Although permanent teeth were meant to last a lifetime, there are a number of reasons why tooth extraction may be needed. The most common is a tooth that is too badly damaged, from trauma or decay, to be repaired. Other reasons include:
A crowded mouth. Sometimes dentists extract teeth to prepare the mouth for orthodontics. The goal of orthodontics is to properly align the teeth, which may not be possible if your teeth are too big for your mouth. Likewise, if a tooth cannot break through the gum (erupt) because there is not room in the mouth for it, your dentist may recommend extraction.
Infection. If tooth decay or damage extends to the pulp — the centre of the tooth containing nerves and blood vessels — bacteria in the mouth can enter the pulp, leading to infection. If infection is so severe that antibiotics do not cure it, extraction may be needed to prevent the spread of infection.
Risk of infection. If your immune system is compromised (for example, if you are receiving chemotherapy or are having an organ transplant) even the risk of infection in a particular tooth may be reason to remove the tooth.
Gum disease. If periodontal disease –an infection of the tissues and bones that surround and support the teeth — have caused loosening of the teeth, it may be necessary to extract the tooth.
Dentists and oral surgeons perform tooth extractions. Before removing the tooth, your dentist will give you an injection of a local anaesthetic to numb the area where the tooth will be removed.
If the tooth is impacted, the dentist will cut away gum and bone tissue that cover the tooth and then, using forceps, grasp the tooth and gently rock it back and forth to loosen it from the jaw bone and ligaments that hold it in place. Sometimes, a tooth that is difficult to remove must be taken out in pieces.
Once the tooth has been extracted, a blood clot usually forms in the socket. The dentist will pack a gauze pad into the socket and get you to bite down on it to help stop the bleeding. Sometimes the dentist will place a few stitches — usually self-dissolving — to close the gum edges over the extraction site.
Sometimes, the blood clot in the socket breaks loose, exposing the socket — a painful condition called dry socket. If this happens, your dentist will probably place a sedative dressing over the socket for a few days to protect it as a new clot forms.
Although having a tooth out is usually very safe, the procedure can allow harmful bacteria into the bloodstream. Gum tissue is also at risk of infection. If you have a condition that puts you at high risk for developing a severe infection, you may need to take antibiotics before and after the extraction. Before having a tooth removed, let your dentist know your complete medical history, the medications and supplements you take, and if you have one of the following:
Following an extraction, your dentist will send you home to recover. Recovery typically takes a few days. The following can help minimise discomfort, reduce the risk of infection and speed recovery.
It is normal to feel some pain after the anaesthesic wears off. For 24 hours after having a tooth out, you should also expect some swelling and residual bleeding. However, if pain is severe or bleeding continues for more than four hours after the extraction, you should call your dentist. You should also call your dentist if you experience any of the following:
The initial healing period usually takes about one to two weeks. New bone and gum tissue will grow into the gap. Longer term, however, having a tooth (or teeth) missing can cause the remaining teeth to move, affecting your bite and making it difficult to chew. For that reason, your dentist may advise replacing the missing tooth or teeth with an implant, fixed bridge or denture.