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Types of Tooth Extraction

The reason for a tooth’s demise may be uncontrolled decay, failed previous therapy that cannot be salvaged, severe periodontal (gum) disease, or to provide for a better dental prosthesis (“prosthetic expediency”). When extractions are performed without surgical sectioning of the tooth, bone removal, and the need for tissue incision, they are called “simple extractions.” However, many of these extractions can be difficult with unanticipated complications. The clinician may make a plan change in the middle of the procedure and decide that the tooth must be removed surgically. Typical simple extractions do not require sutures and dressings, but it is also not uncommon for them to be used as a measure to prevent complications during healing.

While it is generally preferable to save teeth through modern disease control methods, gum disease therapy, root canal therapy, and restorative reconstruction of damaged tooth structure, there are time when teeth must be extracted for the best outcome.

VIDEO: Simple Extraction

VIDEO: Surgical Extractions

In cases where the anatomy of the tooth to be extracted does not permit adequate non-surgical access or will likely result in avoidable trauma to the surrounding tissues or teeth, surgical access may be necessary and appropriate. An incision is made either with a laser or with a scalpel, a control amount of bone surrounding the tooth is removed, and the tooth may be sectioned into two or more pieces for retrieval. Lasers usually result in less post-op discomfort, but the extraction surgery may take longer than the conventional surgical method with a scalpel and rotary handpiece. Many times, sutures and wound dressings may be used to control the tissues and apply pressure after surgical extractions, but they are not always necessary.

VIDEO: Consequences of Extracted Tooth

Once a tooth is extracted, the socket tends to collapse both from top to bottom and from outside to in, which may compromise the bone supporting the adjacent teeth, reduce the bone available for future implant replacement, increase risk of injury to the main nerve in the lower jaw or to the sinuses in the upper jaw by reduced bone thickness for protection, or create a situation where esthetics of a future bridge would be compromised. Therefore, it is becoming routine for dentists to recommend bone replacement grafts at the time of extraction to at least preserve the width of the socket. Often purified bone particles from a cow or even from another person are used for this purpose, but live bone from the same patient can often be used. Once the bone is placed, a membrane that either dissolves on its own or must be removed after the graft has healed may be used to protect the graft. While bone grafting significantly increases the cost of the extraction, most patients report that it is well worth the additional expense.

VIDEO: Bone Graft for Ridge Preservation

Learn More About Tooth Extractions

What is the sharp thing coming out of where I had a tooth extraction?

Tooth Extraction Dover, Ohio

 

No one ever likes to have a tooth extraction done. Unfortunately, there are times when the loss of an adult tooth is unavoidable. As in any surgery, there are many risks such as infection, lasting numbness of the tongue or lips, etc. However, this particular question deals with the healing process after a tooth extraction takes place. Discussing this problem without also discussing the complication of a dry socket would be inappropriate because the two are very closely related.Tooth Extraction Dover, Ohio

A tooth is held in place in a healthy socket by millions of microscopic cables, collectively called the periodontal ligament. An analogy may be that of a very firm trampoline, held stiff by multiple springs. The tooth is the canvas, and the bone is the frame. In between the springs is where cells and fluid that keep the springs oiled reside. In order to perform a tooth extraction, the dentist must sever these very tightly bound springs. This is most commonly done by “stretching” the bone, which is somewhat pliable under continuous pressure. However, bone is also brittle, so some small slivers of bone may flake off and either imbed in the soft tissue during the surgery or fall into the empty socket, becoming masked by blood that flows into the socket.

Blood flowing into an empty tooth socket is nature’s method of filling in the hole that was once covered by the tooth. As soon as blood begins to flow into the socket, a substance called fibrinogen in the blood forms a net over the socket called fibrin. The fibrin traps blood cells and protects the exposed bone in the socket. Once the bone is covered, new skin can begin to develop, which usually takes about three days to fully cover the bone. In other words, the fibrin clot must remain intact and functional for at least three days. If the fibrin clot is destroyed or is physically dislodged somehow, like from the suction of smoking or the use of a straw, the bone becomes exposed with no protection. Nicotine from cigarettes chemically breaks down fibrin, and suction from smoking or drinking through a straw can physically tear the fibrin away from the trampoline frame. Thus, a very painful problem is created: a dry socket. Treatment usually involves placement of some type of artificial clot into the socket to protect the bone until skin can cover it.

Once skin completely covers the bone, the fibrin clot breaks down naturally after three days and is shed because it has served its purpose. The skin grows and thickens rapidly over several weeks, and bone begins to fill in underneath it. During this time, some of those little pieces of bone that may have broken off during the extraction can migrate to the surface and be sloughed off. If they get stuck in the developing tissue, they can be very sharp and painful. Often a dentist can just remove them quickly with a pair of tweezers.

Do I Need to Have My Wisdom Teeth Extracted?

The third set of molars are often called “wisdom teeth” because they are fully developed around what used to be called “the age of wisdom,” which is around 18. They have absolutely nothing to do with intelligence. In fact, quite the opposite…most wisdom teeth can’t even figure out how to get into the mouth headfirst!

There have been many theories and myths about why wisdom teeth should be extracted or left in place. Many dentists used to encourage leaving wisdom teeth in place if they erupt fully, even if they come in crookedly because they would supposedly make a good support tooth for a prosthesis if the second molar (12-year molar) would be lost for some reason. In reality, though, the wisdom teeth make poor abutment teeth for prostheses because their root structures are weak and unpredictable. One of the theories that used to be posed to justify extraction claimed that wisdom teeth “pushed” teeth forward, causing the front teeth to crowd. Good research has proven time and time again that wisdom tooth impaction and/or eruption has absolutely no effect on the lower front teeth.

So, what do we know? We know that wisdom teeth are so far back in the mouth that they are very, very difficult to clean with normal home hygiene practices. Therefore, wisdom teeth are very susceptible to dental decay, especially later in life when dexterity is compromised by arthritis, etc. Impacted wisdom teeth have the potential to cause cysts which can weaken the jaw bone and cause damage to the adjacent second molars. Partially impacted teeth, which poke partially through the gum, can become infected and cause damage to the gums and bone surrounding the adjacent teeth. Sometimes, severe infections can result.

I personally do not know of any logical reason for not having third molars removed at a young age, unless a person simply does not want to undergo the procedure or unless there is some other underlying medical reason that would complicate the extraction surgery. The risks of keeping wisdom teeth usually far outweigh the benefits of taking them out. Since many wisdom tooth extractions are difficult and require substantial healing, the younger a person is when the procedure is done, the less risk is involved and the better healing potential that exists. Once the roots are completely formed, surgery becomes much more complicated in many cases.

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