Extraction of a permanent tooth is usually performed when it is deemed to be unsalvageable (e.g. due to large decay, deeply placed fracture or loss of gum support). It may also be performed as part of braces treatment or aesthetic procedures.

Benefits of dental extraction.

A dead tooth harbours bacteria and can cause localized infections within the tooth socket and surrounding bone. Dental extraction is done with the purpose to eliminate this potential threat and allow the patient to move on with its proper replacement.

What will the dentist do?

The dentist starts by assessing the restorability of the affected tooth. He may take an x-ray to determine the extent of tooth damage and shape of the root/s. He is also likely check with you on your intentions to replace the tooth to be extracted.

Upon your consent, he will proceed to numb the adjacent gum using a fast acting, topical anaesthetic gel. This is followed by an injection of local anaesthetic to numb the tooth. The tooth is thereafter delivered by gently loosening it using either a pair of forceps or luxator.

How long will it take?

The procedure takes approximately 10 minutes on average and is dependent on shape of the tooth root/s and length as well as the amount of tooth structure remaining.

What will the experience be like?

The procedure itself is often painless as it is performed under local anaesthesia. It is quite normal to be able to feel a little pressure (or pulling sensation) during tooth loosening and delivery as you are fully conscious. Your dentist will ask you to bite gently on a sterile piece of gauze to apply pressure on the extraction wound after the tooth is out.

What should I expect after the procedure?

You can expect minor bleeding or oozing of the extraction wound during the first few hours. This can be stopped by placing a piece of sterile gauze onto the wound and biting gently onto it to apply pressure. You can help prevent bleeding problems by avoiding hard, hot or spicy food for the next 48 hours.

The local anaesthetic will usually start to wear off after 2 to 3 hours. Patients who are concerned about pain are encouraged to take painkillers right after the procedure before the local anaesthetic wears off. It is advisable not to eat while experiencing numbness as you may end up biting on yourself without knowing it.

Avoid strenuous physical activity or exercise immediately after the procedure. You can resume your normal routine after 24 hours. Smokers are advised to reduce or refrain from smoking, as there is strong body of evidence that shows that smoking interferes with the normal healing.

Avoid the urge to rinse repeatedly, spit or suck on a straw for the 24 hours. Doing so may cause dislodgement of the blood clot, increasing your risk of complications. You can brush the rest of your teeth gently, avoiding the wound site for the first 2 to 3 days. Most patients will be able to resume normal brushing by the end of the 1st week.

Are there any risks?

As with all surgical treatment, dental extractions can result in complications. Common complications include:

Root fracture

This is usually associated with severely damaged or root canal treated teeth. Such teeth will have to be surgically removed.

Dry socket

This is a painful condition that is characterized by loss of the initial blood clot from within the tooth socket. Treatment is aimed at preventing wound infection and managing pain. Fortunately it is not very common.

Bleeding

On rare occasions, healing is complicated by delayed bleeding. This is often associated with breakdown of the initial blood clot due to an infection. Treatment is directed at promoting blood clot stability and eliminating the infection.

Bone loss

Tooth loss is almost always accompanied by bone loss at the extraction site over time. We know that the bone loss is fastest during the 1st year post-extraction. This affects your future tooth replacement options (e.g. the use of dental implants or denture support).

The best way to manage this issue is for you to discuss tooth replacement options with your dentist prior to the extraction itself. Your dentist will be in the best position to advise you on the use of bone preservation techniques or the possibility of immediate dental implant placement to help you keep a healthy bone level.