It used to be the assumption that as we got older, we’d lose our natural teeth. The good news is that people today are keeping their teeth longer than ever before. In fact, 75% of Americans over the age of 65 still have some or all of their natural teeth. However, sometimes tooth extraction can’t be avoided. While there are many things your dentist can do to save a tooth that’s in trouble, we’re going to list some common reasons a tooth may need to be pulled.
Trauma or decay
When trauma or decay damages a tooth, your dentist will attempt to fix it, usually with a filling or crown. Fillings help repair damaged teeth and return them to their normal function. They also help to prevent further decay. Crowns are used when the structure of the tooth is compromised, and they completely cover the tooth from the gum line to the tooth’s surface. However, a tooth can have damage that’s beyond repair that makes tooth extraction a necessity.
A tooth may need to be pulled to allow for the proper alignment of the other teeth. This is commonly done in patients getting braces or other orthodontic treatments. In some cases, proper alignment may be impossible if the teeth are too big for the mouth. Removing a tooth can make much-needed space so that the other teeth can move into line. Sometimes a tooth won’t be able to come in through the gum because there’s simply not enough room in the mouth for it. Your dentist may recommend tooth extraction in that case.
When tooth decay or tooth damage spreads into the tooth’s pulp — the sensitive center of the tooth that holds nerves and blood vessels — bacteria can get into the pulp and cause infection. It’s possible that a dentist or oral surgeon can remedy the damage and infection through root canal therapy. During a root canal, the dental professional takes out the nerves and pulp and then cleans and seals the inside of the tooth. Millions of teeth avoid extraction each year thanks to root canals.
When a root canal and antibiotics don’t resolve the infection, tooth extraction may be necessary to stop the infection from getting worse and spreading.
Compromised Immune System
Sometimes a tooth needs to be extracted if there’s a chance that it may become infected. This is the case if a patient has a compromised immune system, such as during chemotherapy or after an organ transplant. During chemo, a person is more likely to get an infection, which can be dangerous. To best fight cancer, a dentist should be part of any cancer-fighting team. Patients should visit a dentist before they start treatment whenever possible. People with organ transplants are at a high risk of infection because of the immune-suppressing drugs they must take.
Periodontal disease, commonly known as gum disease, is one of the leading causes of tooth loss. If your dentist has told you that you’ve got it, you’re not alone: One out of every two adults in the U.S., age 30 and older has periodontal disease. Periodontal disease happens when gums pull away from the teeth and create pockets that become infected. The bone and connective tissue that keeps the teeth in place start to break down from bacterial toxins and the body’s natural immune response to the infection. If left untreated, the bones, gums, and tissue that support the teeth are destroyed. The teeth become loose over time and require extraction.
Problematic Wisdom Teeth
Wisdom teeth are often removed before or after they come in during the late teens or early 20s. If they’re decayed, a source of pain or are infected, extraction is usually necessary. If the wisdom teeth are above the gum line, a simple extraction may be sufficient. However, wisdom teeth are frequently problematic and require surgical removal due to impaction, which is when the tooth gets wedged in the jaw and doesn’t come in.
How a Tooth is Extracted
With the help of x-rays, your dentist or oral surgeon will determine the best way to remove the tooth or teeth. Tooth removal is done in the dentist’s office. There are two types of extractions:
1. Simple extraction.
If the tooth is visible in the mouth, your dentist may be able to remove it via simple extraction. He or she uses a tool called an elevator to loosen the tooth and then removes the tooth with forceps. Many simple extractions can be performed using just a local anesthetic.
2. Surgical extraction.
This more complicated procedure is necessary when a tooth is below the gum line, whether the tooth has broken that far down, or it hasn’t come in yet. This usually requires the dentist to make a small incision in the gum. It may also call for removing some bone or cutting a tooth in half in order to take the tooth out. You’ll receive a local anesthetic for a surgical extraction, and you may also receive anesthesia.
You can expect to feel pressure, but not pain, during a tooth extraction.
After Tooth Extraction
Your doctor will give you instructions on what to expect after extraction. Some discomfort is normal and typically is mild. Taking nonsteroidal anti-inflammatories, such as ibuprofen, can substantially reduce pain after a tooth extraction. Take the amount your dentist recommends, generally three to four times a day for three days. Putting ice packs on your face to reduce any swelling is also helpful. A gentle salt water rinse, beginning 24 hours following surgery, helps to keep the extraction site clean. Everyone heals at a different rate, but it commonly takes about two weeks for initial healing to be complete.