Tooth Extraction

This is when your tooth is removed.

Extraction may be offered for several reasons – here are some examples:

• The tooth is no longer restorable- this may be due to the size or extent of decay, tooth fracture or the available remaining tooth structure.
• A dental abscess
• To resolve dental pain. (You will be given all your available options before this is decided which may include root-filling as another option if the tooth suitable).
• If the tooth is very loose
• If the tooth has severe gum (periodontal) disease.
• To help align teeth (following an orthodontist assessment)

Usually tooth extraction is straightforward. You should not feel pain. During the procedure you will feel pressure and hear noises. Some extractions are more complex and may take more than one appointment or require a referral. Your dentist will explain all of this to you.

It is very important after an extraction to take care of the area. Keep the area very clean while it heals – your dentist will tell you how best to do this and we have an information/advice leaflet to remind you.

Certain medications can require greater planning- for example if you take anti-coagulants (blood thinners) or if you are taking (or have taken) bisphosphonates.

Removal of lower molar teeth

Some molar (back) teeth are very close to nerves in the lower jaw. Removal of a tooth which is very close can cause numbness, pain or tingling to the tongue, lip and chin area. If this happens, it is usually temporary but very occasionally it can be permanent.

Your dentist is likely to take x-rays of the teeth which can help tell you whether your teeth are close to the nerves. Where there is a high risk of nerve injury you may be referred to a specialist oral surgeon.

Removal of upper molar teeth

• The roots of upper molar teeth may be close to the sinuses, which are air spaces near your nose.
• Very rarely, after removal of a tooth there can be fracture of the supporting bone or part of the membrane that forms part of your sinus. If this happens, It is called an OAF (oro-antral fistula).

Why is it a problem?

An OAF can cause liquids to pass from the mouth into the sinus and exit through the nose, potentially leading to infection (sinusitis).

Symptoms:

• Fluid going from the mouth to the nose when drinking.
• Sensation of air rushing through the socket as you breathe.
• Pain, especially if sinusitis develops.

Treatment:

• Small OACs (Oroantral Communications) may heal spontaneously, but larger ones or those that persist require surgical closure.
• Surgical closure involves closing the hole and covering it with tissue to help the area heal and form a permanent barrier.
• The aim of treatment is to eliminate infection from the sinus and cover the defect with a suitable graft or flap.

Prevention:

• Your dentist or surgeon may elect to remove the tooth surgically, dividing the roots and possibly removing some bone, to preserve the sinus floor and reduce the risk of OAF formation.
• Avoid blowing your nose for a few weeks after the extraction and sneeze with your mouth open to prevent pressure buildup.
• Maintain good oral hygiene to prevent infection.

Post-operative instructions:

• Avoid hard foods and sharp foods that may interfere with the healing wound.
• Eat soft foods and drink fluids from the opposite side of the extraction.
• Steam inhalations with aromatic substances can help moisten airways and prevent crusting of blood and mucus.

Any risks will be explained by your dentist. Your dentist will help you understand what is involved.