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Posted on 21st April 2017

What To Expect and What Can Go Wrong with Tooth Extraction

What is tooth extraction?

Tooth extraction is a dental procedure where an entire tooth is removed whole from your mouth.

It should always be done under some kind of anaesthetic, normally local. There are generally two types of extraction, surgical and non-surgical or simple. A surgical tooth extraction only happens on rare occasions.

When do you need a tooth extracted?

Teeth need to be removed because of damage, decay or overcrowding that cannot be solved by other methods, for example using a filling or crown to repair damage. The most common reasons according to Bupa are:

  • Severe tooth decay
  • Gum disease
  • An abscess
  • Crowded teeth
  • Impacted wisdom teeth

How long does tooth extraction take?

It really depends on the complexity of the procedure. It can take as little as fifteen minutes up to a couple of hours depending on the extent of the damage, the location of the tooth and the size of the tooth.

Surgical removal will always take at least an hour and a half, if not more. Your dentist should be able to give you an approximation of how long your appointment will take based on the specifics of your procedure.

Non-Surgical (Simple) Tooth Extraction: The Step-by-Step Process

The basic process:

1. The root portion of a tooth is firmly encased in bone (its socket), and tightly held in place by a ligament.

2. During the extraction process, they must both "expand the socket" (widen and enlarge it) and separate the tooth from its ligament.

3. After working toward this goal, a point is finally reached where the tooth is loose and free to come out.

You can view an animated example of the process here.

1. Numbing the tooth

This is when the anaesthetic is administered to numb the tooth and the gums that surround it. A dentist does this by injecting the anaesthetic into your gum. This bit can hurt a little, but is over very quickly - some patients don't feel any pain from it.

2. Expanding the socket

The dentist uses something called a dental elevator:

This tool is used to expand the socket. The elevator is wedged in the space in between the jaw bone and the tooth and twisted around this space. This loosens the tooth from its ligament and expands the socket.

As the movement continues the tooth becomes looser and looser. In some instances the tooth can be removed just using this tool. In other instances your dentist will need to remove the tooth using extraction forceps.

3. Removing the tooth

Your dentist will use extraction forceps:

These are used to remove the tooth. The dentist will use the forceps to rock the tooth back and forth to expand the socket further until it is enlarged enough for the tooth to come loose with little resistance. There are different types forceps used for different types of teeth.

4. Closing the extraction site

The dentist will close up the hole that has been left by your tooth. This can involve a number of different steps, for example:

  • Removing infected tissue by scrapping the walls of the tooth socket
  • Using their fingers to put pressure on the socket and compress it
  • Rounding off sharp bone edges
  • Washing out the socket to remove any loose bone or tooth fragments that remain
  • Placing materials in the socket to help blood clot
  • Placing gauze over the socket and asking you to bite down to create pressure and minimise bleeding

Noises, Pain and Aftercare

Pain

A tooth extraction should not be painful. The only possible painful part should be at the beginning when the dentist is injecting anaesthetic.

If you feel pain you should let your dentist know so they can give you more anaesthetic - the site of extraction should be entirely numb.

You will feel pressure, sometimes a lot of it - this is nothing to worry about and is totally normal.

Noise

You might hear some snapping or breaking noises during the process. In the vast majority of cases this is entirely normal - tooth extraction is a physically demanding process and the teeth and bones are susceptible to breakages.

Broken tooth roots

Sometimes your tooth roots can break during the process meaning the dentist will have to tease out the roots left behind. This can add time to the procedure.

Bone fractures

When pressure is applied to the tooth to loosen it up, the spongy bone surrounding it is compressed (in the "expanding the socket" step). The inner structure of the jawbone is spongy and will compress easily, but the outer surface is more brittle and can snap.

Most of the time this will be nothing more than a hairline fracture - a very minor fracture that will heal up at the same time as the rest of the extraction site with no problem.

Aftercare

The main things you'll be contending with are bleeding, swelling and numbness.

Your dentist might give you a gauze to cover your wound and help stem bleeding. Keep applying pressure to this over the next hour to minimise bleeding and help blood clot.

You should also be given a document detailing how you should care for your wound. If you have any further questions when you get home, call your dentist or check the Oral Health Foundation's list of questions.

The numbness in your mouth will wear off gradually, but may feel strange at first. This is entirely normal. Your speech may be slurred and you might find drinking difficult.

Your dentist will give you an ice pack if they think there is a risk of significant swelling. You can use an ice-pack at home as well to keep swelling down.

Surgical Tooth Extraction

When is a surgical tooth extraction necessary?

If you have an impacted wisdom tooth

This is when a tooth grows at a funny angle and looks a bit like this:

Source: https://www.shoredental.com.au/emergency-dental/wisdom-teeth/

If a tooth breaks during simple extraction and cannot be removed without surgery

These type of teeth are more likely to break:

  • Severely damaged tooth that will not be strong enough to remove using forceps (like a severely decayed tooth, for example)
  • A tooth that has undergone root canal

If the patient is likely to become too distressed during a simple extraction, so general anaesthetic is needed. This is common when a patient is a child, has learning difficulties or suffers from a severe phobia of the dentist.

Common negligence incidences:

As with all negligence cases, it is not enough that something goes wrong during tooth extraction, it must be proven that the dentist had a specific duty of care and failed in their duty of care.

Common incidences of negligence during tooth extraction include extracting the wrong teeth, not giving full warning of the risks involved during the procedure, and lack of care that can result in any of the following:

What can go wrong?

    • Dry socket, also known as osteitis, happens when the blood clot protecting the extraction site disappears. The bony walls of the tooth socket are then exposed, and become inflamed. It is a very painful condition and happens most commonly after wisdom teeth are extracted.

 

    • If you are taking a certain kind of medication know as bisphosphonate medication which is used to treat some cancers and osteoporosis then your dentist should advice you to stop taking the medication before your tooth is removed. This type of medication decreases blood circulation in the head and neck bones which can affect healing and make infection more likely.

 

    • If you have had radiation treatment on the head and neck you may be at risk of developing osteoradionecrosis after surgical tooth removal.

 

    • If your dentist does not arrange for your missing tooth to be replaced with an implant, bridge or denture your teeth can shift leading to improper alignment of upper and lower teeth. Eventually this can lead to cracked and chipped teeth that will require further treatment.

 

    • Nerve injury can occur. This can lead to permanent numbness, though this a rare occurrence.

 

    • If the upper back teeth are removed there is a risk that a hole may be opened in the maxillary sinus. This can be detected easily with an x-ray and is very treatable.

 

    • If surgical, the normal risks that are involved in going under general anaesthetic.

 

  • If non-surgical, the normal risks that are involved in going under local anaesthetic.

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