Tooth extraction - Medical Experts

Tooth extraction may be considered if a diseased or damaged tooth cannot be saved. Tooth decay and periodontitis are the most common reasons for this procedure in adults. Orthodontic treatment may also be an indication.

• Apical periodontitis: A condition affecting the root of the tooth may make tooth extraction necessary.
• Accidental injury: A broken or otherwise damaged tooth may need to be extracted.
• Orthodontic treatment: Teeth are sometimes extracted to facilitate further treatment.
• Impacted tooth: If the tooth is deeply embedded in the jawbone, surgical intervention may be required.

Some patients wish to have a tooth extracted before a decision on treatment has been made. The reason behind this wish is not fully understood. Pain alone does not determine whether extraction is the appropriate treatment.

Before a tooth extraction, it must be assessed whether the tooth can still be saved. This applies particularly to a tooth damaged by periodontitis.

After tooth extraction, the resulting gap can be filled with a dental prosthesis. The most suitable solution cannot be determined solely on the basis of the reason for the extraction.

Before the tooth extraction, the treating dentist should be informed about any blood-thinning medication you are taking and whether you smoke. This information influences the assessment of the risk of bleeding and the planning of aftercare.

• Blood-thinning medication: Please state the name of the medication and do not alter your dosage without consulting your dentist.
• Multiple planned extractions: If you are taking blood-thinning medication, the risk of post-operative bleeding increases if several teeth are removed in a single appointment.
• Smoking: This increases the risk of dry socket and should be discussed before the procedure.

Blood thinners should not be stopped before a tooth extraction without consulting a doctor. In a meta-analysis, the risk of bleeding whilst continuing to take them was not significantly higher than after stopping them. The decision depends on your individual risk and the planned procedure.

A simple tooth extraction is usually carried out under local anaesthesia. It differs from surgical tooth extraction, in which deeply seated or impacted teeth are removed surgically.

1. The dentist administers a local anaesthetic to the area around the tooth to be removed.
2. A pair of dental forceps, a lever or both instruments are used for the extraction.
3. The tooth is then removed from the socket.

It is not possible to specify a fixed duration for every simple tooth extraction. For the surgical removal of an impacted tooth, the professional body estimates approximately 15 to 30 minutes per tooth, depending on the complexity of the procedure. This timeframe is not intended as a guideline for the routine extraction of a tooth.

Planned wisdom tooth surgery constitutes a separate treatment case. Local anaesthesia is usually sufficient for the surgical removal of impacted wisdom teeth. For sensitive patients, or when several wisdom teeth are being removed, twilight sedation or general anaesthesia may also be considered.

Oral and maxillofacial surgery is the specialist field responsible for the surgical removal of teeth that are deeply embedded in the bone or impacted.

Most of the tooth sockets examined in a study healed without complications following a non-surgical tooth extraction. However, post-operative bleeding, an infection of the tooth socket and a dry socket – medically known as alveolitis sicca – are possible.

• Dry socket: According to a review, this painful healing complication occurs in 1% to 5% of routine tooth extractions.
• Typical symptoms: Severe pain usually begins around two to three days after the procedure and may be accompanied by bad breath.
• Absence of a blood clot: In a dry socket, the protective blood clot in the tooth socket is either partially or completely absent.
• Infection: An infection of the socket is one of the possible healing complications.
• Post-operative bleeding: The risk increases in people taking blood-thinning medication, particularly when several teeth are extracted at the same time.

In a meta-analysis, smoking was associated with a more than threefold increased likelihood of developing a dry socket. This association should be taken into account when planning post-operative care.

After a tooth extraction, a stable blood clot must be allowed to form in the wound. One of the care instructions examined was therefore not to rinse the mouth for the first 24 hours.

If bleeding occurs, applying pressure with a gauze swab can help. In a study of people taking blood-thinning medication, most of the bleeding observed was stopped in this way.

Mild pain following a tooth extraction does not automatically indicate impaired wound healing. Anti-inflammatory painkillers such as ibuprofen can help with acute discomfort. The medication must be suitable for the patient’s medical conditions and other medicines they are taking.

If severe pain occurs or existing symptoms worsen, a dental examination is advisable. This is particularly true if the pain only becomes noticeable a few days after the tooth extraction. The dentist can check for inflammation, infection or dry socket.

According to the professional association, wound healing following surgical tooth extraction takes around one week. However, this does not describe the complete healing of the underlying jawbone. Furthermore, this information cannot be readily applied to every simple extraction.

Simple tooth extractions are carried out by dentists and specialists in oral surgery. Dental care encompasses the assessment of the tooth, the planning of treatment and the subsequent care.

It is important that the practitioner has experience with the specific type of extraction planned, whether simple or surgical. During the initial consultation, the dentist should explain clearly why the tooth needs to be removed and whether a treatment to preserve the tooth is an option.

You can ask the following questions during the initial consultation:

• Why does the tooth need to be removed?
• Is there a realistic possibility of saving the tooth?
• Is a simple extraction possible, or will the tooth need to be removed surgically?
• What level of pain and swelling can I expect after the procedure?

You can find specialists in tooth extractions at the end of this text.