Wisdom Tooth Extraction

Whether you have a wisdom tooth extraction, or any other tooth removed, do so in a manner which preserves as much of your underlying jawbone as possible.

A dental extraction is the removal of a tooth from the mouth. Extractions are performed for a wide variety of reasons. Extensive tooth decay, impacted or problematic wisdom teeth, and to make space for orthodontic treatment, are some of the reasons extractions occur.

Types of Extractions

Extractions are often categorized as "simple" or "surgical".

Simple extractions are performed on teeth that are visible in the mouth, usually under local anesthesia, and require only the use of instruments to elevate and/or grasp the visible portion of the tooth. The tooth is lifted using an elevator, and using dental forceps, the dentists will rocked back and forth until the ligament has been sufficiently broken and the supporting bone has widened to make the tooth loose enough to remove.

Surgical extractions involve the removal of teeth that cannot be easily accessed. Wisdom tooth extractions are under this category. They have either broken under the gum line or have not erupted fully. With this type of procedure, the doctor may elevate the soft tissues covering the tooth and bone and may also remove some of the overlying and/or surrounding bone tissue with a drill or other dental device. In some instances, the tooth may be split into several pieces in order to facilitate its removal.

Wisdom Tooth Extraction

A wisdom tooth extraction should occur when the tooth has erupted and surfaced, and there is no room in the mouth for it to grow. If left untreated, it can become impacted and destroy the second molar. According to the American Academy of General Dentistry, third molar impaction is the most prevalent medical developmental disorder. Some of the symptoms associated with an jmpacted wisdom tooth include pain, gum infection, cysts and tumors, facial swelling and/or swelling of the gum line in the back of the mouth. If you are experiencing any of these symptoms with your wisdom teeth, please contact your dentist to see if a wisdom tooth extraction is warranted. Delaying a wisdom tooth extraction or the extraction of any other tooth can result in further harm to your oral health.

Post Wisdom Tooth Extraction Care

Review the following guidelines for caring for the extracted site area. Taking care of the wisdom tooth extraction site area for the first few days allows for better overall recovery.

• After the tooth is removed, whether it is from the wisdom extraction site or the site of any another tooth, using gauze pads, apply firm to the site for about 45 minutes. If bleeding persists, gauze should be replaced over wound and held in place by the patient biting on it for an additional 30 minutes. Repeat this process several times, until the bleeding stops. Small amounts of blood mixed in the saliva after extractions are normal--even up to 48 hours after extraction. If abnormal bleeding continues, contact your dentist immediately.


• If swelling occurs from a wisdom tooth extraction site or any other tooth extraction site, apply ice packs to the face where the site is affected for approximately 24 hours. You can use a towel wrapped around the head to hold the ice packs in place. When sleeping, use an extra pillow to keep the head elevated.


• If you experience moderate pain, Tylenol is usually recommended. If your pain is severe, and your doctor has prescribed medication (often following a wisdom tooth extraction procedure), take the prescribed medication.


• Do not rinse mouth for 24 hours following surgery. After a day, start to rinse frequently with 1 teaspoon of salt to a glass of warm water.


• It is normal for a clot to form in the socket of the wisdom tooth extraction or any other tooth extraction site. Occasionally, it will become dislodged, resulting in a condition called dry socket. This is most commonly found in wisdom tooth extractions of the lower molars, which have a lesser blood supply than the upper molars.
  Certain other factors also contribute to the development of dry socket. Factors such as age, smoking, extent of surgery preformed, duration of time the extraction site was surgically exposed, are some things which contribute to dry socket. Dry-socket lengthens the healing process and usually causes severe pain and discomfort. It is usually treated with medicated gauze, resorbable gel-foam or surgical packing that is changed every two to three days until tissue forms over the bone at the extraction site. These dressings often contain eugenol which alleviates dry-socket pain.
• Limit your diet to cool and soft foods as chewing and swallowing will be difficult during the healing process.

Infections

Infections after a wisdom tooth extraction or any other tooth extraction, although rare, may occur on occasion and swelling is often dictated by the amount of surgery performed to extract a tooth. Generally, when a surgical flap must be elevated, or when bone must be removed using a drill, minor to moderate swelling is more likely to occur.

Risks

Sinus exposure and oral-antral communication can occur with wisdom tooth extractions on the upper molars or the premolars in some patients. The upper sinus sits right above the roots of upper molars and premolars. There is a bony floor of the sinus that ranges in thickness from patient to patient. This bone divides the tooth socket from the sinus. In some cases, this bone is absent and the root of the tooth is in the sinus. In other cases, this bone may be extracted along with the tooth, or perforated during the surgical extraction. Your dentist should be able to determine the relationship between your tooth to your sinus, as if necessary, discuss the risks involved with the extraction procedure.

It is also important to note that the sinus cavity is lined with a membrane which may also be perforated during a surgical extraction. If this membrane is exposed after an extraction, but remains intact, a "sinus exposed" has occurred. If the membrane is perforated, however, it is a "sinus communication". These two conditions are treated differently.

If a sinus communication occurs, the options are to either let it heal on its own or to surgically close it. Surgically closing it is dependent upon the size of the size of the exposure as the patients ability to heal. In both cases, a resorbable material called "gelfoam" is typically placed in the extraction site to promote clotting and serve as a framework for tissue to accumulate. Patients are usually provided with antibiotics and instructions to follow during the healing period.

Nerve injury is primarily an issue involving extractions of third molars. However, it can occur with any tooth should the nerve be in close proximity to the surgical site. Two nerves are typically of concern, the inferior nerve and the lingual nerves. Injuries to these nerves can occur while lifting teeth, but are most commonly caused by damage with a surgical drill. Nerve injuries are rare and usually temporary, but depending on the type of injury, can be prolonged or even permanent.

The tooth, or part of the tooth, can be displaced into the upper sinus area. This occurs with the upper teeth only and in all cases, the tooth or tooth fragment must be retrieved. In some cases, the dentist can irrigate the sinus cavity with a saline solution and the tooth fragment may be brought back to the site of the opening and retrieved. At other times, a window must be made into the sinus in order to retrieve the tooth.

Jawbone and Extraction Site Preservation

When you need to have a tooth extracted, it is usually in your best interest to do so in a manner which preserves as much of your underlying jawbone as possible. From the time teeth are extracted, significant degeneration of the surrounding bone begins to take place. There are many options to prevent this, and it is important that you consider them before any teeth are removed. Some of these procedures are best performed at the time the tooth is removed.

There is a special type of bone called an aleveolar ridge bone which surrounds the teeth. Its sole function is to provide tooth support. When a tooth is removed, this bone begins to degenerate and "melt away." This occurs both in width and height and height of the bone. The width of the bone loss occurs when the bone surrounding the tooth that was extracted collapses. This causes the ridge to be narrower than when a tooth existed. The height of the bone then also collapses.

Fortunately, there are several choices available on how to replace an extracted tooth. All of the options rely on bone support and bone contour for the best function and esthetics. Here is a list of the possible options:

Dental Implants: Dental implants are root-shaped supports which hold the replacement teeth. The more bone support you have, the stronger the implants will be. In some cases, the bone can degenerate to a point where implants cannot be placed without having a more complex bone grafting procedures performed to create the necessary support.

Fixed Bridge: A fixed bridge is a restoration that is supported by the teeth adjacent to the missing tooth space. If the bone is deficient, there will be an unsightly space under the pontic (false tooth) that will trap food and affect your speech.

Dentures: Full or Partial Dentures are artificial teeth that are designed for patients who have lost either some or all of their real teeth on the upper and/or lower arches of the mouth.

Preserving Bone

There are two important phases used to retain the alveolar ridge during and after the tooth extraction. The first technique involves extracting the teeth while preserving as much bone as possible. The second phase is to add bone replacement material to the extraction socket. This is a type of bone grafting procedure with socket grafting supports.

After the tooth is extracted, the socket is packed with a bone-like material and covered with a small absorbable plug or suture. Initially, the grafting material supports the tissue surrounding the socket, but eventually the socket will be replaced by new alveolar bone. This bone will be an excellent support should you choose later to have dental implants. But keep in mind that the bone created by socket grafting supports cannot preserve the socket indefinitely. You should be prepared to have dental implants placed in the area at least four, but no longer than twelve months after the extraction and socket grafting procedure is performed. In this way, you will have the best long-lasting support for preserving the jawbone. If the procedure is done later than this timeframe, the graft may "melt away" or resorb over time.

Immediate Dental Implant Placement

In some selected cases, it is possible to extract the tooth and place the dental implant in the same visit. This is referred to as an immediate implantation. Please speak with your dentist about having a consultation prior to having an extraction performed if this is a procedure you would consider having.

Bone Preservation Costs

Patients usually receive bone preserving extraction techniques at no additional charge. There may be an additional charge for performing a socket grafting procedure at the time of the extraction. Charges may vary depending on the tooth location and number of teeth. Speak to you dental provider for more information.