Extraction of Teeth

Extraction of teeth is the most common form of minor oral surgical procedure performed in the clinic. There are many indications for extraction of teeth. The most common indications are describd below:1. Fractured /carious/broken down teeth. Impacted painful third molars(wisdom teeth)-these are generally stuck in the jaw bone as they have inadequate space to erupt since they erupt at a later stage of life, generally 18-25 years. If a wisdom tooth does not have an opposing tooth or is embedded in bone, it generally is extracted surgically. (Disimpaction). If the tooth is partially erupted, has an opposing tooth, and has adequate space behind it for complete eruption, yet has a soft tissue or gum covering, a minor procedure called operculectomy is performed to remove the soft tissue and facilate eruption. At times, food and bacteria may get lodged beneath this gum tissue, or pouch called operculum, leading to pus formation , swelling(abscess) called pericoronalabscesss, which may be very painful and sometimes may lead to fever and swollen lymph nodes. In this case an abscess drainage is performed and antibiotics may have to be prescribed , following which a decision is made whether to save the tooth or to extract it.

Extraction of teeth for orthodontic reasons: Sometimes healthy teeth especially first or second premolars have to be extracted in cases of overcrowding, so as to make space and facilitate tooth movement.3. Extraction of impacted canines/overetained teeth: Teeth which are overretained, like deciduous teeth which do not exfoliate , or impacted(stuck in the jaw bones) canines have to be extracted, if they interfere with the normal occlusion .4. Atrauamtic extraction and socket preservation : Teeth which are diificult to retain, due to above mentioned reasons need to be extracted atraumatically using special instruments called periotomes, inorder to maintain the tooth socket intact.This is especially important when a dental implant is postulated as the line of treatment for replacement of the tooth after extraction. An adequate height, width and volume of bone of the ridge is required for a successful implant placement.

Extraction of Wisdom Teeth

It is thought that those teeth are called “wisdom teeth” because they appear in the mouth very late, much later than the other teeth, at an age where people have more wisdom than when they were children, when all the other teeth erupt.

Indications for Wisdom Teeth Extraction
There are several situations where dentists advise to extract wisdom teeth, whether following an infection, or to avoid future complications.

When the jaws are not wide enough to allow the wisdom teeth to erupt in an alignment that is useful for chewing.When the wisdom teeth are partially erupted, since this allows bacteria to penetrate around a tooth and cause an infection. Partially erupted teeth are also more susceptible to cavities and gum disease since they are more difficult to clean.A misalignment of the wisdom teeth can squish or damage the second molars since maintaining a good oral hygiene is difficult in this area, making these teeth more vulnerable to cavities and gum disease.To reduce the risk of cysts formation that can appear around an impacted tooth.The best time to extract wisdom teeth is at the end of adolescence, since the roots may not be completely formed, making the treatment less complicated.Sometimes a wisdom tooth does not come out completely, creating an extension of gum called an operculum. While eating and chewing on food, this operculum can be irritated and infected causing a pericoronitis. This condition has signs of redness, intense pain, a bad smell and a difficulty of opening the mouth.

If the operculum does not disappear, it is recommended to extract the wisdom tooth to prevent complications of the pericoronitis.

Under certain conditions, if the wisdom tooth has erupted, but an operculum is still present, it is possible to make an operculectomy, which means the removal of the extension of the gum without extracting the tooth.

Recovery during the First 24 Hours

Prolonged bleeding

The bleeding stops soon after the extraction, but some blood might seep out up to 48 hours after the procedure. The bleeding can be controlled by placing cotton gauze in the extraction area and by closing the mouth to create a pressure.A wet tea bag can also replace the cotton since the tannic acid that it contains helps the formation of blood clots. Spitting and rinsing should be avoided for the first 24 hours to not dislodge the blood clot and cause a dry socket.

Pain
There can be pain for a few days therefore pain killers that the dentist prescribes or recommends should be taken.

Swelling
After applying the ice for the first 24 hours, heat should be applied by using a hot and wet towel. The maximum swelling is reached after four days and decreases slowly after. If the extraction is complicated, there could be swelling of the face and even change of color of the skin. To reduce the swelling, a bag of ice should be placed on the face for ten minutes, every half hour.

Foods
Soft, lukewarm foods should be eaten during the first 24 hours. Hot drinks and alcoholic drinks should be avoided.

Hygiene
Brushing the teeth should be continued but the extraction site should be avoided.

Water and salt
Rinsing with warm water and salt should be started 24 hours after the procedure. Rinsing is recommended after each meal and before bedtime.

Stitches
Usually an appointment with the dentist is booked a week following the extraction of the wisdom teeth to verify the recovery and to remove the stitches. However, if the stitches are absorbable, they can fall out on their own after a few days.

Smoking
It is important to refrain from smoking during the 48 hours following a tooth extraction to avoid severe complications.The complete recovery takes three months. However, after one or two weeks, gums will heal enough to be able to comfortably use the mouth in the extraction area.Possible Complications.

Dry socket
Following the extraction of a tooth, a clot forms on the bone cavity. Sometimes, this clot is dislodged or takes more time to form, creating a condition called dry socket. This situation is characterized by intense pain, a bad taste in the mouth, and sometimes difficulty opening the mouth. It is emphasized by smoking. Dry socket is a temporary condition that lasts a few days and can be relieved by the placement of a dressing soaked in eugenol by a dental professional.

Paresthesia
Very rarely, during the extraction of a tooth, the nerve is touched, causing a loss of sensitivity that usually affects the tongue or the bottom teeth. The loss of sensitivity is rare, and generally temporary, though exceptionally could be
permanent.

Cleaning and polishing
Dental plaque needs to be removed with regular brushing, otherwise, once it becomes mineralised, a hard material knownas tartar (calculus) starts to build up. Tartar cannot be removed by brushing alone and requires expert dentaltreatment. It is also the perfect substrate for more plaque to accumulate and, if left untreated, can worsen cases of gingival inflammation causing swollen, bleeding gums.

Natural Tooth Colour Fillings
Tooth decay, in its early stages, is potentially reversible. However, once the organic makeup of the tooth enamel has been damaged, a cavity will develop. The subsequent decaying tissue must then be removed and the cavity filled.

Modern dentistry has come on leaps and bounds over the last decade and today we have a range of tough amalgam-freecomposite (white) fillings which match the shade of your tooth perfectly.Moreover,contemporary dental techniques meanthat highly retentive fillings can bond to the tooth with minimal cavity preparation and maximum tooth preservation. As a result, we keep drilling to a minimum.