Dental Extractions

A dental extraction (also called tooth extraction/ Exodontia) is the removal of teeth from the dental alveolus of the alveolar bone.

Indications :

Extractions are performed for a wide variety of reasons but most commonly to remove teeth that have become un-restorable through tooth decay, periodontal disease, dental trauma especially when they are associated with toothache, sometimes for orthodontic treatment purposes.

Sometimes impacted wisdom teeth ( teeth stuck under the bone and unable to grow normally) cause recurrent infections of the gum(pericoronitis) and may be removed when other conservative treatments have failed (cleaning, antibiotics, and operculectomy)

In Orthodontics if the teeth are crowded, healthy teeth may be extracted (often bicuspids) to create space so that the rest of the teeth can be straightened.

Procedure: Extractions can be categorized into 1. Non-surgical 2. Surgical, depending on the type of tooth to be removed.

Assessment and special investigations: Comprehensive history taking should be performed to find out pain history of the tooth, patient’s medical history and history of past difficult extractions. Pre-extraction radiographs helps in visualizing the shape and size of the roots which is useful for planning the extraction.

Obtaining consent from patient: In order to obtain consent from the patient, dentist should explain, other treatment options, dental extraction procedure, potential risks and benefits of the procedure.this process of gaining consent should be documented in clinical notes.

Administration of Local Anesthesia: The dentist would deliver local anesthesia to ensure the tooth and surrounding tissues are numb before the start of extraction. There are several techniques in administration of LA, which includes mainly, 1. Infiltration : Injection containing the LA is delivered in to the gum near the root tip of the tooth to be extracted, 2. Nerve block : Injection containing the LA is delivered to the earlier branch of a nerve. Prior to injection the topical anesthetic gel or cream such as lidocaine can be applied to the gum to numb the site of injection, to reduce the discomfort felt during the injection.

Removal of tooth : Extraction forceps are commonly used to remove teeth. Different movements of forceps can be employed for the removal of teeth like buccal-lingual, rotary, figure of eight etc.

— Dental elevators can be used to aid removal of teeth. Elevators are designed to engage in to the space between the tooth and bone of the socket. Rotary movements are made to dislodge the tooth from the socket.

— Luxator is another instrument that can be used gently to cut the periodontal ligament between the tooth and its bony socket.

Achieving haemostasis: Biting down on a piece of sterile gauge over the socket will provide firm pressure to the wound which is sufficient to stop any bleeding. Source of bleeding can either be from soft tissues (gingiva, mucosa) or hard tissues (bony socket) or both. Bleeding from soft tissues can be controlled by Suturing, and /or using chemical agents such as tranexamic acid, ferric sulfate and silver nitrate. Bony bleeding can be arrested by Haemostatic gauge and Bone wax. Other means of achieving haemostasis is by Electrocautery.

Post operative instructions : post operative instructions should be given to the patients to prevent further bleeding from socket and infection. The advice list is to be given verbally and in written form:

— Avoid contacting the toothbrush on the socket as it may dislodge the clot

— Avoid chewing on the side of extraction for 24 hours

— Avoid rinsing the mouth for 24 hours to prevent dislodging the blood clot

— Avoid smoking for 24 hours to prevent risk of infection or development of a dry socket

— Avoid carrying out strenuous exercises

— After 24 hours use warm salt water mouthwash especially after meals to keep the wound clean

— If the socket starts to bleed bite down on a gauge or clean handkerchief for about 20 min

— In case of any swelling apply cold packs externally on the skin to reduce inflammation

— Avoid applying heat or pain-relieving gels at the site of the swelling.

About the author:

Name: Dr. Abhilash Dandy

Qualificaion: B.D.S

I graduated as a Dentist from Sibar Institute of Dental Sciences, Guntur. I have done my externship program at Rutgers school of dental medicine, New Jersey, USA. I have a clinical experience of 3 years and currently working as Administrative head — Dental wing in MediCub India, Hyderabad.