A tooth extraction is the removal of a tooth from its socket in the jawbone. While modern dentistry aims to save natural teeth, sometimes a tooth is damaged beyond repair and must be removed. This common procedure prevents the spread of infection, relieves pain, and prepares the mouth for other treatments. Understanding the professionals who perform this procedure can help ease concerns.
Who Performs Tooth Extractions
The professional performing a tooth extraction depends on the procedure’s complexity. Two main types of practitioners handle tooth removal: general dentists and oral surgeons. General dentists are trained to handle most straightforward extractions, known as simple extractions. These typically involve teeth fully visible above the gum line with stable, accessible roots.
When an extraction is complicated, the patient is usually referred to an oral and maxillofacial surgeon. This specialist has several years of additional surgical residency training and specializes in complex procedures involving the mouth, jaw, and face. Oral surgeons manage surgical extractions, such as removing impacted wisdom teeth, teeth broken off at the gum line, or teeth with complicated roots. They are also equipped to manage patients with complicating medical factors and can administer various levels of sedation, including general anesthesia.
Common Reasons for Tooth Removal
A dentist recommends extraction when a tooth’s condition is compromised beyond repair by restorative procedures.
- Severe decay or deep infection: This is common when damage reaches the dental pulp and cannot be treated with a root canal. Removing the tooth prevents the infection from spreading to the jawbone and surrounding tissues.
- Advanced periodontal disease: Severe gum disease causes the loss of bone and ligaments supporting the teeth, resulting in significant looseness that cannot be stabilized.
- Impacted teeth: Third molars (wisdom teeth) often require removal because they are trapped beneath the gum tissue or bone. They can cause pain, infection, or damage to neighboring teeth.
- Orthodontic treatment: Extractions are sometimes necessary to correct severe overcrowding, creating space for the remaining teeth to be properly aligned.
Understanding the Extraction Process
The specific steps of an extraction depend on whether the procedure is simple or surgical.
Simple Extraction
A simple extraction is performed on a visible, erupted tooth. The procedure begins with administering a local anesthetic to numb the area. The dentist uses an instrument called an elevator to gently loosen the tooth from its socket and surrounding periodontal ligament fibers. Once the tooth is mobile, forceps grasp the crown and remove it entirely.
Surgical Extraction
A surgical extraction is necessary for teeth that are not easily accessible, such as those impacted or fractured below the gum line. The oral surgeon first makes a small incision in the gum tissue to view the tooth and surrounding bone. If needed, a small amount of bone may be removed to create an exit path. The tooth may also be sectioned into smaller pieces to minimize trauma during removal. The site is often closed with dissolvable stitches to aid healing.
Essential Aftercare and Recovery
Following the extraction, a blood clot must form in the empty socket for proper healing. Patients bite down on gauze for a specified time to stop bleeding and encourage clot formation. To protect the site, patients should eat only soft foods for several days and avoid anything hard, crunchy, or chewy.
Activities that could dislodge the blood clot must be avoided for the first 24 to 48 hours. This includes creating suction by drinking through a straw or spitting vigorously. Smoking is detrimental as it delays healing and significantly increases the risk of dry socket, a painful condition where the clot is lost, exposing the underlying bone.
Pain and swelling are managed using prescribed or over-the-counter anti-inflammatory medication. Applying an ice pack to the outside of the face is recommended for the first day. After the initial 24 hours, gentle rinsing with a warm salt water solution helps keep the area clean without disturbing the healing clot. Severe pain that worsens after a few days, or visible bone in the socket, signals a dry socket, requiring immediate contact with the dental provider.