The way in which a dentist pulls, or extracts, teeth is not a complicated procedure. There are several tools a dentist can use and what they choose to use depends on the location and other factors in each individual case. In dental terms there are two types of extractions, simple or surgical. However, both types of extractions include cases that are easy and those that are difficult.
Teeth are tightly rooted in the jaw bone, which holds them firmly in place in the oral cavity. However, some teeth have only one or two root chambers, while others have three or four root chambers. Some people have perfectly straight teeth, others do not. In a patient who has overcrowded, crooked teeth, shifting takes place and the roots of some teeth may be wrapped around roots of other teeth or the jaw bone. In the patient who has had previous extractions and did not have a bridge or partial set in place, some shifting may also occur. A dentist practicing general dentistry usually refers these type cases out to an oral surgeon for extraction.
When a patient develops a toothache, soreness or pressure around a tooth, or other indication of a problem with a tooth, their dentist looks at the area in question and takes an x-ray of the area. The dentist can tell by looking at the x-ray if an abscess is present beneath the gum line. Most dentists will prescribe an antibiotic to be taken for ten full days as well as pain medication for the patient. Delaying the extraction ten days allows a more comfortable procedure for the patient. A patient who has active pain and infection present when a tooth is pulled is more difficult to successfully administer an anesthetic to. The dentist certainly does not want to pull a tooth when it is not fully numb. Avoid caffeine use for a few hours prior to the extraction appointment. Caffeine can interfere with anesthetic.
At the second appointment for a simple extraction, the dentist may take an additional x-ray of the tooth. The dentist will then administer the anesthetic. A topical anesthetic on a swab is first administered at all sites the dentist will be injecting with an anesthetic. If the tooth is located in the anterior of the mouth, it will probably be necessary for the dentist to include an injection into the roof of the mouth. The medication numbs the soft tissues around the tooth and nerves feeding into the tooth so the patient will feel nothing more than a bit of pressure when the tooth is removed. It normally takes fifteen to twenty minutes for the patient to become numb enough for the procedure to begin.
The dental assistant will usually go over the precautions the patient should take after the procedure is done in order to avoid what is called a dry socket. A dry socket occurs when the patient sucks the blood clot out of the socket the extracted tooth was in. Pain from a dry socket is usually much worse than the toothache had been. All patients should heed these precautions. No smoking or no use of straws are allowed during the first 48 to 72 hours after the extraction. Any sucking or spitting motion made with the mouth can cause the newly formed clot to dislodge. If this happens, the patient has to return to the office to have the socket medicated and packed and often more than once. I saw several patients during my years in the dentistry field who failed to take these precautions and all deeply regretted it.
Once the patient has informed the dentist that they are fully numb, the procedure usually does not take but a few minutes. A roll of gauze is usually placed between the gum and inside cheek to catch saliva flow and blood loss from the socket. The dental assistant will keep a suction tube in place and move it as necessary to remove blood and excess saliva flow.
Dentists often use a tool called an elevator to perform the extraction. A dental elevator does exactly what the name implies, elevates the tooth. The tool allows the dentist to simply "walk" the tooth out in seconds. The tool is similar to a wedge and is inserted in the small gap between the tooth to the pulled and the adjacent tooth. As the dental elevator slides below the gum line beside the tooth's root, it widens the socket enough that the tooth loosens and slips out with ease.
A dentist may choose to use a pair of dental extraction forceps to pull a tooth. There are several types of forceps, made different for specific tooth locations in the mouth. All types of extraction forceps look like a small pair of pliers to a patient. Extraction forceps are made to grip tightly to the tooth and allow the dentist to apply maximum pressure at the roots. The dentist will rock the tooth to one side and then the other to widen the socket and allow the tooth to slip out.
In cases where a dentist cannot widen the socket enough to get the tooth out, a dental chisel may be used to split the tooth into sections. By splitting it into, the dentist can then get enough leverage between the pieces to extract the tooth.
After the dentist has completed extraction of the tooth, the dental assistant will elevate the chair to an upright position. The patient will be given damp gauze to clean any area needed on their face or lips. The patient will also be given a pack of sterile gauze to keep on the area of the extraction until the bleeding stops. Most likely the dentist will have left a prescription with the assistant to give the patient for pain medication for the first few days after extraction. Some patients complain of tenderness or soreness of tissue or muscle. The dental assistant should caution the patient if they go to sleep before the bleeding stops they may possibly awake sick at their stomach from swallowing bloody saliva.
If the patient was referred out to an oral surgeon for the extraction, the patient is given the x-ray to present to the oral surgeon. Usually a consultation appointment is made immediately for the patient and the patient then returns to the oral surgeon for the extraction. In some cases the appointment is set only for an extraction but time is allowed for the patient to take an antibiotic prescribed by the dentist. This also gives the surgeon's office staff time to verify insurance dental insurance benefits and get pre-authorizaton for the surgical extraction.
Patients are also referred to oral surgeons for removal of impacted wisdom teeth or a severely decayed tooth that broke at the gum line. An impacted wisdom tooth is one in which the patient's oral cavity was not large enough for it to fully erupt the gum. As the tooth developed, the root system wrapped around the adjacent tooth and possibly the jawbone. The tooth is deadlocked, so tightly bound it never will be able to erupt the gum line. The only choice is to remove it.
The oral surgeon will view the x-ray the dentist sent with the patient prior to extracting the tooth. If the patient fails to take the x-ray to the appointment, a new x-ray will be taken before the oral surgeon will begin. They must confirm the identity of the tooth to be extracted and know the structure of the tooth and root system in order to decide how best to proceed.
The patient will receive anesthetic by injection in the same manner as above. If a patient is apprehensive, they may choose to be consciously sedated or choose general anesthesia. If the patient is using sedation, someone needs to accompany the patient to the appointment that will be able to drive the patient home.
The oral surgeon most likely will use a dental chisel and dental forceps to extract a tooth in the case of a patient with an abscessed tooth referral. The oral surgeon will use the chisel to section the tooth and it is very possible they will need to make an incision in the gum. In the case of broken teeth near or at the gum line or impacted teeth, the oral surgeon will need to cut a flap in the gum in order to gain access to the crown of the tooth. These incisions will be sutured after extraction.
The oral surgeon's assistant will go over post surgical procedures with the patient. The patient will usually be cautioned not to use caffeine, smoke, or use a straw the first 48-72 hours. The patient will be given pain medication and scheduled for a follow up appointment. Most oral surgeons use dissolvable suturing so the patient can expect their stitches to dissolve within seven to fourteen days. The patient who has had stitches may experience itching during the healing process. Rinsing with warm salt water, after the first 72 hours, can help alleviate this, aid in dissolving the sutures, and it has antiseptic qualities.
Most patients who listen to and follow the advice of their dentist or oral surgeon both prior and after a tooth is pulled will not experience any problems with the procedure.