It is the oldest and the most frequently performed of dental procedures. The procedure involves the removal of the tooth (or tooth root) under anesthesia. These teeth are those that cannot be saved / retained in the mouth through any other means. The common dental conditions necessitating extractions are severe gum diseases, extensive damage, decay and wearing out of teeth, abnormally positioned teeth etc.

Basically, there are two methods of extraction. The first method, which would suffice in most cases, is called forceps extraction, which consists of removal of tooth or roots using dental forceps and elevators.

The other method is the surgical removal of the tooth employed in cases where the routine extraction procedure will not suffice. It is done by dissecting the tooth / root out from its bony attachments. This separation is achieved by removal of some amount of bone investing the roots, which are then delivered by the use of elevators and forceps. This method is especially adopted in the cases where the teeth have abnormal shapes, when they are excessively brittle or when some of the roots or even the tooth on the whole are retained deep within bone. Surgical removal of impacted teeth falls in this category.

Most of these procedures are performed under local anesthesia. General anesthesia may be required in certain situations when the procedure turns more complex due to various reasons.

Dental extraction is one of the most feared dental procedures by dental patients. However, allaying fears of the patient and meticulous techniques adopted will make the procedure smooth, absolutely painless and uneventful.


Instructions to be followed by dental extraction patients

* Kindly swallow the saliva tinged with blood, which tends to accumulate in the mouth after the procedure. Spitting out the saliva can only cause more of bleeding and discomfort. Swallowing may be done biting on to the cotton bolus placed over the extraction site.

* Retain the cotton placed at the extraction site by biting into it for about one hour, as this will help decrease bleeding from the extracted tooth socket. Mild ooze is likely from the extraction site for a period of 6 hours after the procedure. If bleeding from the extraction site continues, please feel free to contact your doctor. After half an hour to one hour after the procedure, ensure that the cotton roll(s) placed at the extraction site are removed totally (no cotton portion should remain at the extraction site as they tend to cause infections). This may be followed by ice-cold water rinse. Please remember that you should not replace the cotton that has been removed – this can cause recurrence in bleeding and cause infection.

* The local anesthesia effect can last for an hour or two, or even more. As long as the anesthesia lasts, the lips and cheeks might feel numb. Ensure that you do not chew the numb lips and cheeks, which present with a rubbery (or chewing gum like) feeling while chewing. If you do so, you will experience severe pain and swelling in the area of the chewed up, ulcerated soft tissue. This instruction specially holds good in children who tend to chew the numb lips and cheeks. If the numbness persists beyond 3-4 hours, please contact your doctor.

* Consume only cold, soft foodstuffs during the day after the procedure. Kindly wait for at least about half an hour after extraction before starting on oral food. You may start with an ice-cream or a cold milk shake as these help prevent bleeding. Avoid soda and other carbonated drinks. Hot and hard foodstuffs should be totally avoided.

* Take rest on the day of extraction. If you should lie down, prop up your head with pillows so that the head is kept raised. This will reduce the post-extraction swelling and bleeding. You may pass time reading, writing, listening to music, watching TV, working on computers etc. Avoid strenuous job, games, sports activities etc. within a period of 24 hours after the procedure.

* Do not disturb the tooth socket with the tongue, fingers or any other object. This increases the chances of bleeding and the socket getting infected.

* Start lukewarm salt-water rinse – about thrice a day, from the day after extraction. Continue this for about 2 days. This aids in improved healing of the extraction socket.

* Kindly have the complete course of drugs prescribed by the doctor. Failure to complete the full dosage of antibiotics can be harmful. Continue the painkiller tablets even if there is no pain as these tablets have anti-inflammatory effects, which is beneficial for healing. You may start the medication before the anesthesia effect wears out, in order to avoid pain on recovery from anesthesia. There are occasions when extraction is done during the period of antibiotic treatment, which is termed “antibiotic cover or umbrella” in which case you only need to continue the medications.

* If sutures (stitches) have been placed after the procedure, please report to us after seven days (or as instructed by the doctor) for suture removal. Failure to do so can cause infection in the area.

* You are likely to feel bony prominences or spicules in the extraction site associated with pain or discomfort. Do not disturb them. Please bring this to your doctor’s attention so that corrective measures may be taken if necessary.

* Do not smoke, chew pan, use liquor or entertain such other habits. Such habits increase the incidence of an extremely painful condition called “ Dry socket” in which the extraction wound fails to heal within the normal time span. Use of liquor during the period of medications may cause severe reactions as some of the medicines may interact.

* Restriction in mouth opening after extractions is frequently observed. This happens because of the spasm of the muscles, which help open and close the mouth. This condition will gradually improve over a period of 1-2 weeks to disappear totally.

* If the extraction was a difficult one or a surgical procedure, such as removal of a broken root or a surgical removal of an impacted wisdom tooth, the face on that side will normally swell up over a period of time, the swelling reaching it’s maximum size in 24 hours. After the 24 hour period, the swelling tends to gradually decrease over a period of 1 week, to disappear totally.

* After difficult / surgical extractions, it is ideal to do ice-pack sponging (eg. with ice-cubes taken in a plastic cover) over the face in the area of extraction / surgery. This helps decrease the bleeding and post-operative swelling.

*Alert your doctor if -
*Swelling, pain, discomfort and restriction in mouth opening increases during the post extraction phase.

*You have fever, difficulty in swallowing, persisting numbness, bleeding from the surgery / extraction site, bony prominences at the surgery / extraction site.

Dr. Prasanth Pillai K.S., BDS,MDS-OMFS.

Email  drprasanth@pramodclinic.com

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