When treating a patient, the dentist’s goal is to administer the most care with the least invasion. He or she will aim to leave as much of the original tooth structure intact and use meticulous, if not graceful techniques to ensure minimal trauma and damage to the mouth. This week, its time to chuck all that froufrou delicacy out the window and yank some teeth! Aright, perhaps this description of tooth extraction is a bit over-the-top, but extraction is known as the most barbaric of the dental practices. As such, it is saved as an absolute last resort in most cases. What can you, as the patient expect if you find yourself on the business end of a set of pliers? We’ll discover that today.
Cuspid’s Last Stand: Circumstances for Tooth Extraction
As mentioned before, extraction is saved for grim circumstances most of the time. Often, patients receiving an extraction will have neglected their teeth to the point that there is no repairing them. When a significant enough portion of a tooth’s structure has been compromised, there are only so many options, extraction being the easiest. Other times, a patient may receive treatment which contributes to the breakdown of tooth structure. For instance, a filling a patient received when they were young may, after several decades, begin to act like a wedge, splitting the tooth beyond what a crown can cover. The third and most tragic circumstance is when a patient’s socioeconomic circumstances or insurance prohibits them from receiving the best care, and extraction is the only practical treatment option for them. We’ll save lamentations about dental insurances for another day, but suffice it to say that it is unfortunately common that a patient who could be an otherwise excellent candidate for advanced treatment is unable to afford it. Extraction may be the only choice.
However, not all reasons for an extraction are so dire. If a patient’s mouth is overcrowded with teeth, it may be advantageous to have some removed. This is the case for many preteens who have a premolar removed before getting braces, for example. Other times, a tooth may simply arrive inside the mouth in a non-sustainable orientation, such as horizontally. The vast majority of the population requires the extraction of their wisdom teeth for one or both of these reasons. As with any branch of healthcare, each patient’s treatment is unique in dentistry, and extraction may be the best option in any number of situations.
Not Quite Music to Your Ears: Instrumentation
The picture above shows the basic instrumentation used in a dental extraction. It is possible that your dentist will have more or less equipment than what is pictured above, but so long as he or she isn’t reaching for fishing line and the doorknob, all is well. Starting from the right, you see basic forceps and a mirror. Skipping to the sixth implement from the right, you see a probe. These are essential for any dental procedure, as they help the dentist see, feel, and work inside the mouth effectively. The three tools in the middle which look like weird ice picks are called elevators. They don’t play smooth jazz unfortunately. Finally, the two instruments on the left are also forceps, except these are meant to grasp teeth instead of cotton squares and swabs. They are shaped slightly different from each other, and your dentist will select the correct forceps based on the shape and placement of the tooth that is to be extracted.
Going Up: The Procedure
As with most dental procedures, the dentist will first numb the region in preparation for extraction. Expect a full block in most cases as opposed to an infiltration, as extractions can otherwise be rather painful. (Refer to last week’s post on cavities if you don’t know what these terms mean). After thoroughly numbing you, the dentist will line the surrounding area with cotton so as to catch any blood which may come from the gums during the course of the procedure.
From there, an extraction is relatively straightforward. As shown in the graphic above, your tooth is held to either the maxillary or mandible via little fibers called ligaments. Ligaments are everywhere in the body and connect bone to more bone. They do a great job of anchoring your teeth firmly in your mouth, but with extraction, that is precisely the opposite of the intended outcome. So, these ligaments must be broken. This is where the elevator comes into play. The elevator’s job is to wedge between the tooth and the jaw bone to loosen the ligaments holding them together. Using a wedge and lever motion on the neck of the tooth, the elevator may also begin moving the tooth away from the jaw. In older or weaker teeth, this may be enough to extract the tooth, alone. Most of the time, however, the tooth will be loose, but not yet extracted at this point.
By the time your dentist reaches for his extraction forceps, find peace in knowing the procedure is nearly complete. The dentist will grasp the tooth with the forceps and gently rock and gyrate the tooth until it fully detaches from the bone. My dentist prefers a “figure eight” sort of motion, but as with most things in dentistry, there is no exact science to it. Having successfully removed the tooth, the dentist and assistant will then check to make sure no root fragments are left behind before cleaning and suturing the wound.
As with last week’s post, I would again like to highlight how helpful nitrous oxide can be in helping calm yourself for what can be a traumatic experience if you have any aversion to the dentist. Again, there is no fear of stigma, and often no fear of cost involved in asking for this treatment. Nitrous exists in a dental office to be used, and can make the entire experience smoother for everyone.
Aftermath: What to Expect
Following your extraction, your dentist will likely prescribe an antibiotic and perhaps a painkiller. Depending on the circumstances, simple over-the-counter pain killers may suffice, but the antibiotic is crucial in making sure the open wound does not cultivate infection. There will be some dull, aching pain involved in the following week, but if the pain ever becomes sharp or excruciating, the blood clot forming under your suture may have dislodged. This is called dry socket.
It is important to visit the dentist if you suspect you may be experiencing a dry socket, as blood clot formation is absolutely necessary in the healing process. Your chances of developing a dry socket increase if you perform a sucking motion or engage in vigorous physical activity. This is why the dentist will suggest not using straws or cigarettes, or perhaps taking an easier day at the gym.
In terms of future care, your dentist may place a bridge to replace the tooth that was extracted, leave the gap as is, or suggest an implant. Next week’s post will cover implants, but for now, it is important to know the difference between proper implants and mini implants. Mini implants are a very niche sort of treatment and, while significantly cheaper than proper implants, are usually a failure in both the short- and long-term. If your dentist suggests a mini implant rather than a proper one, carefully consider receiving a second opinion.
In all, an extraction can be scary to think about. It would be a disservice to say that it is a necessarily pleasant experience, so I won’t. Just know that if you are having a tooth extracted, it is a relatively fast and simple procedure. Afterwards, make sure to follow all of the directions given to you and follow up with the dentist as needed; otherwise, you will regret not doing so. All dental procedures have their time and place. Some aren’t as pretty as others, but taking care of your personal health often means enduring unpleasant experiences from time to time. However, having an extraction is far better than an infected tooth or an overcrowded jaw littered with cavities. So, if you need an extraction, it is best to bite the bullet. Just make sure you bite it carefully, or you may need to have more extractions; bullets aren’t typically chewable.
Dentistry 101 