The removal or extraction of a tooth is the oldest form of dental treatment, and it is one of the most common procedures performed in our oral surgery clinic.
Before antibiotic therapy, tooth extractions actually saved people’s lives. While dentists will always attempt to save teeth using fillings, crowns and root canals, even now, it’s sometimes necessary to remove a tooth due to infection, impaction, decay or damage. Whether you’re having your wisdom teeth removed, or one of your other molars, incisors or canines, the procedure will be done correctly, with care, and without pain.
Before the Procedure
X-rays will be taken to determine the exact location of the tooth that needs to be removed. It helps determine the tooth’s location relative to nerves, sinuses and your other teeth. An x-ray can also determine if any infection is present. If so, your surgeon may ask you to take antibiotics for several days before and after the extraction. Do not smoke on the day of the procedure or you risk getting a painful dry socket.
Types of Extractions
Performed when the tooth is not hidden below the gum line. In other words, it can be seen your mouth. After your mouth is numbed with a local anesthetic, the surgeon will loosen the tooth with an instrument called an elevator. Then, forceps are used to remove the tooth from the socket. You will feel some pressure, but should feel no pinching or pain. Be sure to tell the surgeon if you do.
More complex, this procedure is required when the tooth has broken at the gum line or has not erupted into your mouth as often seen with wisdom teeth. Many times, an intravenous anesthetic is used for surgical extractions since the procedure takes longer and is more involved than a simple extraction. After you’re asleep, a small incision will be made in your gum, and the surgeon will remove the broken or impacted tooth.
After the Procedure
For the first hour following the extraction, the patient bites down firmly on the gauze that’s covering the extraction sites. Also, it is important to change the gauze every 15-20 minutes to control bleeding. If bleeding persists after one hour, place new gauze over the surgical site and bite down to apply pressure for another 30-60 minutes.
After you get home, place ice packs on your cheek or jaw where the extraction occurred. Apply firm pressure with the ice pack for 20 minutes, then take it off for 20 minutes and repeat the process. It is recommended that you begin a liquid diet and to take pain medication and/or antibiotics, if prescribed. Eat soft foods as you can tolerate them, and start your regular oral hygiene routine as soon as possible. However, don’t brush vigorously or poke anything in the extraction site. Do not drink through a straw, smoke or spit since these actions will increase bleeding.
If you had a surgical extraction, you may have stitches at the extraction site. These will dissolve within a week or two. Using a warm saltwater rinse beginning 24 hours after the procedure will help the stitches to dissolve.
Learn more about at-home care here, or contact our office if you experience heavy bleeding or pain that radiates through your jaw, toward your ear.
Tooth Extraction Care
Most people experience little or no side effects or complications following a simple tooth extraction. However, you should be aware of the proper way to care for your mouth following the procedure. Doing so will ensure you make a quick, full recovery. If you have questions, don’t hesitate to call us for clarification.
What to Expect
In the first 48 hours following extraction, expect some swelling, bleeding and mild pain. You can usually alleviate these symptoms with attentive at-home care.
Things To Do
Bite down firmly on a piece of fresh gauze to lessen bleeding and oozing.
If bleeding becomes severe, make certain the gauze is pressing against the area of the extracted tooth, not between your gum and cheek. If bleeding doesn’t stop, try biting on a damp tea bag that’s wrapped in a piece of gauze. If heavy bleeding persists, please call our office at 863-665-8878.
To lessen swelling, use an ice pack during the first 24 to 48 hours following extraction. A bag of ice wrapped in a towel or even a bag of frozen peas works well. Apply the pack firmly to your face or cheek adjacent to the extraction. Apply for 20 minutes, and then remove for 20 minutes.
After 48 hours, and when the swelling has dissipated, use heat to speed healing. Press a warm compress to your face or cheek for 20 minutes, then remove for 20 minutes.
Take pain medication for discomfort, but know that it can take up to an hour for the medication to be fully absorbed into your system. If you take a pain pill while you can still feel the effects of the local anesthesia, you’ll be more comfortable immediately following extraction. Take over-the-counter medications like Tylenol or Advil or use the prescription medications ordered by our office.
If pain medication causes you to experience nausea, try eating soft food and drinking plenty of water before taking a pill. You can also try drinking a soft drink that’s been stirred to remove carbonation. If nausea persists, call our office – we can order an anti-nausea medication or change your pain medication.
Rinse your mouth using one-quarter teaspoon of salt dissolved in an 8-ounce glass of warm water. Use the entire glassful, a little at a time. Repeat at least two or three times daily for the five days following extraction.
Things To Avoid
- Don’t smoke for 48 hours.
- Don’t drink through a straw, as this will increase bleeding.
- Don’t spit excessively.
- Don’t brush your teeth vigorously.
- Don’t touch the area with your fingers or a foreign object.
Dry Sockets and Infection
After the third day, you should begin to markedly improve. However, if you experience severe, persistent throbbing pain in your jaw, you could have a dry socket. A dry socket occurs when the blood clot from the socket is lost. The pain may radiate toward your ear or into your other teeth. If you suspect this is happening, call our office so we can help.
Infections are usually rare following tooth extraction, but it can happen if food gets trapped beneath the gum. Signs of infection can even occur in the months following an extraction. If you experience swelling past the first 48 hours after surgery, call our office immediately and speak with one of our oral surgeons.
These instructions will help you care for your mouth after an extraction, but if you have questions about your progress, feel free to call our office. A 24-hour answering service is available for after-hours contact with a doctor, but calling during office hours will ensure a faster response.
Although we can deal with wisdom teeth at any stage, it is wise for children to undergo wisdom teeth removal at the appropriate time in their development (age 13-18), prior to the complete formation of the roots. Wisdom teeth are the last teeth to develop, and some people even have extras. Our digital x-ray and CAT Scan can assess the status of your wisdom teeth, allowing us to accurately advise you about the timing of the procedure. However, if your general dentist or orthodontist has already recommended that you have wisdom teeth removal surgery, we will work with your regular dentist to plan the best course of action. Once we obtain an x-ray and your insurance information, we can assist you with your financial concerns prior to the surgery.
Why Do We Have Wisdom Teeth?
Evolution and genetics are the primary factors that have caused some 90% of the earth’s population to not have enough room in their mouths to allow the wisdom teeth, the third molars, to come in as normal healthy teeth.
Evolution over millions of years has been put forward as one cause, theoretically, and scientists speculate that as the human diet has changed, we have developed smaller jaws.
Genetics may also be a factor as we inherit large teeth from dad and a small jaw from mom. The tooth size and jaw size discrepancy is what leads to both crooked teeth and inadequate room for the wisdom teeth.
Toward the end of high school, the last molars begin to erupt, pushing up through the soft gums. Your teenager’s “age of wisdom” and the concurrent eruption of the last molars has given them their popular name.
Why Do We Need Wisdom Teeth Removal Surgery?
Pain is the great motivator that propels patients to seek removal of their wisdom teeth, and this pain is usually accompanied by jaw stiffness and swelling. As the wisdom teeth begin to erupt, bacteria and food can accumulate under the gum and cause this problem.
Undergoing wisdom teeth removal before they start hurting is the best approach. Even when there is enough room in your mouth for the wisdom teeth, they are difficult to get to with a toothbrush and frequently become decayed, infected, and painful later on. Your general dentist or orthodontist can help advise you of the correct timing for the removal of your wisdom teeth with an examination and x-ray.
If you have worn braces or need to wear braces, chances are you won’t have room for your wisdom teeth to come in as normal, healthy teeth. Even if you have straight teeth now, the eruption of the wisdom teeth in the back of your jaw can push and crowd the teeth in the front. Once this happens, braces are the only way to correct the problem.
Cysts and Tumors
All teeth develop in a sack inside the jaw, and this fluid-filled sack disappears when a tooth breaks through the gum. However, a trapped wisdom tooth sack can continue to grow and destroy bone in the jaw and can even cause the bone to fracture while under the stress of chewing. Other tumors develop around the impacted teeth, such as keratocysts, ameloblastomas, and even rare cancers. Treatment is then extensive and could have been avoided with early detection of impacted wisdom teeth.
What Are Impacted Wisdom Teeth?
When a wisdom tooth is blocked from erupting, it is termed “impacted.” Wisdom teeth impacted in the gum tissue overlying them are called soft tissue impactions. Occasionally, these impacted teeth (and even some fully erupted teeth) can be more difficult to remove than your dentist expects or predicts because of root curvatures that are not fully seen on x-rays or because of other anatomical conditions. Wisdom teeth are more commonly still encased in some bone, which is called a partial or full bony impaction. They are either only partially exposed in the mouth or completely under the gum surface and identifiable only on an x-ray. These complicated issues make the extraction difficult for the non-specialist. However, our specialists consider all factors, including age, jaw size, body type, gender and level of anxiety, to make your procedure as easy as possible for you.
How Does the Wisdom Teeth Removal Process Work?
Wisdom teeth removal begins by making a window in the gum so that the top of the tooth can be seen. Most teeth are removed in pieces to avoid making a large and more painful incision. Usually only one stitch is required to close the window in the gum. This stitch falls out on its own, so post-operative visits for suture removal are a thing of the past. It is recommended that IV anesthesia be used in most cases for the removal of wisdom teeth. Local anesthesia is used after you are asleep so that you will be comfortable after you wake up.
What Are the Risks Involved with Wisdom Teeth Removal?
Wisdom teeth removal is a common procedure, but complications can occur. The following are potential complications that the patient should understand:
Infection: This is not a common complication, but can occur as late as 3-4 weeks following surgery. Swelling and pain are indications of infection and should be reported to your doctor immediately.
Dry Socket: There is a 5-10% risk of this complication. Dry socket is a term used to describe a breakdown in the healing process following tooth removal, and the problem generally starts 3-4 days after oral surgery. Dry sockets respond to treatment rapidly in most cases.
Nerve Injury: There is less than a 1% chance of this complication. Nerves that are in the jaw can become swollen or damaged during wisdom teeth removal, causing the loss of sensation in the lower lip, chin, or tongue. Occasionally the ability to taste can be altered. Your risk for this complication depends on the position of the tooth and your specific jaw and nerve anatomy. Most patients are at a low risk for this complication.
Sinus Perforation: This is NOT a common complication. The roots of the upper wisdom teeth are close to the maxillary sinus, and perforation of the sinus can cause a sinus infection or a persistent fistula that may require closure with a second surgery at a later date.
Tooth Damage: Adjacent tooth restorations may be damaged during the removal of a wisdom tooth, but this is usually due to dental decay that is already under the restorations, indicating that the teeth are already in a state of failure.
Incomplete Removal: Occasionally, root tips remain after the removal of the wisdom teeth. Sometimes it is prudent to leave a portion of the root if it is close to the sinus or the nerves in the jaw. These roots can been seen on dental x-rays, but very seldom cause any problems afterward.
Wisdom Teeth Removal: Pre-Surgical Consultation
It is important for you to be comfortable and fully informed regarding your decision to have your wisdom teeth removed. Hopefully our web site has given you this information. Most of the patients we see have already been informed by their general dentist or orthodontist that their wisdom teeth need to be removed. Generally, x-rays are sent to our office with a referral form. You may also have a copy of the form. It contains important instructions regarding anesthesia and other preparations for your procedure.
When people begin thinking about anesthesia for surgery, they often have some concerns and fears, and worry if something could go wrong. The purpose of anesthesia, of course, is to alleviate the anxiety and discomfort associated with difficult procedures. What’s more, the anesthetics that are used today, along with the monitoring systems used in our outpatient facility, make the whole procedure safe, comfortable, and effective.
We administer IV anesthetics for surgical procedures in our outpatient surgical facility. We believe our excellent record over the past 40 years speaks for itself, and our safe and professional treatment has brought many patients back for return visits. Frequently, we even see patients we treated many years ago bringing their children and grandchildren for treatment. If you have had difficulty with anesthesia in the past or have other special concerns, please let us know so that we can make special provisions for you.
Local anesthesia has been used in dentistry and medicine for years, the common anesthetics today being Xylocaine, Carbocaine, Septocaine, Cytenest, and Marcaine. Each local anesthetic is slightly different. For instance, Carbocaine is a much shorter acting anesthetic than Marcaine, and Septocaine takes effect more rapidly than Xylocaine. Novocaine was one of the first common local anesthetics, and many patients still refer to any dental injections as “Novocaine,” even though it is seldom used today. Because of our experience and training, we can choose the local anesthetic that is most appropriate for your procedure and medical history.
A combination of intravenous anesthesia and local anesthesia has proven to be the safest and most effective method for the majority of our surgical procedures. When intravenous anesthesia is used, local anesthetic injections are given after you are asleep so that you can be comfortable both during and after your procedure.
When only local anesthesia is given for a procedure, a topical anesthesia in the form of a flavored gel can be used to make this injection as painless as possible by numbing the gum in the area where the anesthetic is needed.
Pre-Treatment Checklist for IV Anesthesia
- Do not eat or drink anything, including water, for at least 6 hours prior to your procedure. The morning of the surgery, you may take most medications you would normally take with a small sip of water.
- Come accompanied by someone who will remain in our office for the entire procedure. They must be able to drive you home and stay with you until you are recovered from the anesthesia.
- Wear a short-sleeved shirt or blouse and low-heeled shoes.
- Keep facial make-up to a minimum.
- Remove contact lenses prior to anesthesia.
Anesthesia for Children
We are committed to making your child’s oral surgery experience a good one. We are also focused on making it stress-free for you. Giving your child a mild sedative prior to his/her appointment can make a world of difference. When you call for an appointment, please ask about pre-medication for your child.