Tooth Extractions

Wisdom teeth need to be extracted if they cause pain, overcrowding in your teeth, or become impacted. The decision about whether or not to have wisdom teeth pulled will mainly depend on whether they are already causing trouble or whether it is highly likely that they will in the future. It is important to get answers to the following questions before having any wisdom teeth removed:

• Have your wisdom teeth already caused pain or damage to your jaw or neighboring teeth, or is there an increased risk of that happening?
• Are the wisdom teeth preventing the other teeth from developing properly?
• Might the wisdom teeth interfere with other dental or jaw-related treatments that are already planned?
• What risks are involved?
• Could the wisdom teeth be used to replace other lost or badly damaged molars (back teeth)?

People who have crooked incisors (front teeth) or a small jawbone sometimes worry that their teeth may start pushing each other to the side even more when their wisdom teeth grow out of the gum. But that’s not necessarily the case. The same is true for those people: Their wisdom teeth can be left in if the dentist doesn’t expect them to affect other teeth

Some people believe that removing wisdom teeth is a waste of time if they aren’t causing any problems. Others think that the teeth will only cause trouble and have no real function anyway. There are actually good reasons to carefully consider whether you should have them removed. There are still many unanswered questions about wisdom teeth. This is one of the reasons why there are so many contradictory opinions about them. Some dentists recommend removing wisdom teeth no matter what – even if they aren’t causing any problems.

Please talk to your dentist and weigh the pros and cons of whether wisdom teeth should be removed or not.

If your wisdom teeth are not causing you any problems and cause any overcrowding, we don’t recommend pull them out.

Nerves and blood vessels can be damaged during the procedure. This can cause bleeding and usually temporary numbness in the tongue or face. In very rare cases it may cause a serious infection. Up to 1 out of 100 people may have permanent problems related to the procedure, such as numbness or damage to neighboring teeth. The risk will depend on how extensive the procedure needs to be.

Most people have swelling around their mouth or cheeks after surgery and can’t fully open their mouth for a few hours or even a few days. Many have pain right after the operation, but it doesn’t last long.

If the pain returns after four or five days, though, and also gets worse and is accompanied by swelling or bad breath, the wound could be infected. This can happen if the dried blood that closes the wound comes off too soon, leaving the wound unprotected. Antiseptic mouthwashes or gels can help to prevent these kinds of complications. There’s no need to routinely take antibiotics. Wisdom teeth are typically removed under local anesthesia. General anesthesia may be used for more complex procedures.

Wisdom teeth often do not come in or they only partially break through the gum. Up to 80% of young people in Europe have at least one wisdom tooth that hasn’t broken through. This is more common in the lower jaw than it is in the upper jaw. The reason is usually that there isn’t enough room in the jaw. This can mean that other teeth get in the way of the wisdom tooth, or that it comes in crooked.

Wisdom teeth that don’t break through (sometimes also called “impacted” wisdom teeth) might not cause any problems. But some people have pain, swelling or inflamed gums. Impacted wisdom teeth may also push other teeth out of the way.

But even wisdom teeth that have already come in can also push against other teeth, grow in the wrong direction, and cause inflammation, tooth decay or other complications.

Many people use painkillers after they have had wisdom teeth pulled, and sometimes pain relief medication is also given before the procedure. Both ibuprofen and acetaminophen (paracetamol) can help relieve pain after surgery. ASA (the drug in “Aspirin”) is not suitable before or afterwards because it can increase the risk of bleeding.

Research shows that a 400 mg dose of ibuprofen relieves pain better than a 1,000 mg dose of acetaminophen does. A combination of 1,000 mg acetaminophen and 400 mg ibuprofen relieves pain better than an equal dose of acetaminophen or ibuprofen on their own, and the effect lasts longer too. Adults should only take this combination every eight hours at most to avoid going over the maximum dose for both drugs. The maximum dose of ibuprofen in adults is 800 to 1,200 mg in 24 hours. The maximum dose of acetaminophen is 4,000 mg in 24 hours.

For a few days after the procedure, holding an ice pack against your cheek can help to reduce swelling. Smoking, fruit juices and hot drinks should be avoided at first as they can slow down the healing process. Hard foods also sometimes cause problems. Soups and foods that can be crushed using your tongue are easier to eat, like potatoes, fish or pasta.

It’s better to avoid doing strenuous physical activities like sports or going to the sauna in the first few days after having your teeth pulled – even if you’re already starting to feel better – because that could also affect the healing process.

[source: national center for biotechnology information]

There are a number of reasons why you might need an extraction:

• You have too many teeth: This condition, called hyperdontia, may mean you need one or more teeth pulled to prevent biting and chewing problems.
• You’re getting braces: If you’re a candidate for braces, your dentist may want to remove one or more teeth to make room in your mouth so the braces can work properly.
• You have a tooth infection: You may have an infection in the tooth pulp, which is the area inside the tooth’s root. Sometimes pulling a tooth is the only option to kill the infection and stop the pain.
• You have a loose tooth: If your tooth is loose because of gum disease, then it might be pulled to stop the spread of infection and help save the bone left in the jaw.
• You’re ill: If you’re fighting cancer or have a compromised immune system, you may need decayed teeth pulled to prevent continued spread of infection.

The cost for tooth extraction varies widely depending on whether the tooth is impacted. Simple extraction usually costs between $100 and $200 per tooth, and may be more depending on the type of anesthesia you need.

The cost to remove impacted teeth is significantly higher and can land anywhere between $800 and $4,000. If a general anesthesia is administered, the cost will generally be high.

Before scheduling the procedure, your dentist will take an X-ray of your tooth. Be sure to tell your dentist about any medications you take, as well as vitamins, supplements, and over-the-counter drugs. X-ray is needed to determine the position of all internal structures that could be affected by the surgery.

• If you have an infection, a weak immune system, or certain medical conditions, your dentist may prescribe antibiotics to be taken before or after surgery.
• Never smoke on the day of your surgery, and inform your dentist if you have become sick with a cold or gastrointestinal illness.
• Follow your pre-surgery instructions carefully.

Simple Extractions:

Most affordable dentists can perform simple tooth extractions using a local anesthetic injection. If you are nervous, you may be offered an oral sedative or conscious sedation. The dentist then uses an instrument called an elevator to loosen the tooth and forceps to remove it.The dentist then uses an instrument called an elevator to loosen the tooth and forceps to remove it.

Surgical extractions may require general anesthesia or deep sedation. In addition to pain relief medicines, you may receive steroid drugs to help reduce inflammation. If you feel any pain during your procedure, tell your dentist immediately. The general dentist or oral surgeon will cut into your gum with a small incision. They may need to remove bone around your tooth or cut your tooth before it can be extracted.

Experiencing some degree of discomfort is normal after most extractions. Take your prescribed pain medications as directed. Some bleeding is also expected. Ice packs can relieve pain and swelling. Never spit or use a straw within the first 24 hours of an extraction; this can dislodge the newly formed blood clot and may cause a painful condition known as dry socket. The use of medicated dressings can help relieve dry socket symptoms. Call your dentist or oral surgeon if pain, bleeding or other symptoms increase or persist after several days.

It normally takes a few days to recover after a tooth extraction. The following steps help ensure that your recovery goes smoothly.

Apply an ice pack to your cheek directly after the procedure to reduce swelling. Use the ice pack for 10 minutes each time.

After the dentist places the gauze pad over the affected area, bite down to reduce bleeding and to aid in clot formation.

Leave the gauze on for three to four hours, or until the pad is soaked with blood.

Take any medications as prescribed, including over-the-counter painkillers.

Rest and relax for the first 24 hours. Do not jump immediately into your regular routine the following day.

Don’t use a straw for the first 24 hours.

Don’t smoke.

Don’t rinse for 24 hours after the tooth extraction, and spit only gently.

Use pillows to prop your head up when you lie down.

Brush and floss your teeth like normal, but avoid the extraction site.

The day after the procedure, eat soft foods, such as yogurt, pudding, and applesauce.

After 24 hours, add a half-teaspoon of salt to eight ounces of warm water to rinse out your mouth.

As you heal over the next few days, you can slowly reintroduce other foods into your diet.

If you are experiencing pain that isn’t going away after several days or signs of an infection —including fever, pain, and pus or drainage from the incision — make an appointment to see your dentist as soon as possible.