Whangarei Tooth Extractions
Why do I need an extraction?
Permanent teeth are meant to last throughout your life. With proper care, your natural teeth will give you a lifetime of service where you can enjoy eating, have a pleasing smile and a well balanced facial appearance. However, there are times when a tooth must be extracted.
Damage to a tooth beyond repair is one of the most common reasons a tooth must be extracted. Tooth decay that is left untreated can continue to destroy a healthy tooth to the point there is nothing left of the tooth to save. When decay reaches the pulp of the tooth (the nerve and blood vessel part of the tooth) the tooth will cause pain. If there is still sufficient tooth structure remaining, the tooth may be saved by treating it with a root canal and a crown.
Cracked teeth is another common reason extraction may become necessary. A tooth can become cracked by impact, such as an accident, or by over-stress through grinding and/or clenching. If a crack in a tooth extends below the gum line, the only solution is to extract the tooth.
Advanced gum disease is the most prevalent reason to extract a tooth. As bacteria that live on the root surfaces of teeth cause the supporting bone to recede, the stability of the tooth becomes compromised and there is no hope for retaining the tooth, which must then be removed. Keeping your teeth clean with proper home care and regular hygienist visits will control gum disease.
Wisdom teeth that are unable to completely grow into place (erupt) are usually extracted to avoid further complications to the jaw and surrounding teeth.
Over-crowding of teeth may require the removal of one or more teeth to make room for the remaining teeth. Sometimes an orthodontist will order teeth to be removed to allow the proper eruption of all permanent teeth.
Why are wisdom teeth removed?
Wisdom teeth, or third molars, are the last permanent teeth to erupt as we age. They usually start to appear between the age of 16-21 years. However, more and more people are born without sufficient room in their jaws for the complete eruption of wisdom teeth. If your jaw does have sufficient room for the normal eruption of wisdom teeth, then there is no reason to have them removed.
Without a place to grow normally, wisdom teeth erupt at an odd angle compared to the rest of the teeth and become trapped under the gums. An X-ray will help determine the growth pattern of wisdom teeth and your dentist can explain the likelihood of complications arising from their growth.
The most common issue arising from the incomplete eruption of wisdom teeth is pain. As the wisdom tooth peeks through the gum, a space exists around the rest of the tooth where bacteria live and cause infection. This usually occurs on bottom wisdom teeth and is amplified by the opposing upper wisdom tooth biting on the infected gums over the trapped wisdom tooth. The affliction can be treated with antibiotics for a short term solution, but the cycle will repeat itself until the wisdom tooth erupts normally or is extracted.
When wisdom teeth erupt at an angle which is not parallel to the rest of your teeth, the wisdom tooth will contact the tooth in front and be trapped below the gum line, otherwise known as impacted. It is impossible to clean around an impacted wisdom tooth where bacteria will cause decay and/or bone destruction on the tooth directly in front. Again, the only solution is to have the wisdom tooth extracted to preserve the tooth in front. If left unattended for long enough, then both teeth will be lost.
What complications arise from extractions?
There are several complications that can arise after a tooth is extracted. The most common side effect after a tooth is extracted is tenderness to the area and perhaps some swelling as the site begins to heal. This normally subsides after a day or two as the body starts to fill in the area where the tooth was extracted with bone and gum. The complete healing after a tooth is extracted can take several weeks as bone grows slowly.
If the tooth extracted was infected, then those healing symptoms can be worse and the healing will take longer. Usually, antibiotics are prescribed when an infected tooth is taken out to help the body fight off infection present around the tooth.
If you are taking blood thinners or other types of medication, prolonged bleeding after an extraction can occur. It is essential to let your dentist know all medications you are taking before any dental treatment! Sometimes your dentist will place stitches over an extraction site to help control bleeding. You will need to return to the office to have those stitches removed if the stitches placed are not self-resorbing.
Patients that use medications to treat osteoporosis, known as bisphosphonates, require special care for an extraction. Normal bone healing is disrupted while taking bisphosphonates and may involve hospital intervention to control complications from an extraction if you currently take or have previously taken bisphosphonates.
Severe swelling can occur after an extraction due to your body’s response to bacteria entering the blood stream. This rarely occurs under normal circumstances. Sometimes the infection and swelling requires hospital administered antibiotics in severe cases.
Lingering pain after a tooth is extracted can occur in some cases where patients aggravate the healing site by smoking, using a drinking straw, or dislodging the blood clot after the extraction.
Teeth extracted from the upper jaw can involve the bone that lies under the sinus cavity located near your cheek. If the roots of the tooth being extracted extend into the sinus area, there is a risk of either a root tip breaking into the sinus or an opening will be created between the mouth and sinus. Both of these complications will require further treatment to correct.
Why does it still hurt after my tooth is extracted?
It is normal for there to be some discomfort after a tooth is extracted. Having a tooth extracted involves disruption of the bone and gum holding the tooth in place, which causes trauma to the area. Usually, if you follow the post operative instructions after an extraction, the discomfort is minimal. If the discomfort worsens or lasts for more than a few days, further treatment may be necessary.
There are several factors that influence the amount of discomfort following a tooth extraction. These factors include the amount of infection present, the amount of manipulation done to remove the tooth, the pain threshold of the patient and the compliance of prescribed care after the extraction.
If infection was present before the extraction, the actual removal of the tooth causes the infection to spread to nearby tissues causing inflammation, which is the source of pain. Antibiotics and anti-inflammatories taken after a tooth is removed in the presence of infection will help control this effect and lessen any discomfort.
The removal of stubborn teeth or teeth that are impacted under the gum or bone require the removal of the surrounding tissues to extract the tooth. This causes trauma to the area which, in turn, causes pain afterwards. Unfortunately, the removal of surrounding tissues is unavoidable in most complicated circumstances, but taking anti-inflammatories after the procedure, such as paracetamol and/or ibuprofen, will help reduce discomfort. Also, some people are more sensitive than others, which will influence the amount of pain experienced after a tooth extraction.
Compliance of care after a tooth is extracted is the leading factor for controlling discomfort afterwards.
Be sure to take is easy for at least 24 hours after having a tooth pulled in order to keep your blood pressure down.
Avoid foods and drink that are really hot (like coffee or tea) or really cold (like ice cream or iced drinks) for the first 24 hours.
Be sure to keep the extraction site clean by GENTLY swishing the area with luke warm salt water 4-5 times a day for 5 days.
Most importantly, DO NOT smoke for at least 24 hours after a tooth is pulled to avoid losing the blood clot that forms in the extraction site, also known as dry socket.
Be sure to take your prescribed antibiotics, if any were given.
What is “dry socket”?
If you are experiencing pain 3-4 days after an extraction, you could have dry socket. When a tooth is removed, a blood clot is supposed to form in the site to protect the bone and gums while healing takes place. If this clot becomes dislodged, it leaves the bone and nerves exposed, which causes pain. Sometimes the pain is worse than before the tooth was removed.
If you notice a foul smell or can actually see the bone in the extraction site, then you are probably suffering from dry socket. The pain from dry socket usually develops within 3-4 days after the tooth is removed. Unexplained throbbing in the jaw is another symptom of dry socket.
The main purpose of proper care after extractions is to allow the blood clot that develops after the procedure to remain in place for at least five days. If you smoke or do strenuous activity after the procedure, the likelihood of dislodging or destroying the blood clot increases. Vigorous rinsing of the area can also dislodge the clot. Be sure to take precautions to avoid losing the blood clot after an extraction.
Treatment of a dry socket involves placing a special medicine directly in the extraction site by your dentist. The application of this medicine usually provides immediate relief. The medicine is usually contained in cotton fibres, like gauze, that will naturally fall out after a few days. Sometimes more than one application is necessary depending on the circumstances.