Dr. Cloninger could choose to extract teeth for many reasons, but by far the most common is that the patient is in pain and wants to relieve the pain as quickly, permanently and as inexpensively as possible. This does not mean that there are not other ways of relieving the pain. But the other methods are likely to be more expensive or inconvenient. Other reasons are:
- The patient may choose extraction because the other alternatives are simply too expensive.
- The doctor may decide that the tooth is not repairable and extraction is the best treatment at that time. This includes teeth that are decayed below the gum line, or teeth that have lost too much bone due to periodontal disease.
- Removal of the tooth may be a matter of health. This is the case in the removal of impacted wisdom teeth, teeth associated with cysts or tumors, or teeth that would otherwise compromise the patient’s oral health if left in place.
- Teeth are frequently removed because they are crowded and their removal would create a situation which could be repaired in their absence. Every situation is different some extractions are required in order to continue with either a bridge, implant or other dental appliance to replace the extracted tooth.
This x-ray shows a dark crescent in the root toward the right side of the film. This is decay, and it has reached the nerve, which is labeled with the lower arrow. Decay in this position cannot be filled without touching and killing the nerve requiring a root canal. Also the tooth has severe bone loss from periodontal disease. Thus the most expedient thing to do was to extract it.
The tooth to the left was extracted because of gum disease. The dark material on the root is not decay. It is calculus (hardened plaque) which built up on the root because the bone has been reabsorbed by the body below that point. If the bone had been surrounding the root as it would in the healthy state, plaque could never have reached this far down on the root surface. This tooth was loose because, as the x-ray shows, only the very tip was held in place by bone.
Types Of Extractions
- Simple extractions A Simple extraction is one in which the dentist can remove the tooth simply by loosening the gums around it, grasping the crown above the gum line with a plier like forceps and then moving it side to side until it loosens from the bone. Teeth are normally held into the bone by a thin sheathe, the periodontal ligament, tissue that separates it from the bone like a sock separates a foot from a shoe. The key to simple extractions is to rock the tooth side to side slowly enlarging the socket in the bone while at the same time breaking the ligament which binds the tooth in the socket.
- Complex (surgical) extractions Unfortunately, not all extractions can be done by simply grasping the tooth with forceps and rocking it out. Suppose there is nothing left above the gum line to grasp or if the crown breaks off leaving the roots still in the bone. These things can and do happen, and any dentist that extracts teeth will have to deal with them routinely. In these cases, it becomes necessary to surgically remove the tooth. This is frequently accomplished by prying the root out using a sharp instrument that can be forced between the root and the bone surrounding it. In the case of multiple rooted teeth, the roots are first separated so they can be removed individually. Unfortunately, not all roots or root fragments may be removed in this fashion. This means that the dentist must make an incision into the gums around the tooth and raise a flap of tissue. exposing the tooth and its surrounding bone.
Sometimes after the flap is raised, there is enough tooth exposed to grab and remove it as in a simple extraction. If simple extraction is not done, then the dentist must take a hand piece (drill) and cut away some of the surrounding bone in order to gain a good hold on the tooth. After the tooth has been pried out of the socket, the dentist then sutures (sews) the flap of tissue back in place so that healing can proceed normally.
Normally, impacted teeth, as show in the x-ray to the right, are referred to an Oral Surgeon by our office for extraction. This is done in most cases because these are usually wisdom teeth and if more than one needs to be extracted, it is best to have the procedure performed with the patient being put to sleep.