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Tooth Sensitivity
When it comes to dental procedures, tooth extraction — or having teeth “pulled” — is among patients’ most dreaded prospects. Also referred to as exodontia, tooth extraction involves removing a tooth from its socket in the jaw bone. Before your dentist considers extraction, every effort will be made to try to repair and restore your tooth. However, sometimes it’s necessary.
Wisdom teeth removal is one of the more common categories of tooth extraction. Many dental professionals will recommend removing wisdom teeth (third molars) before they are fully developed — usually in the adolescent years — to help eliminate potential problems. One problem that could occur is development of an impacted tooth that has surfaced and has no room in the mouth to grow. Other problems associated with impacted teeth include infection, decay of adjacent teeth, bite interference and gum disease.
Extractions of some permanent teeth that have not erupted — such as the canines, which are also known as fangs or eye teeth — may be required in order to make space for orthodontic treatment.
Prior to a extraction, your dentist or oral surgeon will discuss your medical and dental histories and take X-rays. Some dental professionals will prescribe antibiotics to be taken before and after surgery. Antibiotics are more likely to be given to patients with infection or weakened immune systems at the time of surgery, those undergoing longer surgeries, or young or elderly people.
To avoid possible complications, inform your dentist about all the medications — prescriptions, over-the-counter (OTC) and herbal — you are taking. For example, aspirin slows the blood-clotting process; gingko biloba and ginseng also affect clotting.
Many people like to be sedated for a tooth extraction. Possible sedation dentistry options include nitrous oxide (“laughing gas”), an oral sedative (such as a Valium pill) or an intravenous sedative that is administered into your veins by injection. If you opt for nitrous oxide, you can drive yourself home. If you choose one of the other types of sedation, you will need someone to drive you to and from your dental visit.
At the extraction appointment, your dentist will numb, or anesthetize, the tooth to be extracted, as well as the jawbone and gums surrounding it. Typically, a local anesthetic such as novocaine or lidocaine is injected to eliminate discomfort.
Simple Extraction: Your dentist will grasp the tooth with specialized pliers called extraction forceps and move them back and forth to loosen the tooth before removing it. Sometimes, a surgical cutting instrument called a luxator — which fits between the tooth and the gum — is used to help loosen the tooth. Dentists also use “elevators,” which are levers that look similar to small screwdrivers. Usually a dentist will first use an elevator to wedge between the tooth and the surrounding bone. The elevator places pressure on the tooth, which helps to expand the tooth’s socket and separate its ligament.
Surgical Extractions: These procedures generally are more complicated, so your dentist may sedate you before numbing your tooth, then use a dental drill, apply pressure to your tooth with an elevator or extraction forceps, and remove your tooth. Greater surgical effort may be needed in other cases. For instance, gum and/or bone tissue may cover or surround a tooth in a way that makes it difficult for your dentist to view and/or access it. If so, your dentist will need to cut and lift back or remove this tissue. Sometimes a tooth is so firmly anchored in its socket that your dentist must cut the tooth into pieces in order to remove each portion individually.
Your dentist may need to place stitches and/or add bone (natural or synthetic) in the extraction site after the procedure. Some stitches are absorbable and will disintegrate on their own; others require removal by your dentist, usually about a week after surgery.
While surgical cutting instruments like scalpels and dental drills are still commonly used in surgical extractions, the use of dental lasers and electrosurgery in such procedures is growing.
Lasers use high-energy light beams to cut, while electrosurgery uses controlled heat to cut. Benefits of laser surgery and electrosurgery as an aid in tooth extraction compared to traditional scalpels and dental drills include greater precision, less chance of damage to adjacent structures, less bleeding and discomfort, and quicker healing time. However, the disadvantages of their use include higher costs, the smell of burning flesh during the procedure, and the inability to use them to directly extract teeth.
Since bleeding is normal after an extraction, your dentist will have you bite on a piece of gauze for about 45 minutes to put pressure on the area and allow the blood to clot. Some swelling and discomfort are normal after treatment.
Cold compresses or ice packs can help decrease the swelling. If your jaw is sore and stiff after the swelling dissipates, apply warm compresses. Sleeping with your head face upward to relieve pressure on the jaw, and keeping your head elevated with extra pillows also may help. In addition, your dentist may recommend you take an OTC pain reliever such as ibuprofen (Motrin or Advil) for several days. With surgical extractions — which generally cause more pain afterwards — your dentist may prescribe a prescription pain medication.
Other aftercare tips include:
In addition to the aforementioned aftercare considerations, it’s also important to avoid certain foods and activities.
Unless it is a wisdom tooth, your dentist likely will advise replacing any extracted tooth to avoid possible complications, such as shifting of the teeth, gum recession and bone loss. Dental implants are the ideal tooth replacement; dental bridges and dentures are other options.
Dry socket, a common complication after extraction, occurs when a blood clot has failed to form in the socket, or the blood clot that did form has been dislodged. This leaves the underlying bone and nerves exposed to air and food. Often quite painful, dry socket typically appears two to five days after extraction and can cause a bad odor or taste.
Dry socket is most frequently associated with difficult or traumatic extractions, such as the lower wisdom teeth. It occurs more often with people over the age of 30, smokers, those with poor oral hygiene habits and women (particularly those taking oral contraceptives). Unless there is an emergency, experts recommend that women using oral contraceptives schedule their extractions during the last week of their menstrual cycle, when estrogen levels are lower.
In most cases, if you develop dry socket, your dentist will place a medicated dressing into the socket to soothe the pain and encourage healing. The dressing is replaced every 24 hours until the symptoms of dry socket lessen (about five to seven days).
Healing from a tooth extraction takes about five to seven days. The gum area should be fully healed in three to four weeks. If the jaw is damaged, full healing may take up to six months.
Generally, the harder the tooth is to remove, the more the procedure costs. Costs range from approximately $130 to $400. A simple tooth extraction of a permanent tooth can range from $100 to $250. Surgical extractions of permanent teeth cost $180 to $400; a simple tooth extraction of a baby tooth ranges from $90 to $150. Many dental insurance plans cover up to 80 percent of extraction costs if the procedure is medically necessary and not for cosmetic reasons. Check with your insurance provider and/or dentist regarding your individual case.
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