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Dental Extractions - A Tooth Saying Good-Bye

By Puja

Dental Extraction

The term itself can cause discomfort to many people. Even though dentistry today has enhanced its focus on preservation of teeth and associated structures rather than its removal, there may be a time when the removal of tooth will prove to be beneficial in the long run.

With advancements in technology and improved effectiveness of anesthesia, dental extractions have become a pain free experience with good recovery rates. Dental clinics and hospitals today focus on making the patient as comfortable as possible before any minor oral surgical procedure and maintain a positive and calm environment throughout the procedure.

If you are scheduled for a dental extraction and wish to know more, this article is for you...

When is a Tooth Extraction Needed?

  • When the affected tooth is decayed beyond salvage.
  • To remove impacted teeth (mostly canines and wisdom teeth)
  • The tooth is affected with a very severe infection like an abscess, cellulitis, etc.
  • Broken or fractured teeth which cannot be saved with the help of endodontic (root canal or something similar) treatment.
  • Highly mobile teeth affected by severe gum disease and bone loss have to be removed
  • To allow for eruption of permanent teeth, when the milk teeth have become an impedance in the path of the former.
  • Supplemental or supernumerary teeth may have to be removed in cases they have erupted in an unnatural position, are infected or are hindering cosmetic appearance.
  • As part of orthodontic therapy in order to create more space for realigning crooked teeth.
  • The tooth/teeth can be removed electively if there is a need to fabricate a removable or fixed dental prosthesis (complete/partial denture).
  • When wisdom teeth become infected. This can be a consequence of a grossly decayed tooth, or when plaque and food begin to accumulate beneath the gums surrounding the wisdom tooth causing a condition called pericoronitis.
  • If you are planning for dental implants then an empty space is needed before they are placed inside the mouth.
  • When the jaw is fractured in such a way that the tooth along the line of fracture cannot remain stable in its position and be a source for more infections.
  • Tooth embedded inside or associated with a cystic lesion needs to be taken out if it cannot be guided along its natural path of eruption.
  • Before any radiation therapy is planned for the head and neck region, it is advisable to have the tooth in line of fire from radiation therapy to be removed. This is done to prevent the occurrence of osteoradionecrosis (death of bone due to radiation).

 

 

When is a Tooth NOT Extracted?

Though there are situations when having your tooth taken out may actually not be a feasible option, most of them are relative instead of absolute. Take a look -

Inflammation

If the area around the affected tooth is inflamed to quite an extent, your dental surgeon may want to delay the procedure till the inflammation is under control. You may be given some medicines to help you with this.

Chemotherapy and Radiation Therapy

This is a delicate time when the patient is on some tough treatment modalities which make the immunity weak in general. Radiation therapy even contributes to xerostomia, or dry mouth, which again makes the mouth vulnerable to oral infections and caries. Any dental extraction performed during such a time may just aggravate the ongoing condition by causing tissue death.

This is the reason why it is advisable to have any dental treatment performed some weeks before radiation therapy or chemotherapy is planned.

Blood Disorders

Conditions which affect the bleeding and clotting times of blood are a serious factor which should be taken into consideration before an extraction is planned. Bleeding needs to stop within a reasonable time frame after the extraction has been performed in order to help with healing of the extraction socket.

If such a health condition exists, you may need to consult with your hematologist or medical specialist before going ahead with the procedure.

Uncontrolled Diabetes

Fasting blood sugar levels above 200mg/dl is a strong indicator of uncontrolled diabetes. The presence of this disease impairs the capacity of a healthy wound healing which can again create grounds for a new infection. But this being a temporary contraindication, if the blood sugar levels can be brought down, extraction would not be much of a hassle.

Hypertension

High blood pressure or hypertension is when the normal blood pressure is above 139 mmHg systolic. If not controlled, it can create problems during the procedure and put the patient at risk of uncontrolled bleeding. Anti-hypertensive drugs like calcium channel blockers have a tendency to cause enlargement of gums, which can again create problems in delivering appropriate treatment.

Epilepsy

The uncontrolled discharge of nerve signals are responsible for creating a condition known as epilepsy. This results in seizures characterized by jerky movements, loss of consciousness and loss of immediate memory. Since an epileptic attack often occurs unannounced, it is often a cause of concern for the dentist.

Thus before any dental procedure is planned in a patient, it is advised to take a certificate of clearance from your medical specialist and a plan of medications to be taken at the time of procedure. This helps in resolving most of the untoward complications.

Cardiac Problems

Heart problems are a delicate issue which is needed to be handled very carefully, since there is always the risk of aggravating the present heart condition. Before any dental treatment is initiated, you need to discuss your health condition in as much detail as possible with your dentist. Different heart conditions need to be dealt with in a different manner, be it angina, heart attack, infective endocarditis and dysrhythmia.

If you have a heart condition, it is best to have your appointments short and preferably scheduled in morning hours.

Pregnancy

When a woman is pregnant, it is not one, but two lives which have to be considered before planning any dental procedure. There are a lot of factors to be thought of, like radiation exposure, dosage and the type of drugs to be used and their impact on the foetus. But research has proven that dental extractions can be performed easily and without any hassles at any time of pregnancy, well except the last trimester, since sitting comfortably can be quite a challenge at that time.

The 2nd trimester of pregnancy is often a safe period and is considered best for all dental treatments. But in the case of a serious dental emergency, it is best to go ahead for the treatment and avoid any further harm.

Thyrotoxicosis

This is a condition where there is too much of thyroid hormones inside the body. It is accompanied by symptoms like anxiety, unnatural weight loss, irregular heartbeat, increased intolerance to heat, weakness, irritability and many more constitutional symptoms.

A dental extraction, like any other surgical procedure is often deemed 'stressful' by many people which can again increase the chances of stress on the body. This stress then again begins a cascade of events which ultimately result in the onset of a thyroid crisis.

Thus, it is important to let your dentist know about your medical condition, along with the medications being taken for the same. Emergency medical services can then be kept on standby for a ready response in case signs of impending thyroid complications are seen.

How is a Dental Extraction performed?

  • Before any extraction procedure, your dentist would need to perform a thorough evaluation of your present dental health. This involves a complete examination of the oral cavity, radiograph of the affected tooth and an OPG (orthpantomography – panoramic X-Ray of the jaws) in some cases. Many diagnostic centers offer radiography and other imaging services for this purpose.
  • To reduce the risk of bacterial infection during and after the procedure, you may be given a dose of antibiotics and painkillers to reduce your pain.
  • If you are suffering from a pre-existing medical condition or are on certain medications, your dental surgeon may ask you to get a written clarification from your general physician regarding your fitness for extraction.
  • Once all the tests are clear, you will be given a date for the procedure. All dental extractions are done under a local anesthetic which does not let you feel any pain while the tooth is being taken out.
  • You will feel some heaviness on the side of injection along with numbness. Using special instruments, the dental surgeon will remove the tooth using gentle movements.
  • Because of the anesthetic solution used, you will not be able to feel any pain, but it is completely normal to feel some sort of pressure during the procedure.
  • In instances when it is difficult to remove the tooth with routine methods, there may be a need to perform it surgically, with the help of incisions and raising a flap.
  • Once the tooth is removed completely, the extraction site is closed with the help of stitches (sutures) and a cotton pellet. You will have to keep the pellet in place for at least an hour before the bleeding stops.

Any Post – Operative Care to be Taken?

  • On day 0, or the day when the tooth is removed, eat soft, liquid food preferably at room temperature. In fact, this is the best time to relish your favorite ice cream since this helps to slow down the flow of blood in the extraction site.
  • The next day post – extraction, use warm saline rinses at least twice a day for the next seven days.
  • Avoid eating any hot and spicy food for the same time period.
  • If there are any stitches in that region, you can visit your dental surgeon and have them removed after 7 – 10 days depending on the extent of incision given.
  • Any Complications of Dental Extractions to Worry About?
  • Like any routine surgical procedure, a dental extraction too has its own set of risks and complications, some of them being:

Uncontrolled Bleeding

This can be immediate or happen a few days after the procedure. In any situation, visit your dentist as soon as possible to have it controlled.

Dry Socket

Also known as alveolar osteitis, a dry socket happens when the extraction site does not heal properly and leaves an exposed area of bone. This situation is very painful and a major cause of discomfort to the patient. But it can be managed with the help of a therapeutic dressing and a short course of medicines.

Delayed Wound Healing

This is most often a consequence of any infection left after the tooth has been taken out. In some cases, the flap may not have been able to hold the wound properly because of which the healing takes time longer than usual to become its normal self.

Apart from local causes, generalized factors like poor immunity, use of immunosuppresants, dietary deficiencies and treatments like radiotherapy also delay wound healing.

Dental extractions, or exodontia procedures are among the routinely performed dental treatments. Utmost care is taken to execute these minor surgical procedures in a way which is uneventful and with minimal complications.

With the best level of sterilization and professional care in dental hospitals, a happy smile is a beautifully possible reality.

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