Extractions
Remove a problematic tooth and allow your body to heal.
Dental extractions form a crucial part of dentistry and are routinely carried out in dental offices. If you have infected, severely decayed, loose or fractured teeth, you may need to get them pulled out. Pulling out of the tooth or teeth for therapeutic or preventative purposes is known as dental extraction. These are generally reserved as a last resort and performed only when there is no way a tooth can be saved.
Ideally, dental extraction is a painless removal of the whole tooth with minimal trauma to the surrounding oral tissues. This ensures proper and uneventful healing. Tooth removal leaves an empty space in the mouth, which can compromise chewing, speech and aesthetics. Therefore, most of the time, a replacement via a bridge or a denture is advised once the surgical wounds heal.
When is an Extraction Needed?
Every dentist will try to preserve the teeth as far as possible. However, sometimes, a tooth or teeth can be beyond saving and must be extracted. A dentist can recommend you opt for tooth removal in the following situations.
- Severely decayed and damaged teeth which cannot be saved with the help of dental fillings or root canal treatments have to be extracted.
- Highly mobile teeth due to advanced periodontal diseases that periodontal therapies cannot save.
- Teeth that have lost their structure due to attrition or erosion.
- Infected teeth where the core and surrounding jawbone have been involved.
- Dead tooth.
- Tooth or teeth that are involved with a cyst.
- At times, primary or milk teeth stay retained even after the eruption of all permanent teeth. In such cases, they can misalign the permanent teeth and must be removed.
- Broken or fractured teeth.
- At times, due to a lack of space, a tooth fails to come out and remains stuck inside the gums and jawbone. This is known as an impacted tooth and must be removed as it leads to pain, discomfort and is prone to infections. Third molars are the most commonly impacted teeth that are extracted due to their complications.
- Teeth that are in between a fracture line or associated with a malignancy of the oral cavity also need to be removed.
- Teeth may also be removed for orthodontic purposes. If you have overlapping and crowded teeth, your orthodontist may refer you to an oral surgeon to remove the first or the second premolars. This is done to create space in the mouth for proper alignment of remaining teeth.
- At times, teeth may be extracted for prosthetic purposes, especially when they interfere with or compromise the fitting of a bridge or dentures in the mouth.
- Sometimes, a tooth can also be removed if it is misaligned and causes constant trauma to the oral soft tissues.
To summarise, any teeth that cannot be saved, interfere with everyday life or, pose a challenge to the success of dental treatments are generally extracted.
What is the Procedure to Get an Extraction?
Dental extractions can be broadly classified into Intra-alveolar and Transalveolar extractions.
Simple (Intra-alveolar) Extractions
Commonly known as simple extractions, this procedure takes the help of dental forceps and elevators to remove a tooth. Simple extractions are reserved for cases where the tooth is clearly visible and can be accessed easily.
Surgical or Complex (Trans-alveolar) Extractions
Simple extractions cannot be undertaken in cases of root deformities, impacted teeth, brittle or severely decayed teeth. In such cases, trans-alveolar extractions, commonly called surgical or complex extractions, are undertaken. In these types of extractions, an incision is made through the gums to access the tooth. At times, some bone removal may be indicated, and the tooth may have to be sectioned (broken up) before removing.
The Procedure
The procedure of tooth extractions, be it for anterior teeth, premolars, molars, or wisdom teeth, starts with injecting a local anesthetic agent. This ensures you have pain-free and comfortable tooth removal. Dental x-rays are usually recommended before a tooth extraction is planned. This enables a better view of the tooth’s anatomy and any pathology which may be associated with it.
Once the adequate amount of anesthesia has been achieved, a dental forcep is used to hold the intended tooth firmly. Next, precise movements are used to put pressure on the tooth and loosen it. This involves to and fro motions plus rotatory motions in cases of anterior teeth. Once the tooth has been sufficiently loosened, it is removed with one swift and precise movement. Next, the bleeding from the socket is brought under control, and aftercare instructions are given. It is crucial to follow these aftercare instructions correctly to ensure the blood clot stays put, as it is key for the healing process to begin.
In cases of surgical extractions, the incised gums have to be brought back together and sutured to ensure proper healing. Your dentist may also prescribe you some painkillers and antibiotics for adequate relief and prevention of infections.
Anterior teeth have a single and slender root and can be removed easily. In contrast, multiple rooted teeth like molars take some time and are more complex due to the presence of multiple roots and their location. Wisdom teeth are most commonly impacted teeth and have to be removed by surgical extraction methods.
How Much Do Extractions Cost?
The price of extractions varies depending on the clinic and the complexity of the case. Below is a list of prices you can expect to pay in various countries.
| Dental Extraction Cost Table | |||
|---|---|---|---|
| Country | Simple | Complex | Surgical/Impacted, Wisdom |
| United States of America | $150 | $420 | $450 |
| Mexico | $50 | $85 | $190 |
| Costa Rica | $60 | $100 | $200 |
| Colombia | $90 | $150 | $225 |
What Are the Risks of Dental Extractions?
Every surgical procedure carries some risks with it, and it’s no different for a dental extraction. Although rare, certain risks and complications can arise after dental extractions, especially if not done correctly.
- At times a tooth may be tightly bound to the jawbone or maybe oddly placed. This can complicate its removal, and the extraction can fail.
- The tooth, especially molars, has multiple, curved roots and can break inside the jawbone, which can further complicate the extraction process.
- In cases where the crown part of the upper back tooth break during the process of extraction or excessive force is used, the remaining portion of the root end may puncture and enter the maxillary sinus.
- There can be excessive trauma or injury to the gums, tongue, and oral soft tissues, especially in cases of surgical extractions.
- If you gag or jerk while the tooth is about to be pulled, it possible that you may end up swallowing it.
- Uncontrolled bleeding, which does not stop after 30 to 45 minutes.
- Nerve injury happens to be one of the most severe complications of extractions.
- If proper aftercare is not done and the blood clot is dislodged, a dry socket may form. It is a type of infection and leads to excruciating pain.
Additional Resources
Sources
Howe, Geoffrey Leslie. The Extraction of Teeth, Second Edition, Revised Reprint. John Wright & Sons, 1974.
Howell, Maria Lopez. “Crowns.” Mouth Healthy TM, American Dental Association, https://www.mouthhealthy.org/en/az-topics/e/extractions.
This article is intended for informational purposes only. It is not meant to be used as medical advice, diagnosis, or treatment. Always seek the advice of a qualified health provider with any questions you have surrounding a medical condition. Never disregard professional medical advice or delay in seeking it as a result of anything you read on this Site.
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