Tooth Extraction: When It's Necessary and What to Expect

While permanent teeth are designed to last a lifetime, various circumstances can necessitate their extraction. One primary reason is severe damage from trauma or decay that renders a tooth irreparable. Beyond this, dental professionals may recommend extraction due to a crowded mouth, often in preparation for orthodontic treatment to properly align teeth. If a tooth is impacted and cannot erupt due to insufficient space, removal may also be advised. Infections pose another significant reason for extraction. When decay or damage reaches the pulp—the tooth's core containing nerves and blood vessels—bacteria can lead to severe infection. While root canal therapy (RCT) often resolves this, if the infection is too advanced or doesn't respond to treatment, extraction might be necessary to prevent its spread. For individuals with compromised immune systems, such as those undergoing chemotherapy or organ transplants, even the risk of infection in a particular tooth can warrant extraction. Furthermore, advanced periodontal (gum) disease, which weakens the tissues and bones supporting teeth, can cause them to loosen, leading to the need for removal. Tooth extractions are performed by dentists or oral surgeons. The procedure typically begins with a local anesthetic to numb the area. In some cases, a general anesthetic may be used, inducing sleep throughout the procedure. If the tooth is impacted, the dentist will make an incision in the gum and bone tissue covering the tooth. Forceps are then used to gently rock the tooth back and forth, loosening it from the jawbone and ligaments. Occasionally, a tooth may need to be removed in pieces. After extraction, a blood clot forms in the socket. The dentist will place a gauze pad for biting down to control bleeding and may use self-dissolving stitches to close the gum edges. A common complication is "dry socket," a painful condition where the blood clot dislodges, exposing the bone. This is treated with a sedative dressing. Before an extraction, it's crucial to provide your dentist with a complete medical history, including all medications and supplements. This is because the procedure can introduce bacteria into the bloodstream, posing a risk of infection, especially for individuals with compromised health. Patients with conditions such as damaged heart valves, congenital heart defects, impaired immune systems, liver disease, artificial joints, or a history of bacterial endocarditis may require antibiotics before and after the extraction to mitigate infection risks. Post-extraction recovery typically spans a few days. To minimize discomfort and promote healing, follow these guidelines: Take prescribed pain relievers, firmly bite on the gauze pad for 3-4 hours, and apply an ice pack to the affected area for 10-minute intervals. Rest for at least 24 hours and limit strenuous activity for the next day or two. Avoid forceful rinsing or spitting for 24 hours to prevent dislodging the blood clot. After 24 hours, rinse with a warm saltwater solution (1/2 teaspoon salt in 8 ounces of water). Do not use straws or smoke, as these can impede healing. Stick to soft foods initially, gradually reintroducing solids. When lying down, elevate your head with pillows to reduce bleeding. Continue regular oral hygiene, carefully avoiding the extraction site. While some pain, swelling, and minor bleeding are normal within the first 24 hours, contact your dentist if severe bleeding or pain persists beyond four hours. Other reasons to call include signs of infection (fever, chills, redness, excessive discharge), nausea, vomiting, cough, shortness of breath, or chest pain. The initial healing period usually takes one to two weeks, with new bone and gum tissue filling the gap. However, missing teeth can cause remaining teeth to shift, affecting your bite and chewing. Your dentist may recommend replacing missing teeth with an implant, fixed bridge, or denture to address this.