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Tooth and Teeth extraction - procedure and complications

Tooth and Teeth Extraction

teeth extraction by blacksmith This picture of two to three centuries ago, shows what tooth extraction was like then.  The picture of the face contorted by extreme pain says it all.  It was also a common practice for tooth extractions to be performed on a stage in front of all passerby's.  Perhaps great entertainment then, but today we can take comfort in pain killing drugs and the privacy of our dentist's surgery, when a tooth needs to be extracted.


Preparation for a Tooth Extraction: Tooth Extraction Cost, Tooth Extraction Pain and other things to prepare for,

The Tooth Extraction - Procedure, how it is done,

What To Do After The Tooth Extraction - Tooth Extraction Care and Aftercare,

Tooth Extraction Complications - Complications During and After a Tooth Extraction which Includes Infection, Dry Socket, Bleeding and Misaligned Teeth, amongst others.

Long Term Complications of a Tooth Extraction.


Tooth Extraction Healing and a Warning if you are taking Osteoperosis Medications

Preparation for a Tooth Extraction:

Tooth Extraction Pain

In preparing for a tooth extraction, anticipate one big thing, pain and controlling that pain. 

The morphine based drugs, if you can get them, appear to work well when the tooth extraction is less than three days old; such drugs also help to put you to sleep and can be taken every four to 12 hours, depending on the strength.  The active ingredient is called oxycodone and, being a narcotic, it is normally a prescription medication. 

  The second type of pain medication to have on hand following a tooth extraction is ibuprofen, around the 400mg strength, which one can normally take every eight hours.

  Paracetamol and codeine based pain killers can be taken according to directions, but wont likely help much with pain relief following a tooth extraction, if the pain is very great.

  Do not take aspirin pain relievers, unless the risk of bleeding has passed and you have stopped the ibuprofen.

Tooth Extraction Cost

The cost of a tooth extraction may be a financial drain, so saving up a bit for a rainy day isn't such a bad idea.  The cost of a tooth extraction ranges from about $130 to $300.  The harder the tooth is to get out, the more it costs, hence the range.  The cost of the tooth extraction can go much higher, for example, if the tooth disintegrates, it can take the dentist a while to get all of it out and the dentist may charge you extra if that happens.

Other Preparations to Make for a Tooth Extraction

In preparing for a tooth extraction, be aware that the above pain relievers may cause constipation and thereby play havoc with hemorrhoids, so taking some high fibre capsules, such as Metamucil, may be quite important, so have some of these ready to take as well.

Taking about three to five days off work following a tooth extraction is suggested due to the pain and discomfort following the extraction of a tooth.  So one may want to arrange this time off work beforehand.

Clean your teeth really well and have your mouth as hygienically clean as possible when the tooth is pulled.

The tooth extraction:

You are now laying down on the dentist chair, mouth wide open, wondering how the dentist is going to get the tooth extracted.  Assuming nothing goes wrong with the tooth extraction, the likely procedure will be:

1..The dentist rubs a cotton bud soaked in anesthetic round the tooth to be extracted.  Front and back of the tooth.

2.. After a very little wait, he then starts a series of anesthetic injections around the tooth to be extracted.  A little bit of pain may be experienced with each injection.

3... After a slightly longer wait, another series of deeper anesthetic injections around the tooth to be extracted and if there is a tooth abscess, an injection will likely be placed into the abscess - an extremely painful injection for the most part.  I nearly flew through the roof.

4..If the dentist is caring, there may occur a minor wait, followed by another few deep anesthetic injections - the area is numb, so NO pain is likely to be felt.

5.. A small wait, then the dentist starts to peel down the gum from the tooth to be extracted, so that no flesh is left attached to the tooth - prevents the flesh being torn from the tooth when the tooth is extracted.

6.. The dentist uses a pair of purpose built pliers to grip the tooth to be extracted, then starts rotating the tooth in a figure 8 pattern.  The figure 8 pattern is repeated several times until the dentist feels the tooth will come out.

7.. The dentist then pulls the tooth out and the tooth extraction as such is over.

8.. The dentist will then clean up the area, squeeze the area hard to remove any puss, push the loose gum tissue into the hole that's left and possibly crush the tooth socket to promote a firmer area - to encourage good healing.

9...  The dentist will place a wet cotton gauze, rolled up, across the hole left by the tooth being extracted, asking you to bite down on it hard for the next 30 minutes, so as to encourage a solid blood clot to form.  Being wet beforehand, the cotton gauze should leave the blood clot intact in the hole when the gauze is lifted out at home by your self.

What To Do After The Tooth Extraction:

Tooth Extraction Care and Aftercare

The care and aftercare of a tooth extraction entails following the five suggestions below:

1.. DO NOT rinse your mouth out for 24 hours following a tooth extraction - doing so may cause the blood clot, that is sealing the hole and allowing healing to take place, to come away.

2.. NO SMOKING FOR 2 DAYS following the tooth extraction.  Some dental associations recommend no smoking for two weeks.

3.. Only warm, soft foods and drinks to be taken, and kept as far from the extraction hole as possible - Definitely no swishing in the mouth, as the blood clot may be removed or a piece of food may enter the hole and become lodged in causing much pain. After 7 days, you can normally return to a normal diet.

4.. The day following the tooth extraction and for at least the next 5 days, stir a teaspoon of salt into 250 ml - a glass - of warm water until dissolved.  Rinse the mouth GENTLY with the salt water and give the salt water a little time to be soaking the tooth extraction point.  Use after eating or drinking anything, as it keeps the extraction wound clean and the salt helps to keep the area sterile from germs.  Use the salt rinse every night before bed as well.

5.. Resume good teeth cleaning practices from about day 2 following the tooth extraction, but be careful near the extraction site.

Complications During and After a Tooth Extraction:

Tooth Extraction Complications

1... Something goes wrong with the tooth extraction - the tooth may break up, which means the tooth extraction may take much longer to perform, as the dentist has to get it all out.  This complication may also mean more pain and swelling, as the area may become more damaged at the extraction site.

2.. Infection following a tooth extraction is a rare complication, but can occur.  The value of antibiotics perhaps should be sought if pain increases over the healing period, or if puss becomes noticed.  Obviously, if more than the root area was infected at the the time of the tooth extraction, then antibiotics should perhaps be prescribed by the dentist before you leave the dental surgery.

3.. Swelling may continue to increase for two days following a tooth extraction, but should start to reduce by day 5.  Ice packs can be used to help reduce swelling - 20 minutes on the cheek area next to the extraction site, followed by ten minutes off, then repeat.  Also, the swelling may cause trouble in opening your mouth, so when the swelling reduces, your mouth should work better as well. On another note, some bruising may appear as the swelling recedes.

4.  Pain and discomfort when trying to sleep.  Sleeping with head face upward helps to relieve pressure on the jaw, using two pillows may help also.  Certainly try and avoid laying down on the area of the tooth extraction site - to avoid pain and discomfort.

5... I personally found that I had heaps of referent pain going into the tooth above the extraction tooth, so when I clamped down for half an hour to keep the gauze in place on the extraction site, it turned very quickly into a living nightmare.

  The pain became intolerable from the tooth above the extracted tooth site - all I could do was walk hard up and down the hallway at home - yelling, screaming and crying from the intense agonizing pain.

  When the 30 minutes was up and I got the gauze out, the pain persisted at that level for hours.

  Eventually the morphine based pill kicked in and I remember going quiet sitting in the sun with the sun on my cheek, still in pain, I climbed onto the bed and went to sleep.  When I woke up the pain was all but gone, but once the pain medication wore off the pain returned. 

As the days progressed, the pain got less - I stopped the morphine based pills, but the ibuprofen, being 8 hourly, didn't quite cover me for those eight hours, but definitely feeling much better and in much less pain.

Another item that really helped me with the discomfort of the pain, was using a hot water bottle filled with hot, but NOT burning water.  I placed this over the cheek of the tooth extraction site and found relief could be gotten that way quite well.  I used that hot water bottle whenever the pain killers didn't work starting from day 2 and, whenever I had trouble going to sleep because of the pain and so on.

6... It is possible that when the tooth is extracted that it may affect the alignment of the teeth in some people, in which case the teeth will tend to hit in certain areas of the mouth rather than uniformly across all the remaining molars.  If this happens, further dental work will likely be needed to correct the problem, as if the teeth are left out of alignment, it is possible that the teeth that are taking the brunt of the force of the jaw will crack or splinter, cause pain, bruxism behavior - teeth grinding - cause pain in the jaw sockets and so on.

However, misalignment of teeth can be common in the first five days following extraction of teeth, as any swelling may cause some teeth to sit proud - be slightly elevated - causing them to hit the teeth above or below them when biting.

7... Following my tooth extraction, I also came down with an ear ache, which is also a common side effect of a tooth extraction.

8.. A little bleeding following a tooth extraction is common for the first day.  If bleeding following a tooth extraction continues or gets heavier:

a. Rinse gently around the extraction site with cold water and

b. With clean hands and clean gauze or hanky, place the gauze in a roll and place over the tooth extraction site the same way the dentist did it and

c.  Bite down gently for 60 minutes, with your head slightly elevated and rest.

If, after this, the bleeding persists or is severe contact your dentist straight away.  If dentist unavailable, try your hospital's emergency department.

9... A dry socket following a tooth extraction is a common complaint afflicting about 5% of people who have a tooth extracted. The tooth extraction dry socket, is where the blood clot that seals the extraction site comes away and is not replaced by another blood clot.  The bone and nerves are exposed to air and anything else that may be in the mouth, thus causing pain and sometimes a foul odor as well.  A dry socket normally clears up in about 5 to 7 days.

  Following the "Tooth Extraction Care and Aftercare" section above, should minimize the risk of developing a dry socket following a tooth extraction.

10... Other teeth may become damaged, chipped or loosened during the extraction of a tooth or teeth, sometimes requiring more dental work.

11... If a top tooth, upper tooth was extracted, then a hole may have been made into one of the sinus areas.  It will normally heal quickly of it's own accord, if it doesn't, you may need to go back to the dentist.

The Long Term Complications of a Tooth Extraction:

Long Term Problems from extracting a tooth: Other teeth may tilt into where the tooth was extracted from, thereby making eating difficult and teeth that tilt to fill the gap are at greater risk of tooth decay.  The tilt is normally forwards.  That is to say, for example, the tooth further back in the mouth next to the tooth that was extracted, will likely tilt into the gap somewhat.

  Further, the cosmetic appearance of the mouth may be adversely affected by the extraction of teeth, particularly if the front teeth are involved. 

If it was a molar that was removed, chewing food may be difficult to achieve, particularly if it was a large molar that made up a large section of the chewing area.

  Further, when chewing food that is hard, like bread crust or an apple, pieces can be pushed down into the extraction socket by the tooth opposing it, causing pain.

  Your dentist may suggest that as the tooth has no opposing tooth to bite against, that removing  that opposing tooth could be considered.  This is because the tooth has nothing to bite against and is therefore useless.  However, without an opposing tooth, the tooth above or below the extraction socket will, over some years, like ten years, move out of it's socket more and more, likely exposing it's roots and becoming sensitive to variations in temperature and so on.  A tooth relies on it's opposing biting tooth to keep it firmly in place.

Another of the long term problems is thinning of the jaw bone, particularly when several teeth have been extracted - when the side of the extraction site is not chewed on as much, if at all, for example, then bone loss from the extraction area can become significant over time, making it more easier to break.

If a nerve is damaged during a tooth extraction, it will likely heal in several weeks to a couple of years, sometimes the nerve will never fully recover.  Symptoms can include loss of feeling - numbness - and tingling in any of the parts of the mouth, including the tongue.


Tooth Extraction Healing + Warning

Tooth extraction healing takes only about five to seven days to be mostly complete.  After seven days the healing is good enough to eat the harder foods without causing pain.  Healing following a tooth extraction is rapid because the inside of the mouth is designed to heal quickly.  When my tooth came out the pain was so great I was skeptical that I would heal so quickly, but it did.  Healing can be delayed by smoking, so for a faster healing, try giving up the cigarettes.  The gum area should be fully healed in three to four weeks following a tooth extraction.  If the jaw was damaged during the tooth extraction, then it may take up to six months for full healing to take place.

WARNING:  If you are taking an osteoperosis medication, such as Fosamax, try and save the tooth if you can.  Some of these medications firmly attach the tooth and bone together and may also hinder the bone recovering from a tooth extraction - meaning you may be in pain for a lot longer than normal.  Check it out with your dentist, prior to the tooth extraction.



Top tooth extraction picture courtesy of the National Library of Medicine.

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