The Truth about Tooth Extraction
The thought of having a tooth - or sometimes a number of teeth - extracted or "pulled" is never pleasant. Consider this however: when a poor or hopeless prognosis (estimate of the likelihood of being able to maintain a status of health) is given to a tooth or teeth in your mouth, it is because the dental professional has considered all of the clinical information specific to this tooth or teeth and determined the tooth is more of a detriment to your health to keep in your mouth and may actually cause more harm to leave it.
When performing an examination of your teeth and gums, the dentist will:
-
evaluate pertinent radiographs,
-
determine if the remaining bone that holds the tooth in place is adequate,
-
check pocket depths around the tooth to see if you have deeper or infected gum pockets, and,
-
if there is presence of active infection that may have a risk of spreading, to name a few.
The old misconception and artistic renditions of a dentist yanking on a tooth with his foot on your chest or a string on a door handle attached to a tooth that needs to come out, are gross exaggerations of the past. These were likely based upon a select few individuals who had rare conditions of a tooth that was more difficult to remove. The fact is, these days tooth extraction is considered a minimally invasive procedure. Local anesthesia is always used, and, I would suggest even that anesthesia does not just lessen discomfort, it truly makes a localized area of your mouth numb so that there should not be any pain or discomfort at all. In fact, the only thing almost every patient feels when they are having dental work after having an anesthetizing injection is nothing more than pressure or pushing.
In regards to the other points of this article posted by the American Dental Association (ADA), the most important things a patient can do is make sure they understand the recommendation for treatment and the consent form which every patient is given for an extraction. If you do not understand something, your dentist will be more than happy to take the time to answer and address any concerns or questions you may have.
Be honest about your medical history and include any and all medications you previously have or currently take, whether or not you smoke, other health problems, etc...
Post-operative Care
Ice is crucial during the first 24 hours after an extraction. After the first 24 hours, only using heat is beneficial. Your body’s natural healing plug which closes the wound of an extraction socket, is a blood clot. Rinsing too aggressively or creating suction in the mouth can dislodge the blood clot that has formed. If it becomes dislodged and the bone underneath becomes exposed a condition of localized osteitis or "dry socket" can occur which is very painful and takes much time and effort to heal.
All post-operative instructions will be reviewed with you prior to leaving the office. You will also receive these instructions in written form, in case you have forgotten what we told you, to ensure the best and most optimal healing response.
Bone Grafts
I plan to discuss in a future blog about the importance of considering a bone graft. If you have a tooth or teeth removed, the bone will begin to resorb (To dissolve and assimilate such things as bone tissue.) in that area very quickly over the next few weeks. This can result in long term esthetic and functional changes, drifting of teeth, and other consequences that are permanent. The best time to consider a bone graft is either the same appointment as the tooth extraction or within a few weeks of the tooth extraction if there is serious infection present. A bone graft is important to preserve the jaw bone, especially if the patient may want an implant option in the future. This will be discussed in more detail in the future.
- Kevin R. Suzuki, DMD, MS