All About Teeth Extraction

Reasons for Tooth to be extracted

There are several likely reasons why a tooth cannot be saved:

• The tooth is very loose and can be made to move by applying lip or tongue pressure to it.
• The crown of the tooth is decayed. The decay extends way below the gum line. It is no longer possible to fit an artificial crown.
• Chronic inflammation of the root tip is present. The usual endodontic/surgical procedures to treat the inflammation have not been successful in effecting a cure.
• Because of absence of an opposing or adjacent tooth, the tooth has lifted out of the gum; it is out of alignment or tilted extremely severely.
• The tooth must be removed as part of orthodontic treatment.

How is tooth extraction performed?

As a rule, teeth are extracted under local anaesthesia – in isolated cases, general anaesthesia is necessary. When the local anaesthetic has taken effect, the dentist will separate the gum from the tooth with a special instrument. He/She then grasps the tooth with a forceps and either pulls it from the jawbone using slow movements or raises it out of the socket with an elevator. If inflammation of surrounding tissues is present, the affected tissue will be removed. If the wound is large or if several neighboring teeth are extracted, gum tissue will be sutured over the wound. Bleeding can be stopped by biting on a wad of gauze for approximately 30 minutes in order to compress the bleeding areas. In addition to suturing the wound, under certain circumstances a special plate (splint) may be placed over the wound and left in place for a specific time in order to protect it. If necessary, materials to stop the bleeding (packing) will be placed in the wound.

Complications

As a rule, tooth extraction is easily tolerated. Severe problems that cannot be managed hardly ever occur. Nevertheless, complications can occur in isolated cases, which will then necessitate additional measures. How likely it is that these complications will occur will depend on your general health condition, your age, your lifestyle, and other factors which can affect the treatment. Complications can occur during and/or after the operation, for example:

·        General reaction: Change in blood pressure, the pulse rate or side-effects related to the nervous system (restlessness, seizures, breathing impairment) can occur in very rare cases due to the medications (e.g. local anaesthetic agent). These side-effects usually disappear by themselves without treatment

·        Injury to the mucosa the tongue, and rarely to the bony tissue can be caused by injections that are needed and the dental instruments. This type of injury is generally harmless and usually heals by itself. In very rare cases, the damage can result in infected pockets of tissue (abscess/needle track abscess) or it can lead to necrosis (death) of tissue.

·        Foreign bodies (e.g. instruments, extracted tooth) can be  swallowed or inhaled. If a foreign body is swallowed, monitoring the patient will generally be adequate. If the foreign body is inhaled, it must be removed by a specialist – usually with the aid of a bronchoscope.

·        Bleeding and post surgical bleeding can occur. As a rule, bleeding can be easily managed; it can be a serious complication in patients who have a clotting disorder or when medications to thin the blood are taken.

·        Infection rarely develops. This can lead to impairment of wound healing or to increased pain in the treated area. Treatment with antibiotics may be necessary.

·        Mild hypersensitivity to the anaesthetic agent or other medications is rare. This is manifested as skin rash, hives, or itching. Severe allergic reaction occurs extremely rarely. In the most unfavorable case, this reaction can be manifested by, for example, life threatening circulatory collapse and necessitates hospitalisation on an intensive care unit.

·        Part of the root can break off during extraction of the tooth. If the retained root cannot be grasped with a forceps, surgical removal will be necessary. Part of the bony wall may need to be removed.

·        A communication between the oral cavity and the maxillary sinus can be created when extracting the tooth because the roots of the upper molars are frequently separated from the maxillary sinus only by a thin bony partition; If this happens, the wound will be closed firmly by a special suture to avoid development of maxillary sinusitis.

·        Fracture of the mandible can occur when extracting certain teeth in the lower jaw if the location of the teeth is unfavorable. This complication will necessitate more extensive treatment.

·        Damage to the nerve of the lower jaw and tongue occurs in extremely rare cases, caused by the injection of anaesthetic agents or the procedure itself. This leads to a loss of sensation of the tongue and the lips which persists for a prolonged period. This condition usually goes away by itself.

Safe dental extraction can be done in 

Schön Dental by Drg. Henri Mudjono.