Tooth extraction

Tooth extraction is the removal of a tooth from its socket in the bone. Extraction is performed for positional, structural, or economic reasons. Teeth areoften removed because they are impacted. Teeth become impacted when they areprevented from growing into their normal position in the mouth by gum tissue, bone, or other teeth. Impaction is a common reason for the extraction of wisdom teeth. Extraction is the only known method that will prevent further problems. Teeth may also be extracted to make more room in the mouth prior to straightening the remaining teeth (orthodontic treatment), or because they areso badly positioned that straightening is impossible. Extraction may be usedto remove teeth that are so badly decayed or broken that they cannot be restored. In addition, patients sometimes choose extraction as a less expensive alternative to filling or placing a crown on a severely decayed tooth.

Tooth extraction can be performed with local anesthesia if the tooth is exposed and appears to be easily removable in one piece. An instrument called an elevator is used to loosen (luxate) the tooth, widen the space in the bone, and break the tiny elastic fibers that attach the tooth to the bone. Once the tooth is dislocated from the bone, it can be lifted and removed with forceps.

If the extraction is likely to be difficult, the dentist may refer the patient to an oral surgeon. Oral surgeons are specialists who are trained to give nitrous oxide, an intravenous sedative, or a general anesthetic to relieve pain. Extracting an impacted tooth or a tooth with curved roots typically requires cutting through gum tissue to expose the tooth. It may also require removing portions of bone to free the tooth. Some teeth must be cut and removed insections. The extraction site may or may not require one or more stitches toclose the cut (incision).

Before an extraction, the dentist will take the patient's medical history, noting allergies and prescription medications. A dental history is also taken,with particular attention to previous extractions and reactions to anesthetics. The dentist may then prescribe antibiotics or recommend stopping certain medications prior to the extraction. The tooth is x-rayed to determine its full shape and position, especially if it is impacted.

If the patient is going to have deep anesthesia, he or she should wear looseclothing with sleeves that are easily rolled up to allow for an intravenous line. The patient should not eat or drink anything for at least six hours before the procedure. Arrangements should be made for a friend or relative to drive the patient home after the surgery.

An important aspect of aftercare is encouraging a clot to form at the extraction site. The patient should put pressure on the area by biting gently on a roll or wad of gauze for several hours after surgery. Once the clot is formed,it should not be disturbed. The patient should not rinse, spit, drink with astraw, or smoke for at least 24 hours after the extraction and preferably longer. Vigorous exercise should not be done for the first three to five days.

For the first two days after the procedure, the patient should drink liquidswithout using a straw, and eat soft foods. Any chewing must be done on the side away from the extraction site. Hard or sticky foods should be avoided. Themouth may be gently cleaned with a toothbrush, but the extraction area should not be scrubbed. Wrapped ice packs can be applied to reduce facial swelling. Swelling is a normal part of the healing process. It is most noticeable inthe first 48-72 hours. As the swelling subsides, the patient may experience muscle stiffness. Moist heat and gentle exercise will restore jaw movement. The dentist may prescribe medications to relieve the postoperative pain.

Potential complications of tooth extraction include postoperative infection,temporary numbness from nerve irritation, jaw fracture, and jaw joint pain. An additional complication is called dry socket. When a blood clot does not properly form in the empty tooth socket, the bone beneath the socket is painfully exposed to air and food, and the extraction site heals more slowly.

After an extraction, the wound usually closes in about two weeks. It takes three to six months for the bone and soft tissue to be restructured. Complications such as infection or dry socket may prolong the healing time.

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