Extractions

Extraction is the surgery to remove a tooth. This surgery can be performed in-clinic with the use of local anaesthetic, or under general anaesthesia at a hospital.

When is an extraction required?

  • To remove an infected or abscessed tooth.
  • When a tooth is no longer restorable/salvageable due to cracks, decay, failed root canal treatment or trauma, where no other options are available.
  • Prior to orthodontic treatment. It is common to remove some teeth in a crowded mouth, to provide space to accommodate for movement of teeth during orthodontic treatment.
  • In cases of severe gum disease, when a tooth has lost significant amount of bone and gum support.

What is involved in an extraction?

  1. An appointment to assess the tooth will be required. Your dentist will take a radiograph (x-ray), to view the tooth and if required, you may be referred for an OPG radiograph – a “panoramic” x-ray, which shows a view of your tooth and the surrounding bone structure.
  2. Your dentist will walk you through the x-ray and discuss with you any foreseeable difficulty or complications with the removal of the tooth. On many occasions, the tooth may display an extra root, curved root, or close proximity to important structures in the jaw, for example, nerves or sinuses that may require extra caution during the procedure.
  3. We will then schedule an appointment for extraction under local anaesthetic or, depending on the difficulty and risks associated with the individual tooth, you may be referred to an oral surgeon for the extraction.
  4. Review appointment is scheduled post-surgery to ensure all is healing well.

What are the possible complications with extractions?

All surgical procedures carry an inherent risk, and therefore the assessment of the tooth prior to extraction is carried out carefully, to minimise the risk of complications.

  • A thorough assessment of your medical history is carried out prior to extraction to ensure your risk of excessive bleeding post extraction is minimal. It is important to disclose any bleeding disorder and medications that you are taking, as these are often crucial in pre-op assessment to determine if you might suffer from excessive post op bleeding. If required, we may also speak to your GP regarding alterations to your medications, that may be required prior to the day of extraction.
  • Fracture of part of the tooth during extraction that may necessitate the need for a full surgical extraction. This is where part of the adjacent gum is lifted up and a small section of the jaw bone removed, to allow access and removal of the remaining tooth and roots.
  • Occasionally, a small segment of the tooth root tip may be left in the socket. The decision may be made to avoid damaging important structures close to the root tip. The jaw bone will usually fill around the small remaining tip and rarely risk reinfection.
  • Bruising, swelling and trismus (locked jaw) post operatively.
  • Displacement of a piece of tooth or root tip into adjacent areas e.g.: into the upper sinuses or behind wisdom tooth area.
  • Damage to adjacent teeth, fillings or dislodging of crowns, especially where there is crowding or the teeth are heavily filled.
  • Dry Socket where the clot is lost from the socket, often due to smoking, pre-existing infections or medical history or medications, often in lower teeth or female patients.
  • Injury to the nerve where you may experience temporary tingling or numbness on the lips, chin, cheek and tongue (Paraesthesia). Feeling usually returns with 6 – 18 months, but in a very small number of patients, the change is permanent for life. This is rare and usually fore-see able when assessing the x-ray prior to extraction. Weighing the risk, the patient is usually recommended for referral to oral surgeon for management.

Instructions for after-care post extraction:

Please follow these simple rules so that the healing after a tooth extraction is relatively uneventful; although a small degree of discomfort is to be expected during healing, but hopefully you can resume normal daily activities with no post-op complications.

  • Local anaesthetic administered, may last up to 6 hours post operatively depending on the site of the injection and the amount used. Please be mindful of this and exercise caution not to bite your cheek, lips or tongue.
  • Your dentist will apply pressure on the extraction site with a sterile gauze to stop bleeding after the extraction. This will take between 5-10 minutes after extraction until clotting takes place. Once clot is formed and stable, your dentist will check that bleeding has ceased. You will be given packs of sterile gauze to take home to manage bleeding at home, if required.
  • When you get home, if you notice oozing from the wound, please use the gauze pad according to your dentist instructions. With clean hands, insert the sterile gauze onto the extraction wound and bite down. Apply firm pressure for 5 minutes, remove gauze and check if oozing continues without pressure. If oozing appears to continue, reapply new gauze and again bite down and apply firm pressure for another 5-10 minutes. Continue this until stable clot forms and the bleeding stop. Remember to replace the gauze if soaked.
  • If heavy bleeding continues for over 45 minutes, please contact your dentist. In the rare situation where there is serious bleeding outside of operating hours, go to your nearest hospital immediately.
  • Maintaining the blood clot is an important part of the normal healing process. You should therefore avoid activities that might disturb the clot. Do not smoke or rinse your mouth vigorously after an extraction. These activities create suction in the mouth, which could dislodge the clot and delay healing.
  • Dislodging the clot could result in a “dry socket”, a condition where the pain, similar to toothache, can occur about 2-3 days post extraction. Please contact your dentist immediately. You may be required to have a dressing applied in the wound, or prescribed antibiotics.
  • Limit strenuous activity for 24 hours after the extraction. This will reduce bleeding and help the blood clot to form.
  • You may notice some swelling and bruising. You can help reduce swelling and bruising by applying cold packs to the face if required for short periods of time on and off, to reduce swelling.
  • Pain relief in the form of over-the-counter medication is recommended prior to the numbing wearing off. Pain relief is more effective this way rather than waiting till pain starts. Every individuals need for pain relief is different and this is also dependent on the difficulty of the extraction procedure itself, so your dentist will discuss the appropriate pain relief regime with you post-op.
  • A soft diet is recommended following extraction.
  • It is important to maintain good oral hygiene following an extraction, as it reduces the risk of post-op infections. Normal brushing and flossing where possible, following an extraction, is recommended. However, if the extraction site is tender and swelling may be present, gentle warm salt water rinses, a few times a day, is recommended until normal brushing can resume.

Do not hesitate to contact your dentist if you are concerned with healing after an extraction. Always be mindful that an extraction is similar in nature to a minor surgery and the rate of healing is different for everyone.

Wisdom Teeth

Wisdom teeth are your third molars and commonly erupt between the ages of 17 – 25 years. Wisdom teeth can be problematic for many people, as the jaw often does not have enough room to allow them to come through the gum sufficiently to be functional, or to be cleaned.

One of the most common complaints with wisdom teeth is frequent gum infections around the wisdom tooth, a condition called “pericoronitis”, which can range from a low-grade discomfort to very severe pain in some cases.

How do you treat pericoronitis?

Pericoronitis can be very painful and is usually managed with oral pain relief, combined with topical numbing or antiseptic gel applied to the infected gum. Your dentist may also recommend the use of antiseptic or salt water mouthwashes, during the infection period. It is very important to keep the gum around the wisdom tooth clean.

In some cases of severe pain with swelling and trismus (locked jaw or very limited opening of the jaw), your dentist may prescribe antibiotics.

Pericoronitis can recur and can be quite frequent. This usually precipitates the scheduling of wisdom tooth removal surgery.

Do I need to have my wisdom teeth removed if I suffer from pericoronitis?

Your dentist will first assess whether there is space available for full eruption of the tooth, or whether the tooth is “impacted”, whereby the tooth will be unable to fully come through the gum to be functional for chewing.

If there is sufficient room, the wisdom teeth can come through uneventfully and can be functional teeth for chewing. If they can be cleaned like all the rest of the teeth, it is always our recommendation to keep them! All surgeries for removal of teeth carry with it risks, whether it be complications that may occur during the procedure or post-operatively and should patients not benefit from the removal of their wisdom teeth, it is certainly best avoided.

What are the risks of removing wisdom teeth?

All surgery carries with it surgical risks and anaesthetic risks, depending on the choice of anaesthetic (local anaesthetics in-chair, versus general anaesthetic at the hospital).

The surgical risks of third molar surgery include:

  • postoperative infection
  • swelling
  • pain
  • trismus (locked jaw or limitation of mouth opening)
  • cellulitis (wound infection)
  • The lower wisdom teeth can often be close to dental nerves and arteries. Removal should be carefully planned to prevent complications such as damage or compression to the nerve, which may result in loss of feeling, altered feeling or the sensation of pain in the chin, lip or anterior part of the tongue. This may be temporary or (in very rare cases) permanent numbness or altered sensation.
  • The upper wisdom teeth are commonly much less complex to remove than the lower ones, but they are often very close to the maxillary sinus – a hollow space in the upper jaw that is important for respiration. In rare cases, the removal of the upper wisdom tooth may create an opening to the sinus floor, an “oral-antral communication” and will need to be surgically repaired.

Do I need my wisdom teeth removed if they are impacted?

Impacted wisdom teeth are usually partially erupted, or they can remain completely under the surface of the gum.

The partially erupted wisdom teeth can be very difficult to clean resulting in frequent gum infections, a condition known as pericoronitis. Frequent food lodging into the gap between the partially erupted wisdom tooth and the adjacent tooth, can also result in long term gum disease. It also increases the risk of decay to the wisdom teeth themselves, or to the other teeth adjacent to them.

The impacted wisdom teeth that remain completely under the surface of the gum, may also pose a risk to the neighbouring tooth, as they can cause resorption of the roots of the adjacent tooth – a condition where the adjacent tooth roots start to break down.

If unerupted, the soft tissue sac surrounding the developing wisdom tooth (tooth follicle), may form a developmental cyst.

These are some of the indications or guidelines your dentist will assess for, when deciding whether removal of impacted wisdom teeth is recommended.

However, the decision to remove or not to remove some wisdom teeth, is not always straightforward. From the information available, the issue of when it is right and when it is wrong to remove third molars, remains open to discussion.  While guidance on wisdom tooth management is helpful, no guidelines can, nor should, dictate what should be done for every individual third molar tooth.

A more holistic, patient-by-patient approach is adopted at this practice to minimise the risk of surgical procedures.

What is involved in having my wisdom teeth removed?

  1. Schedule a visit to your dentist for a dental examination. Your dentist will refer you for an OPG radiograph, a “panoramic” x-ray that shows a view of your wisdom teeth, both erupted and unerupted wisdom teeth, in the jaw.
  2. Your dentist will walk you through the x-ray and discuss with you whether the removal of your wisdom teeth is recommended. Here at this practice, we adopt a patient-by-patient approach, where the risks versus benefits of removal of your wisdom teeth, are assessed individually.
  3. We schedule an appointment either under local anaesthetic or referral to an oral surgeon, depending on the difficulty, risks and patient’s individual needs.
  4. Review appointment is scheduled post-surgery, to ensure all is healing well.

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