When should a tooth be taken out?

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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.

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 Extraction stage

 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.

X-ray

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.

Local anaesthesia

Anaesthesia is not only essential, it also means that the tooth extraction will be ​painless​.

Surgical stage

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.

Swelling

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.

Bleeding

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.

Infección

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

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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.