentist or the oral surgeon, patient can check with national Dental Organizations or Associations.