Extractions (Simple / Surgical)

Tooth extraction – is the removal of teeth from the jaw bone. There are various reasons why a tooth is extracted. This is a simple procedure and most of it is performed using a local anaesthetic injection while the patient is awake to eliminate painful sensation. However, if on request or certain conditions a general anaesthetic can be utilized.

Indications For Extractions

Common reasons for extraction include:

Severe tooth decay or infection.

Extra teeth (supernumerary) which are blocking other teeth.

  • Severe gum disease with mobility of the teeth.
  • In preparation for orthodontic treatment (braces)
  • Fractured teeth
  • Malformed, supernumerary or supplemental teeth
  • Wisdom tooth impaction (insufficient space for last set of teeth to erupt)
  • For cosmetic reasons: teeth of poor appearance, unsuitable for restoration
  • Tooth in line of fracture of the jaw
  • Tooth fracture following root canal treatment
  • Receiving radiation therapy to the head and neck area may require extraction of teeth in the field of radiation
  • Tooth/teeth detrimental to the fit or appearance of denture

The removed tooth can be replaced with an implant, a denture, or a bridge

Wisdom Tooth Impaction

Wisdom teeth are the last molars on each side of the jaws. They are also the last teeth to emerge, or erupt, usually when a person is between 16 and 25.

Since wisdom teeth are the last permanent teeth to come in, or erupt, there is often not enough room left in the mouth to accommodate them. This can lead to wisdom teeth that are impacted.  An impacted wisdom tooth is a very common disorder and the primary reason they are extracted, because the teeth are trapped beneath the gum tissue by other teeth or bone. Wisdom teeth that only partially emerge or come in crooked can also lead to painful crowding, gum disease and or tooth decay of the adjacent tooth. Swelling and tenderness is a common feature.  There are various forms of presentation:

  • Mesioangular impaction – This is the most common form of impaction; when the tooth is angled forwards.
  • Horizontal impaction – This is the least common form of impaction; when the tooth is angled 90 degrees sideways.
  • Vertical impaction – When the tooth only partially erupts through the gums
  • Partial impaction – The wisdom tooth fails to fully erupt through the gums, forming a soft tissue flap around the tooth. This flap can be difficult to clean and is prone to decay.
  • Distoangular impaction – Where the tooth is angled backwards

These teeth are best removed before age 20 when the roots are not fully developed and fewer complications are expected. It is recommended that people between 16 and 19 have their wisdom teeth evaluated to see if they need to be removed.

Wisdom teeth extraction is commonly done by an oral and maxillofacial surgeon, who has specialized in treatments like this. The severity of the extraction can vary depending on how the tooth is positioned and how far along the roots have developed. In most cases the procedure is relatively simple and does not cause much pain. If the tooth has fully erupted through the gums it can be extracted as simply as any other tooth. However, when the tooth has only partially emerged or is underneath the gums your dentist will have to cut into the gums and remove the portion of the bone under the tooth.

Before removing the tooth, your dentist or surgeon will give you a local or general anesthesia to alleviate the pain. Once the area has been numbed your dentist can open the gum tissue over the tooth and remove any evidence of bone covering the tooth. Then the tissue that connects the tooth to the bone is separated and the tooth is removed. After the extraction many require stitches that generally dissolve over time.

After the procedure you might experience some pain, bleeding and inflammation, particularly within the first 24 hours. These symptoms will subside by themselves over time.

Procedure

A surgical extraction is a more complex procedure than routine tooth extraction. Your dentist or a dental specialist, called an oral surgeon, will recommend either “going to sleep” using general anesthesia, or numbing this area in your mouth with a local anesthetic to alleviate the pain. The severity of the extraction can vary depending on how the tooth is positioned and how far along the roots have developed. In most cases the procedure is relatively simple and does not cause much pain. If the tooth has fully erupted through the gums it can be extracted as simply as any other tooth. However, when the tooth has only partially emerged or is underneath the gums your dentist will have to cut into the gums and remove the portion of the bone over the tooth. Then the tissue that connects the tooth to the bone is separated and the tooth is removed. After the extraction many require stitches that generally dissolve over time.

After the tooth (or teeth) is removed, you will be asked to bite down softly on a piece of gauze for a few minutes, to limit any bleeding that may occur. Some pain and swelling may be expected but it will normally go away after a few days; however, you should call your dentist if you have prolonged or severe pain, swelling, bleeding or fever.

Removal of wisdom teeth due to crowding or impaction should not affect your bite or oral health in the future.