All About Tooth Extractions and What to Expect
Hello, Dr. Virginia Ellis here. Today, I am going to be talking about tooth extractions.
What is a tooth extraction?
As I just said, it's basically when a tooth is taken out of your mouth. We call extraction our technical word for getting it pulled. By the way, we don't yank or pull the teeth. We actually wiggle them very gently and take them out very well. It's not like what people think, "Oh, they yanked it out of me." We don't do that.
What are the reasons tooth extractions may be necessary?
Well, it could be multiple things. If you have a huge cavity and the tooth cannot be saved, or if you have advanced gum disease where the tooth is just about to come off, we have to take it out. If you have an infection or an impaction—an impaction is when your tooth is stuck underneath the gum line and the bone, and it's going to cause you problems—that's an impacted tooth. Sometimes you can grow a cyst or an infection, and then it has to be taken out. Those are the reasons.
What are the types of tooth extractions?
There is one called a simple tooth extraction. This is when we put lever force and go back and forth until the tooth eventually gets loose, and then we gently take it out.
The other one is called a surgical extraction. A surgical extraction is needed when you can't just wiggle or lever a tooth back and forth. You actually have to cut into the gum, cut into the bone, and take out the tooth, then put sutures. Sometimes you don't need sutures for a surgical extraction, but usually, you do. That's the main difference.
When would a dentist recommend a wisdom tooth extraction?
When they're causing problems or are going to cause problems. If you have wisdom teeth that are stuck, you can't clean them, and they're partially out, you may come in with horrible gum inflammation in the back. That happens. You chop food, and no matter how hard you try to clean, you need to take those teeth out.
Or if they're underneath the gum line, sometimes people leave them there. I just recently had a person who grew a carcinogenic cyst—a cyst that was turning into cancer—because he didn't take his wisdom teeth out. Sometimes you can get a complication.
A rule of thumb is if you have impacted teeth, you should get a panoramic X-ray, the rectangular X-ray that checks around your wisdom teeth, once every two years. The X-rays we normally take in the office with the little sensors don't usually capture or reach the wisdom teeth because they can be far back.
When would braces require tooth extraction?
Doctors tend to be very conservative when it comes to that, but it's really when you don't have enough space. If the orthodontist says, "I can't get enough space to straighten the teeth, and we need to fix your bite," they'll recommend an extraction. It's when there's not enough space to straighten the teeth or achieve a correct bite. You can have straight teeth, but your bite can be off. We want to ensure the bite is spot-on from a functional point of view and that your teeth are also straight. It's not just about looks.
Is tooth extraction advisable for young children?
It depends. Usually, if a child comes in with cavities and they're really young, like 3 years old, we will try certain methods like sodium diamine fluoride to slow the growth of the cavity until they're a little older, and then we'll do the fillings. It depends. If a kid comes in with an abscess, infection, and pain, the tooth's got to come out. Then we'll either refer them or they'll have to go into hospital dentistry to get numbed up. You usually have to put a child under general anesthesia or IV sedation for that. We try to hold off as much as possible unless it's really necessary.
If I have gum disease, when would tooth extraction become necessary?
That's when the gum disease is spreading and affecting other parts of your mouth or other teeth. That's when we recommend taking out a tooth due to advanced gum disease.
Are all tooth extractions considered oral surgery?
No, they're not. Simple extractions, where we gently take the tooth out, are not considered oral surgery. It's only when you have to cut into the gums, cut into the bone sockets, and usually put sutures that it's considered oral surgery.
What is the difference between simple and surgical tooth removal?
I just explained it. Simple is to gently take the tooth out. Surgical requires cutting the gums, bone socket, taking the tooth out, sometimes in pieces, and putting sutures or stitches. That's surgical.
Where should I go if I need an emergency tooth extraction?
The best place is to call us because we can evaluate the tooth and send you to an oral surgeon if necessary. If it's really complicated, sometimes you need to be numbed up and under IV sedation, especially if you're very infected and your face is swelling, which endangers closing your airway.
At that point, you would need IV sedation or general anesthesia because a shot alone won't take care of the pain for a comfortable extraction. So, basically, call us or the oral surgeon. You can go to the emergency room; sometimes they have an on-call oral surgeon, but it's best to have it looked at by a dentist.
Don't wait until your checkup. Sometimes accidents happen, and you need to go to the emergency room, but it's better to keep up with your dental work. That way, we catch things early. It's highly recommended to do the work when advised. Don't wait until it becomes an emergency because it will likely happen when you're going on vacation, getting married, having a job interview, or when your spouse is out and you have no childcare, on a weekend, or when specialists are out on a holiday.
So, make sure you follow up with recommended dental care and see your dentist at least twice a year.
How long does a tooth extraction procedure take?
It depends on the complexity of your case. I would say 20 minutes for a simple extraction, including numbing, taking it out, controlling the bleeding, and giving home care instructions. We call these post-operative instructions. Sometimes it could take up to two hours. If you don't have controlled bleeding, are on blood thinners, or had an accident, it will take longer. If you have an impacted tooth next to your eyeball, it will take longer than one that's already outside. It depends, and you can find out at your consultation.
Will I need dental implants after a tooth extraction?
Well, yes and no. Sometimes you do. Most of the time, if it's between your teeth towards the front, you'll need one. You don't want to walk around without a front tooth. If you're missing a first or second molar, which helps a lot in chewing food like bread and meat, you'll likely need one. Unless it's a rear tooth where the bite won't be impacted, an implant or something to replace the missing tooth is usually necessary.
Should one avoid rinsing after getting a tooth extraction?
Yes, I would say avoid rinsing for two or three days. While the area is healing, a blood clot forms a little milky beige coat around the tooth, similar to a scab. You don't want to dislodge that because if you do, you'll bleed and expose the bone underneath, which hurts.
What is a dry socket, and how can I avoid it after a tooth extraction?
A dry socket is a situation where a blood clot didn't form, or you dislodged it with harsh or hard food, sucking, spitting, or brushing too hard. This exposes the bone and nerves and is quite painful. If that happens, call us, and we can apply medicine to help it feel better. To avoid it, don't suck or spit. Avoid anything that moves the soft blood clot in your mouth. That's how you avoid it. Key advice there.
How long should I wait to exercise after a tooth extraction?
It really depends. I recently had a teenager whose tooth I extracted, and the orthodontist recommended taking the tooth out. The bleeding was controlled, so she could jump in the pool right away. In many cases, you should wait two or three days, sometimes even a week.
If you get your wisdom teeth extracted, you're not exercising for at least four or five days, especially if your teeth are impacted. There's a lot of swelling, and you don't want to dislodge the blood clot by heavy breathing or lifting.
How long should it take to recover from a tooth extraction?
Complete healing usually takes about 6 weeks for most people, anywhere between 6 and 10 weeks. It takes about 6 weeks for the bone to build over. If you have a bone graft, it takes about 3 months for it to settle in and become stable. You're looking for stability. It depends on the case, so ask your dentist. They'll let you know because every person's case is different.
When should I schedule an appointment for a tooth extraction?
As soon as your dentist recommends it, don't wait. Especially with wisdom teeth, the lower wisdom teeth in particular. If you wait too long, the roots may grow close to a long nerve, increasing the risk of nerve damage. In such cases, those teeth have to stay. But that's only if you wait. To avoid pain and complications, don't wait. When we tell you to do it, just take it out. Otherwise, you risk unnecessary pain and infection. We have your best care in mind and are looking out for you.
At Virginia H. Ellis, DDS Dental Corp., your dental health is our priority. If you have any questions, don't hesitate to call our team at (925) 272-2698, or you can email us at [email protected]. Our staff would love to talk with you!