In odontology, our work focusses on keepingallteethhealthy,withoutextractingthem;however, sometimes extraction is unavoidable.
Reasons for extraction
Chronic periodontitis, also known as pyorrhoea
After years of destroying the gum and bone structure, periodontitis eventually results in a moving tooth. This may mean that one or more teeth have to be taken out.
Using dental implants to replace missing teeth has changed the moment of extracting teeth affected by severe gum disease. Before, we used to wait as long as we could, sometimes until the tooth fell out by itself.
Today we don’t wait as long and tend to extract teeth that we know have no hope of survival before the point of no return, i.e. before too much bone is lost, since we need it to fit the implant.
If we wait too long, it will be impossible to fit an implant after extraction, or even to regenerate the bone.
Deep tooth decay affecting the roots
In this case it is impossible to apply a root canal or endodontics to the tooth, since its roots are no longer intact. This means that we cannot reconstruct it with composite or fit a crown.
A fractured tooth, if said fracture affects the root
Vertical fractures, which sometimes occur in highly reconstructed teeth, even in those which have no previous fillings, mean that the tooth must be extracted. Deep fissures, without total fracture of the tooth, also lead to chronic infection which cannot be cured, even with antibiotics.
Impacted teeth either completely encased in bone or which have grown in slightl
These teeth are extracted when they have already caused, or we can see that they will cause, repeated infection. Here we mainly refer to wisdom teeth, which grow in at between 17 and 25 years of age, and often don’t have enough space to grow into.
In the case of the canines, particularly if they are impacted in the palate, they can be pulled into place using orthodontic techniques, if there is enough space for them in the dental arch.
To proceed with orthodontics, in the event of crowded teeth
This is when the teeth are slightly or excessively crossed over one another, and when there is not enough space for all of them in the upper or lower jawbone. To make space, a tooth must be extracted – often the first or second premolar – in order to leave enough space for the others.
Clinical background and medication
We analyse possible general diseases (of the heart, respiratory tract, allergies, etc.) and their corresponding medication, to know whether or not they could cause a problem during the operation, and
whether they interfere with the medication prescribed for the extraction itself, such as antibiotics and anti-inflammatory medication.
It is important not to forget blood thinners and antiplatelet drugs like Sintrom and Adiro (aspirin), since people who take these medicines could suffer heavy bleeding during the extraction.
We analyse the anatomy of the tooth to be extracted, any restoration work such as fillings and reconstructions, and the state of the roots, i.e. whether they are broken or infected. We also check for the existence of cysts, or deconstruction of the bone around the tooth due to periodontitis. This enables us to plan the extraction and know whether or not there will be complications.
Anaesthesia is not only essential, it also means that the tooth extraction will be painless.
In a normal extraction, the tooth is pulled away from its base and taken out. Sometimes, in the case of curved roots, or where the crown of the tooth is in very bad condition, we separate the roots with a drill to extract them.
If the tooth has half grown, or is inside the gum, as in the case of impacted wisdom teeth, we make an incision with a scalpel to separate the gum and extract the piece. The space is then stitched if required.
Post-operative medication and advice
As already said, this is a question of antibiotics and anti-inflammatory medication to be taken in a dose and for an amount of time depending on the state of the tooth and the gum prior to the operation, and of the intensity of the surgery required for the extraction.
Prevention of potential complications
Discomfort or pain
We always prescribe anti-inflammatory medication such as ibuprofen. If the patient has no inflammation, they can also take paracetamol or nolotil.
This will depend on the complication of the operation. To prevent swelling, the patient will take ibuprofen and use ice or the like held against their cheek in the area from which the tooth was extracted.
To stop bleeding, the best solution is to bite on a ball of gauze for some 30 minutes. If the bleeding continues, the operation should be repeated.
The patient should not drink hot liquids for 24 hours; heat expands the arteries and increases bleeding. Food should be eaten warm rather than hot during the first couple of days, and ice cream or cold yoghurt are recommended as they will help to calm the inflammation and the bleeding.
This is prevented and treated with antibiotics taken before, during and after the extraction. The type of antibiotic and the duration and instructions of the treatment will be prescribed at the surgery before and after the extraction.
Replacement of the extracted tooth or teeth
This will be done using different kinds of dental prostheses. Initially, while healing, a provisional prosthesis can be used. Later, we will proceed with the permanent teeth which can be fixed in place, such as an implant or bridge, or removable.
If you are very worried about the extraction, at our surgery we can prescribe sedatives to make the experience highly tolerable.