Tooth Extraction Health Article

Definition

Tooth extraction is the removal of a tooth from its socket in the bone.

Purpose

Extraction is performed for positional, structural, or economic reasons. Teeth are often removed because they are impacted. Teeth become impacted when they are prevented from growing into their normal position in the mouth by gum tissue, bone, or other teeth. Impaction is a common reason for the extraction of wisdom teeth. Extraction is the only known method that will prevent further problems with impaction.

Teeth may also be extracted to make more room in the mouth prior to straightening the remaining teeth (orthodontic treatment), or because they are so badly positioned that straightening is impossible. Extraction may be used to remove teeth that are so badly decayed or broken that they cannot be restored. In addition, some patients choose extraction as a less expensive alternative to filling or placing a crown on a severely decayed tooth.

Demographics

Exact statistics concerning tooth extraction are not available. Experts estimate that over 20 million teeth are extracted each year in the United States. Many of these are performed in conjunction with orthodontic procedures. Some extractions are due to tooth decay.

Description

Tooth extraction can be performed with local anesthesia if the tooth is exposed and appears to be easily removable in one piece. The dentist or oral surgeon uses an instrument called an elevator to luxate, or loosen, the tooth; widen the space in the underlying bone; and break the tiny elastic fibers that attach the tooth to the bone. Once the tooth is dislocated from the bone, it can be lifted and removed with forceps.

If the extraction is likely to be difficult, a general dentist may refer the patient to an oral surgeon. Oral surgeons are specialists who are trained to administer nitrous oxide (laughing gas), an intravenous sedative, or a general anesthetic to relieve pain. Extracting an impacted tooth or a tooth with curved roots typically requires cutting through gum tissue to expose the tooth. It may also require removing portions of bone to free the tooth. Some teeth must be cut and removed in sections. The extraction site may or may not require one or more stitches (sutures) to close the incision.

Diagnosis/Preparation

In some situations, tooth extractions may be temporarily postponed. These situations include:

• Infection that has progressed from the tooth into the bone. Infections may complicate administering anesthesia. They can be treated with antibiotics before the tooth is extracted.
• Use of drugs that thin the blood (anticoagulants). These medications include warfarin (Coumadin) and aspirin. The patient should stop using these medications for three days prior to extraction.
• People who have had any of the following procedures in the previous six months: heart valve replacement, open heart surgery, prosthetic joint replacement, or placement of a medical shunt. These patients may be given antibiotics to reduce the risk of bacterial infection spreading from the mouth to other parts of the body.

Before extracting a tooth, the dentist will take the patient's medical history, noting allergies and other prescription medications that the patient is taking. A dental history is also recorded. Particular attention is given to previous extractions and reactions to anesthetics. The dentist may then prescribe antibiotics or recommend stopping certain medications prior to the extraction. The tooth is x rayed to determine its full shape and position, especially if it is impacted.

Patients scheduled for deep anesthesia should wear loose clothing with sleeves that are easily rolled up to allow the dentist to place an intravenous line. They should not eat or drink anything for at least six hours before the procedure. Arrangements should be made for a friend or relative to drive them home after the surgery.