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When Do You Need Tooth Extraction?

Wisdom tooth extraction is the most common dental extraction procedure. However, there are also many other times when tooth extraction can be a viable solution for persistent dental health problems. Removing a badly damaged tooth can make room for a long lasting and fully functional restoration such as a dental implant.

Tooth extraction is a very common procedure. Many teens and adults have one or more wisdom teeth removed to resolve ongoing dental problems or to prevent tooth crowding. Extraction is also a final resort for teeth that are damaged or diseased. Many teeth extraction procedures are minor. However, some involve oral surgery.

What Dental Problems Require Tooth Extraction?

This treatment is recommended for patients when the results of leaving a tooth in place would be more harmful than losing a tooth. Here are some of the most common indications for extraction:

Wisdom teeth are frequently plagued by recurring or chronic gum irritation. This is because third molars often erupt only partway through the gum, leaving a flap of gum tissue partly covering the tooth. Food and bacteria can get lodged in the gums and cause irritation, pain and infection. If this gum inflammation persists, it can lead to periodontitis. Gum disease damages the jaw bone around the wisdom tooth and the adjacent molar.

Because wisdom teeth can also make proper flossing difficult, patients may develop cavities where the second and third molars meet. Third molars usually don’t line up with their opposing molar in a way that makes them functional. So, filling a wisdom tooth cavity isn’t very beneficial or cost-effective compared to wisdom tooth extraction.

Third molars can also cause crowding, pushing the front teeth together so they overlap. Crowded teeth are at higher risk for gum disease and decay. When a wisdom tooth is positioned at an angle so that it presses against a second molar, this can cause ongoing pain. A “sideways” impacted wisdom tooth trapped in the jawbone may also erode the tooth root of the second molar. Wisdom tooth extraction is a permanent solution to relieve symptoms and reduce long term oral health risks.

Tooth Damage

Sometimes, teeth are too badly damaged for repair. This can happen with a deep fracture or a very large cavity. There may not be enough healthy dental tissue left to support a restoration like a crown or a porcelain overlay. In this case, teeth extraction may permit the placement of a prosthetic such as a bridge or a dental implant.

Gum Disease

Advanced periodontitis often leads to loose teeth. Once a tooth becomes very mobile from bone loss in the socket that is supposed to hold it in place, the damage is usually irreversible. These loose teeth make it difficult to chew. The receding gum line exposes the root of the tooth, which may cause significant sensitivity or pain. At this point, the only solution may be tooth extraction followed by the placement of dental implants, bridges or dentures.

Infected Tooth

A root canal is the standard treatment for getting rid of infected tooth pulp and cleaning bacteria out of its roots. However, the tooth abscess may return or spread. If it does not respond to more aggressive surgery such as the removal of the root tip (apicoectomy), extraction may be the only choice for stopping the infection.

Tooth Extraction Procedure Overview

Dr. Meyers and Dr. Sullivan generally performs tooth removal as an outpatient procedure done using a local anesthetic and nitrous oxide. Some patients also request conscious sedation for added comfort. After the local anesthetic is injected, there should be no pain during the procedure – just a sensation of pressure.

There are several types of teeth extraction. With front teeth that have only one tooth root, a tooth can simply be pulled straight out of the socket. Back teeth generally have at least two roots going in different directions. These teeth need to be cut into pieces and removed in sections to prevent damage to the jawbone. Lower wisdom teeth that are impacted (trapped in the jawbone) or upper wisdom teeth that are located very close to the sinus cavities may require special skill to remove safely. These cases may be handled by an oral and maxillofacial surgeon. The exact locations of the roots of a tooth are determined using x-ray before any extraction.

Recovery from tooth removal has several stages. A blood clot forms in the socket during the first 12 hours. Swelling starts to subside after about two days. Stitches come out in the first week. Jaw soreness may persist for several days when a back molar is removed. After two weeks, the area is mostly healed and any lingering signs of discomfort should be gone. With a surgical extraction, gum tissue may take an additional couple of weeks to fully recover. The bone socket fills in over a period of several months.

More Information about Tooth Extraction

Discomfort after having a front tooth pulled is usually mild and can be managed with over the counter pain relievers. More complex extractions (including those that require gum or bone surgery) tend to cause more post-operative discomfort. Pain medications may be prescribed for use during the first few days after the procedure. Dry socket, a condition that occurs if the blood clot protecting the extraction site is dislodged, can cause ongoing pain and sensitivity. Follow-up treatment may be required to address these symptoms. Patients who follow their post-procedure instructions carefully are unlikely to experience this complication.

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