Home > Encyclopedia of Nursing & Allied Health > Tooth Extraction

Definition

Tooth extraction is the removal of a tooth from its socket in the bone. It is performed to control disease, improve function, or treat malocclusion.

Purpose

Tooth extraction is performed for many reasons. Teeth are often removed because they are impacted, that is, they cannot erupt normally on their own. Teeth become impacted when they are prevented from growing into their normal position in the mouth by gum tissue, bone, or other teeth. Wisdom teeth sometimes are impacted and require extraction. Teeth might also require extraction if they cause pain or cause crowding of other teeth.

Teeth may also be extracted to make more room in the mouth prior to straightening the remaining teeth (orthodontic treatment), or to make room for the placement of dental implants or dentures. Sometimes, teeth are extracted because they are so badly positioned that straightening is impossible. Extraction may be necessary because of severe gum disease or because the teeth are so badly decayed or broken that they cannot be restored. Patients also sometimes choose extraction as a less expensive alternative to filling or placing a crown on a severely decayed tooth.

Precautions

Tooth extractions may sometimes need to be postponed temporarily. Such situations include:

• When an infection has progressed from the tooth into the bone. Infections may make anesthesia difficult and can be treated with antibiotics before the tooth is extracted.
• When a patient takes blood-thinning medications (anticoagulants), such as warfarin (Coumadin) or aspirin. The patient may need to stop using these medications for three days prior to extraction if medically advisable.
• When patients have had any of the following procedures in the previous six months: heart valve replacement, open-heart surgery, prosthetic joint replacement, or placement of a medical shunt. Such patients may be given antibiotics to reduce the risk of bacterial infection.

Description

Once the area has been numbed with a local anesthetic, an instrument called an elevator is used to loosen (luxate) the tooth, widen the space in the bone, and break the tiny elastic fibers that attach the tooth to the bone. When the tooth is dislocated from the bone, it can be lifted and removed with forceps.

If the extraction is likely to be difficult, the dentist may refer the patient to an oral and maxillofacial surgeon, a specialist trained to give intravenous sedatives or general anesthesia to relieve pain. Examples of difficult procedures are extracting an impacted tooth or a tooth with curved roots. This typically requires cutting through gum tissue to expose the tooth and may also require removing portions of bone to free the tooth. Some teeth must be cut and removed in sections. The extraction site may require one or more stitches to close the incision.

Preparation

Before an extraction, the dentist takes the patient's medical history, noting allergies and prescription medications. A dental history is also taken, with particular attention to previous extractions and reactions to anesthetics. The dentist may then prescribe antibiotics, or consult with the physician and recommend stopping certain medications prior to the extraction. The tooth is x rayed to determine its full shape and position, especially if it is impacted.

If the patient is going to have deep anesthesia, loose clothing should be worn that allows access for an intravenous line. The patient should not eat or drink anything for at least six hours before the procedure. Arrangements should be made for a friend or relative to drive the patient home afterwards.

Women who take oral contraceptives are twice as likely to develop dry socket, a common complication in which a blood clot does not properly fill the empty socket after extraction. Women taking birth control pills should try to schedule their extractions during the last week of their cycle to coincide with low estrogen levels.

Aftercare

An important goal of aftercare is achieving clot formation at the extraction site. The patient should put pressure on the area by biting gently on a roll or wad of gauze for several hours after surgery. Once the clot is formed, it should not be disturbed. The patient should not rinse, spit, drink with a straw, or smoke for at least 24 hours after the extraction and preferably longer. Vigorous exercise should be avoided for the first three to five days.

For the first two days after the procedure, the patient should drink liquids without using a straw and eat only soft foods. Any chewing should be done on the side away from the extraction site. The mouth may be gently cleaned with a toothbrush, but the extraction area should not be scrubbed.

Facial swelling is a normal part of the healing process and is most pronounced in the first 48 to 72 hours. Wrapped ice packs can be applied to help it. As swelling subsides, the patient may experience muscle

stiffness. Moist heat and gentle exercise usually restores normal jaw movement. The dentist may prescribe medications to relieve postoperative pain.

Complications

Potential complications of tooth extraction include temporary numbness from nerve irritation and jaw joint pain, which usually resolve with time but can be treated with over-the-counter pain-killing medications. Antibiotics are given if postoperative infection develops. If dry socket occurs, the dentist must wash out the area and pack the socket with an antiseptic paste and cover it with a dressing. These dressings must typically be changed a few times by the dentist before the problem resolves. Jaw fracture or bone fragments left behind in the gum are unusual complications that may require further surgical intervention.

Results

After an extraction, the wound usually closes in about two weeks. It takes three to six months for the bone and soft tissue to restructure. Complications such as infection or dry socket may prolong the healing time.

Health care team roles

Dental assistants and dental hygienists can assist with taking pre-extraction x-rays. Dental assistants usually

prepare the room for the procedure and assist the entist during the extraction, as well as educate patients about post-operative home care.

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KEY TERMS

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Dental implants—Anchors placed on bone, which are used to secure bridges, partials or dentures.

Dry socket—A painful condition following tooth extraction in which a blood clot does not properly fill the empty socket. Dry socket leaves the underlying bone exposed to air and food.

Extraction site—The empty tooth socket following removal of the tooth.

Impacted tooth—A tooth that is in an abnormal position or is growing against another tooth or a bone so that it cannot erupt normally.

Luxate—To loosen or dislocate the tooth from the socket.

Oral and maxillofacial surgeon—A dentist who specializes in surgical procedures of the mouth, including extractions.

Orthodontic treatment—The process of straightening teeth to correct orofacial appearance and function.

Wisdom teeth—The third molars.

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Lisette Hilton