Most of us are concerned with taking proper care of our teeth so that our teeth will stay firmly in our mouths for our lifetime. But on occasion, a tooth fails and has to be extracted to eliminate or prevent pain and infection. Here’s what you can expect from us if we are involved with a tooth extraction of one of your teeth.
Since the Arrival of fluoride application to the general American population scene began in the 1950’s, American dentistry has morphed from repair of teeth damaged by decay and removal of unrepairable teeth to preservation and protection of teeth through fluoride application and reduction of tooth loss through the placement of minimally invasive restorative materials(fillings).
Not all of us have had the opportunity to be protected with fluoride that prevents tooth decay. Some of us grind or clench our teeth and that can cause cracks or fractures in our teeth. Not all of us have paid close enough attention to brushing and flossing and controlling the sweet tooth and that can lead to new tooth decay. In addition, thinning of the gum with aging, the exposure of roots with periodontal disease or due to toothbrush abrasion can lead to more decay on exposed root surfaces. The root surface of the tooth is more porous than the enamel crown and therefore more susceptible to decay. As we age, medications can cause less saliva flow. It is saliva that protects our teeth by carrying concentrations of Calcium to remineralize areas that may have been damaged by demineralization from bacterial waste products on our teeth. Saliva also lubricates the mouth so that it is easier for the tongue and cheeks to rub off plaque and prevent new decay on exposed roots.
These scenarios facilitate the development of cracks or decay in teeth. Teeth that have had multiple restorations over the years can weaken and fail. And this is where we can start to lose one tooth at a time. Replacing teeth gives you a better chance to keep your other teeth without adding the stress bearing benefits of the lost tooth to your remaining teeth. Failure to replace functioning teeth can lead to tipping, drifting, with subsequent poor occlusion that leads to further tooth loss.
Our goal at Specialty Dental is to leave you with choices that can be made for the areas where you lose the tooth by minimizing any damage to surrounding bone and gum and maximizing the preservation of the bone and gum and if needed regeneration of bone and gum where it has been lost to disease at the site of the extraction or adjacent teeth.
To begin the procedure, you’ll receive a thorough evaluation of your health to make sure that we will not stress your system. In addition, we will evaluate your dental anxiety level to make sure that we give you the opportunity to use antianxiety agents or sedation to help you relax in the dental chair. When we have determined that all your questions and any potential problems are addressed, we start by applying topical or surface numbing drugs to the area that needs to be ‘numbed’. This will anesthetize the area so that placement of longer acting anesthetics into the mucosa or soft areas where the nerves run will be accomplished with little or no sensation. This local anesthetic will numb the whole area where the surgery will take place. The time taken to prepare the instruments for the procedure allows the ‘numbing to take hold’. The areas where the injections have previously been made are then tested again to make sure and to assure you that the area has no feeling. If there is any ‘feeling’ more anesthetic will be added, sometimes with different techniques that allow us to ‘numb’ the ligament space around the tooth that is to be extracted
Your teeth are held firmly in place with ligaments holding the root to the bone and skin cells hanging onto the tooth with an adhesion force that is known as VanDerWaals. In order to extract a tooth, you must first loosen the ‘skin’ attachment. The seperation of the skin from the crown of the tooth is known as curettage. This also confirms that the numbness is ‘deep’ The next step requires doing two things: expanding the bony socket where the tooth is held and detaching the ligaments that are holding the tooth in place.
Surprisingly enough, the bone surrounding the tooth is somewhat spongy. By moving the tooth back and forth, the bone that comprises the socket walls actually expands and enlargens the socket to give the tooth some ‘wiggle’ room. Often, after the socket has been expanded by moving the tooth from side to side, your surgeon will twist the tooth back and forth to elevate the root from the bony housing. This is very often the way single rooted teeth are removed with little or no awareness on your part.
When we are dealing with multirooted teeth, it can become more difficult to ‘wiggle’ the tooth out as roots may be directed at opposite angles. The extraction can be facilitated by sectioning the tooth and widening each individual socket thus making it much easier on you to remove one crown root fragment at a time. Often, we cover the site with a collagen barrier so that no bone is exposed after the surgery and so that there will be less likelihood of pain from exposed bone or gum.
To perform the process described above, we will employ tools to move and manipulate the teeth, the two most common of which are the dental elevator and the extraction forceps.
The dental elevator looks somewhat like a woodworker’s small chisel, with a round handle and a narrow, curved tip. The dental elevator is wedged between the tooth and the bony socket, and used to wiggle the tooth side to side and back and forth. During this process, some of the ligaments typically break, and the bone at the top of the socket begins to expand. On occasion, the tooth extraction can be completed using only the dental elevator.
However, in most cases, once the socket has been enlarged, the surgeon dentist puts the elevator down and picks up the extraction forceps. This tool looks like a small pair of pliers. It’s used to grip the tooth, allowing the surgeon dentist to twist the tooth and eventually wiggle the tooth out of the socket.
What You’ll Feel
Thanks to the anesthetic administered at the beginning of the procedure, you won’t feel pain during the tooth extraction. However, you will feel pressure, and movement, and a lot of it. You can sense the movement of the tooth as it’s moved around in the socket expanding the size of the socket. Often times, we place bite blocks that allow you to bite together on the teeth in the opposite side of the mouth and reduce the sense of pressure. The pressure you feel is not a precursor to pain; it’s simply you sensing the procedure with any pain component removed.
What You’ll Hear
Your teeth put up with a lot and still stay firmly tethered in place. That’s thanks to the strength of the ligaments attached to the roots of the teeth. These ligaments are so strong, in fact, that as they break or tear during the extraction, you may hear them snapping or, pulling away, or tearing as they are separated from the tooth root or bone.
Once the tooth is out, the surgeon at Specialty Dental will scrape the inside of the socket to make sure no infected tissue was left behind. The surgeon then washes the socket out with a cleansing solution. We will then inspect the socket one last time to make certain that there are no defects in the bony wall of the socket. If there are no defects, we will press our fingers around the expanded socket to compress the sides and restore the shape of the jawbone. If there are bony defects, we will determine how severe they are. If the bone loss will lead to significant gum shrinkage, we will recommend bone ridge preservation techniques to keep the gum at an ‘even’ level to make it less likely to have food traps when an implant or bridge is placed. After this, we will cover the area with a collagen barrier and secure the collagen with stitches that often dissolve on their own. Finally, we’ll place a piece of gauze over the empty socket and have you bite down to create pressure and help the wound clot.
For more questions about what you can expect during your tooth extraction, call Specialty Dental Care in Omaha, NE at 402.704.3171.