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Tooth Extraction

What is tooth extraction ?

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Tooth Extraction explained

Dr. Sarah explains everything you need to know
about tooth extraction treatment at the dentist

It is the last resort, but a solution that dentists hate to go to is tooth extraction. Our teeth are precious, and just because there are 32 of them, doesn’t mean we should easily give one away. There is a divine reason in that number, and all 32 teeth work in unison to create a stable environment, enabling you to perform all the activities you need with your mouth, namely chewing, biting, and speech. You would be surprised how much a single tooth lost or removed may affect these basic daily activities, and how much toll that takes on your everyday life.

Who needs tooth removal?

Modern dentistry is all about conservation, and one basic principle of conservation is keeping your teeth in your mouth for as long as possible. This means the decision to remove a tooth is an absolute last resort for most dentists, and it should be so for you as well. In the old days, there was no other option but to remove an infected tooth or one that decay has ravaged, but now the situation is different. There are a lot of solutions to preserve the teeth. That being said, there are some situations where teeth removal is the only option such as:

  1. Severe decay:

    Decay is a long and ongoing process. If your tooth has started to decay, then it continues to do so for a long period of time. If it is caught early, fixing a decayed tooth is incredibly easy. A 1-hour session under local anesthesia to remove the decay and replace it with a filling is probably all you will need, with virtually no complications afterward. However, some people are lethargic when it comes to their healthcare, or simply too afraid to go to the dentist –understandably-. When decay is left unchecked, it breaks down the tooth structure. You may not feel anything at all until that decay with all its bacteria and their toxins reach the tooth nerve, then the pain truly starts. Again this is not the end of the road, as most teeth can be saved with root canals and kept healthy with crowns. But if that point has passed, meaning the decay has destroyed your tooth so much that it is rendered non-restorable, then the only solution is unfortunately to remove it.
  2. Mobility:

    Tooth mobility has a great many reasons, the most common of which is periodontitis. Periodontitis is the inflammation of the periodontium, which is basically the strings holding your teeth in position inside their sockets in the bone. With improper oral hygiene, the gums get inflamed and are invaded by bacterial toxins and acids. Gum inflammation quickly escalates to periodontitis if not treated swiftly, and when that periodontitis sits there for a while, the periodontium gets degraded, and there is nothing holding the tooth in position. The teeth become so mobile that the only solution is to remove them to prevent further damage to the adjacent structures.
  3. Trauma:

    Accidents happen, unfortunately. The face is usually the first thing to be hit, and the teeth are usually gravely affected. The teeth are strong but fragile, much like glass, so when your teeth suffer a knock – say from a motor vehicle accident or a fight – they can easily break. In some cases, the break can be repaired with fillings or crowns or a combination of both, but in some cases, the breakage is just too much for the teeth to recover, and removing them is the only option.
  4. Non-responsive infection:

    One of the many consequences of untreated decay is teeth infection. Infection (commonly known as an abscess) affects your teeth’ nerves, decaying and liquefying them. These liquefied remains seep into the surrounding bone, causing the ever unpleasant swelling and pulsating pain beneath the tooth. Abscesses are usually treated with root canals, but in some cases, they just refuse to go away even with proper treatment and medication. In these cases, removing them is safer lest they affect the neighboring structures.
  5. Impacted (buried teeth):

    These are no fault of your own but are very common. The wisdom teeth are the last to appear in the mouth (usually by the age of 18 to 25 years). By that time, all the growth has stopped, and these teeth find no place to properly erupt, so they end up being partially or completely buried in the bones and gums. They could go on for years without causing any problems or symptoms, but that’s not often. They tend to trap food because of the awkward angle they’re buried in, causing decay, gum disease, swelling, and even jaw pain. These extractions are very necessary to avoid more complications, and in some cases, and emergency wisdom tooth impaction surgery could be needed. The process is a bit different though, as we’ll explain in a bit.
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How does the tooth extraction process happen?

There are 2 basic teeth extraction procedures, simple and surgical extractions.

The simple extraction procedure:

  • The tooth and the surrounding area are numbed with a local anesthetic. Sometimes sedation is used if your dentist provides it.
  • The tooth is loosened in its socket using elevators so that the pulling action is less uncomfortable. Sometimes the teeth are already loose, so this step is skipped.
  • A forceps is used to grasp the tooth, and with a gentle back and forth movement, a rotation movement, or a combination of both, the tooth is pulled out of its socket.
  • The wound is then checked for debris and cleaned, and a piece of gauze is inserted on which you bite on for about an hour, along with a list of instructions for aftercare (more later on)

Surgical extraction procedure

  • After numbing the area, a simple incision is made in the gums to expose the tooth.
  • If the tooth is buried in the bone, then some bone removal may be required to gain full access to the tooth. This is usually done with the dental turbine.
  • The tooth is then segmented into 2 or more pieces, to facilitate their removal.
  • After all the pieces are removed, the bone is smoothened with a file, and the wound is cleaned and debrided with warm saline.
  • A few stitches are usually needed to close the incision. These should be removed about a week later.

Post-extraction instructions

These are a key part of the healing process. Make sure to follow these steps to the letter as you care for wisdom teeth extraction procedures, or even after simple extractions.

  • Keep biting down on the gauze for an hour to stop the bleeding. The gauze is then removed and thrown away.
  • Refrain from disturbing the wound with your fingers and tongue as much as you can.
  • You should restrict yourself to a soft and cold diet (example: Yogurt, Juice, ice cream) for the entire day of the surgery, and try to use the other side, keeping the extraction site clean as much as you can.
  • Do not use any mouth rinse for at least 2 days after the extraction. Liquids squishing around in your mouth could remove the blood clot, elongating the healing process.
  • After these 2 days, use warm saline (you can make that at home using half a glass of lukewarm water, with a teaspoon of salt) to rinse your mouth. 3 to 5 times a day should be enough, for about 5 days.
  • Smoking is strictly PROHIBITED during the entire healing period, which lasts about a week on average.
  • If you have stitches, then head on down to your surgeon’s office after a week to remove them.
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How long is the tooth extraction healing time?

On average, the socket should heal within 1 week. Some people have amazing healing powers, and their wounds would heal in just 2 days. Others are more unfortunate, and the healing process could extend to 2 or 3 weeks.

What’s more important is what to expect during that healing period. Some pain after tooth extraction is certainly expected. In most cases, it is a simple dull pain that can be resolved easily with some pain medications. However, if the pain is so severe that is wakes you up at night, then by all means head to your dentist for a check-up. Some swelling is also expected (especially with surgical extraction), which should subside on its own with 2 days. Cold compresses should help with that swelling.

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How much does tooth extraction cost?

It is a wide range depending on the complexity of the procedure. Simple extractions range from $100 to $300, while surgical extractions start at $250 and could go all the way up to $600. Surgical extractions are understandable more expensive since they involve more work, stitches, follow ups and possibly sedation.

Basic Medicare insurance could not be enough to cover the entire procedure, as they would usually cover emergency procedures and child extractions, but not all procedures. For that, you would need to get some extras if you want insurance to be a part of your treatment costs bearing.

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Final thoughts

Our teeth are extremely precious, and losing one should not be taken lightly. Your dentist will do all he\she can to preserve your teeth and keep them in your mouth for as long as possible. However, in some cases as we explained, there might be no other choice than to remove a tooth. If that is the case, then you should strive to replace that missing tooth as soon as you can. A single lost tooth could have a detrimental effect on the oral environment, and replacing it may feel like an option, but it certainly is not. It is an absolute necessity.

So our advice is .. Keep your teeth healthy through great oral hygiene measures, and keep up your follow-ups with your dentist to avoid the headache of not only tooth extraction, but replacement as well.

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The procedure itself is not painful at all as you would be under local anesthesia. You may feel a slight pulling motion when the tooth is moved, but nothing too uncomfortable.

Hopefully it never comes to that, but that depends on several factors. How many visits are needed, how complicated the process will be, and what offer can you get from your dentist for a “bulk deal” as this one.  On average a single tooth extraction costs around $250. Multiply that by how many teeth you need extracted and you have your answer.  However, it doesn’t stop there.  You also need to think about the cost of replacing the ability to chew your food.  This could be with a set of dentures or implants. 

Simple extractions go as follows:

  • Numbing the area.
  • Loosening the tooth with elevators.
  • Using forceps to gently pull out the tooth.
  • Inserting gauze to bite down on, and post-operative instructions.

Surgical extractions are a bit different:

  • Numbing the area.
  • An incision to expose the tooth
  • Bone removal for complete exposure (if needed).
  • Segmenting the tooth with a turbine, and removing each piece separately.
  • Smoothening the bone and cleaning and debriding the wound.
  • 2 or more stitches as needed. These are removed a week later.

During the procedure itself, your blood vessels may get injured causing some bleeding, or the nerves could also get damaged and so you would feel numb for a while. Finally, if the extraction was forceful, the bone could crack or break under the pressure. These complications are extremely rare, especially with simple extraction procedures.

After the surgery, if the proper instructions were not followed, the wound could get infected causing severe pain, and a foul taste and smell from the infected wound.

Usually, it takes about a week for the wound to fully close, but in some cases that would extend to 2 or 3 weeks. All that is within normal range.

You should be limited to a soft diet for the day of the surgery, and try to keep the food away from the extraction side as much as you can. The next day you could eat and drink normally, but on the other side of the extraction.

Usually no, as local anesthesia is enough. Sedation may be needed for surgical extractions and wisdom teeth impaction surgeries.

It depends on the location of the anesthesia (or the location of the tooth to be pulled). The anesthesia for all the upper teeth, as well as the lower front teeth should last for only 2 or 3 hours. For the lower back teeth, it could be a bit longer, about 6 hours. Some people even report it lasted throughout the night, only letting up the next morning.

For simple extractions, you could go out the next day and live normally. For surgical extractions, a 3 to 5 days rest is needed for the swelling to go down and the pain to subside.

Dos:

  • Bite on the gauze for an hour.
  • Take medication as prescribed
  • Use a warm saline rinse 2 days after the procedure
  • Follow up after 1 week for stitches removal if you got them.

Don’ts:

  • Disturb the wound with the fingers or tongue.
  • Use any mouth rinse for 2 days after the surgery.
  • SMOKE.
  • Eat hard food the day of the surgery.

It is preferred you stick with the brush only for an entire week after the tooth extraction procedure.

Hard, hot and spicy foods, disturbing the wound with the fingers or tongue, smoking, and using mouth rinse (water included) for a couple of days.

If no sedation was performed, then yes driving is safe and allowed. If you were sedated, however, you can’t drive, go to work, supervise children or operate machinery for at least 1 day.

Sure. Just avoid squishing it around your mouth so as not to remove the blood clot.

Antibiotics are rarely needed after tooth extraction. Only cases of severe infection require antibiotics, as prescribed by your dentist.

It is best to avoid hot drinks such as coffee for the entire day of the surgery.

You should start the rinses 24 hours after the procedure. 3 to 5 times a day for 5 days should be sufficient.

Yes, of course. It is very healthy for your gums as it helps to reduce the level of bacteria in your mouth.  When you have a tooth extraction it is recommended to use warm salty mouth rinses for 2 – 3 days post-extraction to help keep the area free of debris and reduce the growth of new bacteria in the healing socket.

When it is rendered non-restorable, meaning they reach a point where they can’t be repaired. Examples include severe decay, severe mobility, non-resolving infection, and broken down teeth from a trauma.

For best practice, use warm salty mouth rinses starting 24 hours after the tooth has been removed, do not smoke or drink alcohol while the area heals, eat a diet of soft wholesome foods and have lots of rest to allow your body to heal itself naturally.  

You should not expect to have much blood as the mouth is a fast-healing part of the body and will begin to clot quickly after the tooth is removed.   If you do swallow some blood, no harm should come to you – however it’s not ideal to do so.  Best to use the gauze pads the dentist provided you in your post-operative care kit and bite down on this for 20 minutes until the area stops bleeding. 

Stick to your normal routine of brushing and flossing as best you can.  You will be the best judge of how the area is healing and when you can start brushing the area as normal.  During healing use warm salt water rinse several times a day for a period of 2-4 days.

Yes, since you removed the source of that infection. All it needs is time to heal.  However, there is the possibility of a secondary infection called a dry socket.  This is a very painful ache in the gum and bone that comes on 2-3 days post extraction.  If you begin to experience an increase in pain around the extraction site, or begin to feel unwell, contact your dentist immediately and ask to be seen.  Failing to treat a dry socket could result in hospitalization and in extreme cases, death.

If the extraction was straight forward you should expect some mild, controllable pain for a day or two after the procedure.  Most often, over the counter pain relief is all that is needed to ease the discomfort.  If your extraction treatment was more complex and the gum  needed to be cut and bone removed, you can expect tenderness, swelling, difficulty in chewing and opening the jaw and soreness for 3 – 5 days.  Again, over the counter pain relief, cold packs on the area and lots of rest will help in your recovery and management of any post-operative symptoms.

After the gauze is removed, you can eat soft and cold foods and drinks on the day of the surgery. After that, eat whatever you feel comfortable with, but try to keep the food on the opposite side of the extraction site.

Swelling is not very common with simple extractions. With surgical extractions, swelling is expected and should subside on its own in 2 or 3 days. Cold compresses and rest help a great deal.

Bleeding should stop by the time you remove the gauze from your mouth which is normally around 20 mins post-procedure.  You should expect a slight amount of blood from the socket until the area clots – this is normal to see after brushing your teeth and eating as you may accidently bump the tender gum tissue and cause some slight bleeding.  If the area continues to ooze blood for more than 24 hours, contact your dentist immediately.

You should follow the same recovery process as if you had a single tooth removed.  Cold compression following the appointment, pain relief as needed, lots of rest and warm salty rinses for 2 – 3 days.  

That depends on many factors, including your medical history, time and cost factors, and replacement plans.  The comprehensive consultation and discussion of your unique needs will determine how many teeth can be removed at once safely.  

Be sure to have a good meal prior to the appointment, with the exception of fasting if you are having sedation or a general anesthetic.  Ensure you have a few pre-prepared meals in the fridge so you can easily heat things up and continue to rest.  Take as long as recommended off work to aid in a speedy recovery and fill any prescriptions and purchase the recommended pain relief prior to the day.

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