What You Need to Know About Tooth Extractions

Of the many health care procedures you may have to undergo, a tooth extraction is probably among the least desirable. Hollywood script writers sometimes turn to tooth extraction (without an anesthetic) to depict torture scenes. In real life, tooth extractions -- with an anesthetic, of course -- are sometimes necessary, says Dr. Leena Palomo, an associate professor of periodontics at Case Western Reserve University in Cleveland. Most tooth extractions are performed without complications, but some patients require multiple tooth extractions at the same time, Palomo says. "If it's a straightforward extraction, with one tooth, you're in and out and it's done," she says. "But if it's a complicated case, if you're having 32 teeth removed, that's a much more involved procedure. That might take place in a hospital or medical center operating room and require you to be admitted."

Here are typical reasons for a tooth extraction or extractions:

-- Irreparable tooth decay.

-- Bone loss around the tooth.

-- Fracture of a tooth or tooth root.

-- An impacted wisdom tooth.

Reasons for a Tooth Extraction

1. Irreparable tooth decay.

Bacteria that enter into the tooth through a crack or chip can cause tooth decay. Tooth decay that infects the pulp, or the area where blood vessels and nerves are collected, can become infected, and over time an abscess can occur, says Dr. Samuel B. Low, a dentist based in Gainesville, Florida. He's the chief dental officer for Biolase Inc., a global medical device company that develops, manufactures and sells laser systems in dentistry and distributes medical imaging equipment. Periodontal disease is the "primary culprit in tooth loss among older adults," according to Harvard Health. Periodontal disease is characterized with an array of mouth ailments in older adults: receding gums, unsecure (wobbly) teeth and degradation of the jawbone, according to Harvard Health.

When a dentist determines that a tooth is nonviable because of infection to the nerve caused by a large amount of decay or trauma, it could be time to extract it, says Dr. Sheila M. Samaddar, a dentist at the South Capitol Smile Center in the District of Columbia. She's also a national spokesperson for the Academy of General Dentistry. "In some instances, an infected tooth or teeth can be restored with a root canal," Sammadar says. Following a root canal, a dentist would place a crown to cover the tooth to restore it to its normal shape and function. In terms of cost, "it's much less pricey to just extract a tooth, but then you have nothing with which to chew," she says. A dentist can replace an extracted tooth with a dental bridge -- a cemented dental restoration used to replace one or more missing teeth by joining an artificial tooth definitively to adjacent, crowned teeth or to dental implants with crowns. A dental implant is an artificial tooth that's placed into your jaw to hold a replacement tooth or bridge, Sammadar says. Partial dentures, which replace missing teeth and can be removed by the patient, are another option.

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2. Bone loss around the tooth.

Loss of bone around the tooth is often caused by periodontal disease, says Dr. Inna Chern, a dentist with New York General Dentistry in New York City. "When the bone loss is (excessive) due to poor hygiene, increased oral inflammation, systemic disease or environmental factors such as smoking, the teeth become compromised and loose," she says. "These loose teeth move into a misaligned state and do not provide the proper support for eating and function. They can often be painful as they move in basic functions and require removal to stop the progression of pain and trauma to the jawbone."

3. Fracture of a tooth or tooth root.

External trauma caused by an accident or physical assault can lead to fractures along the root surface of a tooth or teeth, causing it or them to be irreparable, Chern says. These fractures can be caused by being in a car wreck or having a player elbow you in the mouth while you're playing basketball. Or, they could be caused by biting down on a the wrong food while eating. "Foods such as popcorn kernels, nuts and poorly cooked rice are notorious for causing tooth fractures," she says.

4. An impacted wisdom tooth.

Impacted wisdom teeth are typically stuck in the bony section of the jaw or in gum tissue at an angle that's harmful to other parts of the mouth, Chern says. These teeth are the third molars at the back of the mouth that don't have sufficient room in that location to emerge and grow in a healthy fashion, according to the Mayo Clinic. Wisdom teeth are typically the final adult teeth to emerge from the gum into the mouth, or "erupt." If they fail to do so, they are called "unerupted" teeth. Impacted wisdom teeth can cause pain and are challenging to clean, which could cause gum disease and other dental problems, Chern says. An impacted tooth is a technical term for an unerupted tooth and can include wisdom teeth, baby teeth and adult teeth that don't have room to come into the jaw, she says. Wisdom teeth typically emerge between the ages of 17 and 25, unless they're impacted.

Symptoms of Damaged Teeth

For teeth that are damaged to the point that they may have to be extracted, there are no typical symptoms. Someone who needs a tooth extraction could be asymptomatic for long stretches of time or experience pain and swelling, Chern says. Once a tooth is irreparable, the nerve in it begins to die. "The body mounts an immune response, which varies depending on the person," Chern says. "This is usually an acute phase of severe pain or a chronic slow-moving phase, which elicits mild discomfort." The immune response can cause swelling that ranges from a small bump in the mouth to a large mass that can block the airways.

[See: 7 Creative Soft Food Ideas to Ease Dental Procedure Recovery.]

Who Performs Tooth Extractions

Tooth extractions are typically conducted by:

-- A general dentist.

-- A periodontist.

-- A maxillofacial and oral surgeon.

1. A general dentist.

General dentists are trained to do extractions and often do straightforward ones with a local anesthetic in their office, Chern says. Some general dentists seek continuing education to perform surgical extractions of severely decayed and impacted teeth, she says.

2. A periodontist.

Periodontists are dentists who specialize "in the prevention, diagnosis and treatment of periodontal disease, and in the placement of dental implants," according to the American Academy of Periodontology. Periodontists have three additional years of training beyond the education they receive in dental school. They can do procedures ranging from the straightforward removal of one tooth to more complex cases involving the extraction of multiple teeth, Chern says.

3. An oral and maxillofacial surgeon.

An oral and maxillofacial surgeon (it's one specialty) is trained to "recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region," according to the American College of Oral and Maxillofacial Surgeons. Dr. Michael Ray, an oral and maxillofacial surgeon in Dallas, says he often removes wisdom teeth in adolescents and young adults and also extracts plenty of decayed and fractured teeth in older adults. "Sometimes teeth have to be removed by oral surgeons (like himself) in cases of severe trauma, but this isn't very common now because people use seatbelts more and often and use facial protection (like mouthguards) when playing sports," he says.

How Are Tooth Extractions Performed?

Whether it's a general dentist, periodontist or oral surgeon, the actual procedure is very similar, Chern says. "Any specific differences come about from school of training and personal surgical preferences," she says. "Dentists are notorious for loving certain techniques and instruments." Simple extractions involve anesthesia to numb the area. The dentist checks the area for proper numbness with a probe; an instrument is used to move the gum tissue away from the tooth needing to be removed. A drill or laser may be required to gain access to deeper parts of the tooth in order to make room for the next sequence of instruments. That next series of instruments is used to loosen the tooth in its socket.

Once the dentist has the desired amount of tooth movement, a forcep is applied to the loose tooth, and the tooth is pushed downward until it pops out of its socket. "Teeth are never actually pulled out," Chern says. The dentist cleans the open area and makes sure there are no fragments or infected tissue left in the socket. The area is washed with a sterile saline solution and stitches are placed to replace the gum tissue into its original position, she says.

[See: 6 Nonopioid Ways to Ease Postoperative Pain.]

Healing From a Tooth Extraction

Typically, a dentist will advise a patient who's just had a tooth extracted to apply an ice pack to the area and bite on gauze for 30 minutes in a recovery area, Low says. The health care provider could prescribe pain medication if needed, and schedule a follow-up appointment about a week later to check on the healing. The healing process commonly takes one to two weeks, he says. If your pain doesn't recede and you're taking pain medication as instructed, and you have a fever, swollen jaws or see signs of infection, call your provider for a follow-up appointment as soon as possible, Low says. Depending on your level of pain, you may want to avoid certain foods for a while. It might be best to avoid harder foods -- such as nuts and chips -- during the first 24 hours or so after a tooth extraction, he says. Ray recommends consuming cool, soft foods -- like yogurt and smoothies -- for about 24 hours after a tooth extraction.