Tooth Extractions

Tooth extractions, or the removal of one or more teeth, are usually used as a last resort in dentistry, as keeping the natural tooth in the mouth is ideal. There are many reasons why single or multiple extractions may be performed, including pervasive tooth decay, the impaction of wisdom teeth, or the need to create space for orthodontic devices.

The most significant short-term benefit associated with tooth extraction is the elimination of pain. If a tooth is severely decayed or an infection is present, removing the affected tooth almost immediately alleviates discomfort. However, it should be noted that further procedures are necessary to replace the extracted tooth. Leaving a gap is not a viable option as the other teeth tend to twist out of alignment to fill the space.

Why might I need to have a tooth extraction?

Tooth extractions are incredibly common procedures. It should be reiterated that an extraction is used as a procedure of last resort, when nothing more can be done to save the tooth.

Here is a brief overview of some of the main reasons for tooth extraction:

Deep decay – This is easily the most common reason for tooth extraction, accounting for around two-thirds of all extraction procedures performed. When decay affects the surface of the tooth as well as the pulp, root canal procedures cannot be performed. Root canal therapy is only viable where the general structure of the tooth is in stable condition.

Extra teeth –There are a variety of explanations associated with extra teeth, but most commonly they are baby teeth that do not shed. Extra teeth take up space on the arch, causing nearby teeth to twist out of place. A tooth extraction is necessary in this case to provide enough space for the teeth to properly realign.

Periodontal disease – Often teeth have to be extracted because the gums and underlying bone are so severely eroded that they can no longer hold the tooth in place securely. The cause of bone and gum recession is almost always advanced periodontal disease (gum disease). Poor bone density means that the chance of restoring the natural tooth is minimal.

Prior to braces – Traditional orthodontic braces require enough space to for the teeth to move into ideal alignment. If space cannot be created naturally, a tooth may be extracted as an alternative.

Fractured teeth – Fortunately, dentists are able to save injured teeth in most circumstances with the aid of root canal therapy. However, there are some instances where the tooth has become fractured in a way that makes repair impossible. Your oral health professional will remove the tooth and use a prosthetic replacement in most cases.

How is the extraction procedure performed?

Generally, tooth extraction can be simple in nature or involve more complex surgical processes. Simple extractions are performed on fully emerged teeth after applying local anesthetic to the treatment site. Instruments are used to elevate the tooth and then sever the periodontal ligament. The tooth is then carefully removed with dental forceps.

Surgical extractions are performed on teeth that are either invisible or inaccessible, like un-erupted wisdom teeth. An incision is usually made in the gum tissue and a drill is used to precisely remove some of the adjacent bone tissue. Sometimes, the tooth has to be split into several pieces to completely remove it.

If you have any questions or concerns about tooth extraction, please contact your oral health care provider.

Simple Tooth Extractions

If you are experiencing extreme sensitivity or are suffering from advanced periodontal disease, you may be required to have a tooth extracted.  With a simple extraction, the dentist can safely remove the affected tooth without the need for major surgery.

Reasons for a tooth extraction

There are numerous situations in which a simple extraction can help alleviate pain or prepare you for another cosmetic or restorative procedure.  Some common reasons for extraction include:

• Advanced periodontal disease that has loosened the tooth roots
• Extra teeth or baby teeth that impede adult teeth
• Preparing a patient for orthodontic treatment
• Removing a fractured or malformed tooth
• Severe tooth decay which cannot be remedied with root canal therapy

How is a tooth extracted?

As a precaution, the dentist will first take X-rays of the tooth or teeth in question, to help plan the procedure.  After preparing a method of extraction, you will be given a local anesthetic that will prevent you from feeling pain during the procedure.  Next, the dentist will use a tool called an elevator to lift the tooth and loosen ligaments and gum tissue around the base of the tooth.  Finally, the dentist will use a pair of forceps, to gently rock the tooth back and forth until it breaks free of the ligaments holding it in the gum tissue.  Occasionally, a stubborn tooth will resist the dentist’s soft tug, refusing to come out.  In these and more complex cases, the tooth may need to be broken up into smaller pieces for removal.

Once removed, we will pack gauze into the socket and have you place pressure on the area by biting down.  If necessary, the dentist will place stitches to close the socket.

If you are sick the week prior to your scheduled extraction or on the day of, please contact our office, as alternative arrangements may need to be made.  Please contact us if you have any questions or concerns.

Oral Pathology

An oral exam is routinely performed by the dentist during the course of an initial comprehensive exam and regular check-ups. An oral cancer exam refers to the identification and management of diseases pertaining to the maxillofacial and oral regions.

The soft tissue of the mouth is normally lined with mucosa, which is special type of skin that should appear smooth in texture and pink in color. Any alteration of the color or texture of the mucosa may signal the beginning of a pathologic process. These changes may occur on the face, neck, and areas of the mouth (e.g., gums, tongue, lips, etc.). The most serious of these pathologic changes (which may or may not be painful) is oral cancer, but there are also many other common pathologic problems.

Geographic Tongue – Also known as Benign Migratory Glossitis or Erythema Migrans, is a condition where the tongue is missing papillae (small bumps) in different areas, and a map-like appearance can develop. This condition is usually seen as red well defined areas on or around the sides of the tongue. The red patches (which can look like an unsightly rash) may come and go from hours to months at a time and cause increased sensitivity to certain substances.

Median Palatal Cyst – This cyst is of developmental origin and is essentially a fluid filled skin sac. It usually appears in the middle of the palate and may cause substantial discomfort.

Hairy Tongue – An overgrowth of bacteria or a yeast infection in the mouth which can cause the tongue to appear hairy and black. This condition is usually a result of poor oral hygiene, chronic or extensive use of antibiotics, or radiation treatments to the head or neck. It is often also seen in HIV positive patients and those who are intravenous drug users. Hairy Tongue may or may not require treatment.

Treatment of Pathological Diseases

In the majority of cases, the pathological changes experienced in the oral region are uncomfortable and disfiguring, but not life threatening. However, oral cancer is on the rise (especially among men) and the chances of survival are around 80% if an immediate diagnosis is made.

Oral cancer is a general term used when referring to any type of cancer affecting the tongue, jaw, and lower cheek area. Since it is impossible for the dentist to decisively diagnose a pathological disease without taking a biopsy sample of the affected area, seeking immediate treatment when changes are first noticed might be a life and death decision. For less serious problems, there are several options available, such as:

• Antibiotics – In the case of a bacterial infection or persistent soreness, the dentist may prescribe a dose of antibiotics to return the mucosa to its natural state. This will alleviate soreness and discomfort.
• Diluted Hydrogen Peroxide – When poor oral hygiene is causing changes to the soft tissue, the dentist may prescribe a diluted hydrogen peroxide mouthwash. This will kill more bacteria than regular mouthwash and improve halitosis (bad breath).
• Oral Surgery – If the patient has cysts or abnormal non-cancerous growths, the dentist may decide to completely remove them. This can improve comfort levels, alleviate breathing problems, and make speech substantially easier depending on the location of the cyst.

Oral Examinations

During the course of a regular check up, the dentist will thoroughly inspect the soft tissue of the mouth and take serious note of any changes. If there are cell changes present, the dentist will take a biopsy of the affected area and send it away to be analyzed by laboratory specialists. When definitive results are obtained, the dentist can decide on the best course of treatment.

Oral Cancer Screenings

An oral cancer screening is usually performed during a comprehensive or recall (check-up) exam. Screening is painless and only takes a few minutes. The dentist or hygienist will use a laser light to assess the soft tissue for cell changes that might be indicative of oral cancer. If such cell changes are present, a small biopsy will be taken and sent to a laboratory for review. If the biopsy indicates that oral cancer is present, an excision (removal) will generally be performed.

If you are experiencing any pain or symptoms that cause you concern, we encourage you to contact us today to schedule an appointment.

Wisdom Teeth Extractions

Third molars, commonly referred to as wisdom teeth, are usually the last four of 32 teeth to erupt (surface) in the mouth, generally making their appearance between the ages of 17 to 25. They are located at the back of the mouth (top and bottom), near the entrance to the throat. The term “wisdom” stems from the idea that the molars surface at a time typically associated with increased maturity or “wisdom”.

In most cases, inadequate space in the mouth does not allow the wisdom teeth to erupt properly and become fully functional. When this happens, the tooth can become impacted (stuck) in an undesirable or potentially harmful position. If left untreated, impacted wisdom teeth can contribute to infection, damage to other teeth, and possibly cysts or tumors.

There are several types, or degrees, of impaction based on the actual depth of the teeth within the jaw:

Soft Tissue Impaction: The upper portion of the tooth (the crown) has penetrated through the bone, but the gingiva (gum) is covering part or all of the tooth’s crown and has not positioned properly around the tooth. Because it is difficult to keep the area clean, food can become trapped below the gum and cause an infection and/or tooth decay, resulting in pain and swelling.

Partial Bony Impaction: The tooth has partially erupted, but a portion of the crown remains submerged below the gum and surrounding jawbone. Again, because it is difficult to keep the area clean, infection will commonly occur.

Complete Bony Impaction: The tooth is completely encased by jawbone. This will require more complex removal techniques.

Reasons to remove wisdom teeth

While not all wisdom teeth require removal, wisdom teeth extractions are most often performed because of an active problem such as pain, swelling, decay or infection, or as a preventative measure to avoid serious problems in the future. If impaction of one or more wisdom teeth is present, and left untreated, a number of potentially harmful outcomes can occur, including:

• Damage to nearby teeth: Second molars (the teeth directly in front of the wisdom teeth) can be adversely affected by impacted wisdom teeth, resulting in tooth decay (cavities), periodontal disease (gum disease) and possible bone loss.
• Disease: Although uncommon, cysts and tumors can occur in the areas surrounding impacted wisdom teeth.
• Infection: Bacteria and food can become trapped under the gum tissue, resulting in an infection. The infection can cause considerable pain and danger.
• Tooth Crowding: It has been theorized that impacted wisdom teeth can put pressure on other teeth and cause them to become misaligned (crowded or twisted). This theory isn’t universally accepted by all dental professionals, and it has never been validated by any scientific studies.

Wisdom teeth examination

As with any dental procedure, your dentist will want to initially conduct a thorough examination of the wisdom and surrounding teeth. Panoramic or digital X-rays will be taken in order for your dentist to evaluate the position of the wisdom teeth and determine if a current problem exists, or the likelihood of any potential future problems.  The X-rays can also expose additional risk factors, such as deterioration or decay of nearby teeth. Early evaluation and treatment (typically in the mid-teen years) is recommended in order to identify potential problems and to improve the results for patients requiring wisdom teeth extractions. Only after a thorough examination can your dentist provide you with the best options for your particular case.

What does the removal of wisdom teeth involve?

Wisdom teeth removal is a common procedure, generally performed under local anesthesia, intravenous (IV) sedation, or general anesthesia by a specially trained dentist in an office surgery suite. The surgery does not require an overnight stay, and you will be released with post-operative instructions and medication (if necessary), to help manage any swelling or discomfort.