Tooth extraction

By painless tooth extraction we mean surgery under anesthesia to remove an affected tooth, which causes and maintains local, loco-regional and general pathological processes that cannot be resolved by conservative therapies.

Before making the decision to perform a tooth extraction, the dentist will discuss with the patient all existing options to save the tooth.

If the tooth cannot be saved, the dentist will also present the patient with solutions for post-extraction prosthetics of the resulting edentulous gap:

• dentures

• dental bridges

• dental implants

Therefore, a dental extraction is performed only if the condition cannot be cured by other therapeutic options.

Dental extraction is indicated when:

• The carious lesion has affected the tooth up to below the alveolar ridge.

• The tooth has a high degree of mobility and is affected by periodontal disease

• When root canal treatments have not given the desired results

• There is a granuloma and there is no therapeutic alternative to remove it

• The infection has affected a large part of the tooth and bone stock

• Teeth are crowded

• There are teeth preventing eruption of other teeth

• Tooth extractions are necessary for the application of orthodontic appliances, thus making room for teeth to be straightened

• There are impacted teeth (often wisdom molars), due to a developmental blockage. They allow bacteria to penetrate the jawbone, causing infections with serious repercussions.

Tooth extraction is NOT indicated:

• Pregnant women, in the first and third trimester of pregnancy, not indicated as it may affect pregnancy, even leading to miscarriage

• Patients who have suffered a myocardial infarction in the last 6 months.

• Patients with a weakened immune system, patients undergoing cytostatic treatments, immunosuppressive drugs, radiotherapy

• Patients with clotting disorders or taking anticoagulants, unless we have prior agreement from the hematologist.

A tooth extraction can be simple, when the tooth is erupted into the oral cavity, or surgical tooth extraction, when the tooth is not yet erupted or does not have an easy degree of access into the oral cavity.

When laborious extractions of consecutive dental units are performed, alveoloplasty is recommended, thus also shaping the alveolar bone.

Sometimes it is necessary to perform alveolectomy, making surgical incisions in the dental alveoli.

Before choosing this therapeutic procedure, the dentist will take into account certain aspects that may influence the success and difficulty of the extraction:

• increased tooth mobility due to periodontitis

• alveolar bone mass

• the configuration and number of roots (extraction becomes more difficult the more roots the tooth has, the more divergent they are and the further apart they are)

• the level of hypercementosis, which is higher in the elderly

• proximity of the roots to the maxillary sinuses or mandibular canal

Simple extractions are most often performed by dentists.

The patient is anesthetized locally, so he will not feel pain but only a slight pressure.

With a syndesmotome or elevator inserted between the tooth and the gum, the dental ligaments are torn, facilitating the extraction of the tooth with the forceps through increasingly large rocking movements, which widen the tooth socket.

After the tooth is extracted, the alveolus is patched if the tooth had infection and the wound is sutured or the wound edges are tightened and compresses are applied until the bleeding has stopped completely.

After tooth extraction is recommended:

• keep compresses on for 2 hours

• during the first 24 hours do not suck from the extraction site and do not use the straw to drink liquids

• for pain relief, after the anesthesia loses its effect, take the medication prescribed by the dentist.

• eat soft foods

• do not touch the extraction site with your tongue

• brush your teeth carefully in the extraction area

• do not smoke

• avoid dairy or acidic drinks

Post-extraction swelling and bleeding

Tooth extraction is a radical, surgical operation that is performed when a tooth can no longer be preserved in the dental arches.

The reasons why teeth need to be extracted are manifold and range from severe trauma, complicated carious processes extending subgingival to extraction for orthodontic purposes.

Regardless of the reasons why teeth are extracted, accidents may occur during the operation and complications may occur post-extraction.

Some of these events can be prevented by strict adherence to the indications for extraction, the instruments used and the techniques applied.

The vast majority of dental extractions are accompanied by the following signs:

Swelling of the region – especially in the case of complicated extractions that also require significant bone sacrifice, swelling is likely to occur in the region of intervention.

This will set in fairly quickly post-extraction and will peak three days after the operation.

Starting on the fourth day, the swelling will gradually reduce.

It is advisable to apply cold water compresses to the tegument immediately post-extraction, which should be kept for a maximum of half an hour. From the fourth day, when the swelling begins to recede, the compresses may be at room temperature.

Pain – is almost ubiquitous following dental extraction. Even if the extraction is an atraumatic one, easy to perform, pain is a frequently occurring symptom.

To reduce the intensity of the pain, it is recommended to take painkillers, if necessary, with a maximum of 2 grams per day.

On the other hand, if extractions have been laborious and the doctor has had to use more pressure intraoperatively, the strain on the surrounding tissues leads to increased postoperative pain.

Pain can also occur in relation to alveolitis, an extremely painful inflammatory condition that develops in relation to a postoperative infection, which only manifests itself 3-4 days after the extraction.

The nature of the pain is excruciating, acute, strong, which brings the patient urgently back to the dentist. Treatment of this condition is symptomatic, cleaning the alveolus, irrigation with antiseptic solutions and general administration of anti-inflammatory and analgesic drugs.

Bleeding normally occurs during and after extractions due to the rupture of the vascular bundle of the tooth in question.

It is normal to have bleeding after tooth extractions lasting 10-15 minutes.

However, bleeding that persists longer than this is already a sign that an imbalance has occurred.

For example, if after extraction of a tooth with apical pathology the remaining granulation tissue has not been cleaned very well, the bleeding persists.

On the other hand, if root remnants or irregularly shaped, cracked bone chips remain, they will traumatize the alveolus, prevent clot formation and this will lead to prolonged bleeding with a high risk of superinfection.

The patient should be aware that these events occur frequently following dental extractions. However, by following the indications, the time needed for the oral structures to heal will be shorter.

Many patients use the term dental extraction. In medical language the term tooth extraction or root extraction has become established.

Square root extraction is a mathematical expression with a completely different meaning than the medical one.