You and Dr. Torrey may determine that you need a tooth extraction for any number of reasons. Some teeth are extracted because they are severely decayed and are not able to be restored; others may have advanced periodontal disease, or have broken in a way that cannot be repaired. Other teeth may need removal because they are poorly positioned in the mouth (such as impacted teeth), or in preparation for orthodontic treatment.
The removal of a single tooth can lead to problems related to your chewing ability, problems with your jaw joint, and shifting teeth, which can have a major impact on your dental health as well as your appearance.
To avoid these complications, in most cases, Dr. Torrey will discuss alternatives to extractions as well as replacement of the extracted tooth.
The Extraction Process
All teeth are slightly different in how they are removed. Many times a tooth can be removed gently and with finesse. Occasionally a badly broken down tooth or a large molar needs a surgical extraction to safely remove it. Every effort is made to preserve bone and minimize trauma and risk with all extractions.
Sectioning A Tooth
Some teeth require sectioning. This is a very common procedure done when a tooth is so firmly anchored in its socket or the root is curved and the socket can’t expand enough to remove it. The doctor simply cuts the tooth into sections then removes each section one at a time. This is sometimes done in conjunction with “a flap.” A flap is the temporary gentle pulling back of the gums in order to gain access to the underlying bone. After the tooth removal the gums are placed back and sutures placed for 7-10 days. Sometimes dissolving sutures are used which do not require removal.
Very often Dr. Torrey will recommend a ridge preservation procedure in the socket. This is also referred to as a ‘Graft.’ Ridge preservation is the utilization of either bone bank bone (allograft) or synthetic bone (alloplast) or a to help stabilize the underlying bone to minimize its loss. Allografts are superior to alloplasts in their ability to allow for implant placement more quickly. Synthetic bone takes many more months to be replaced with you own bone and will not allow implants to be placed as soon.
When a tooth is removed up to 60% of bone loss top to bottom and side to side can occur within the first 12 months. Ridge preservation helps mitigate this loss. Additionally in areas where there is inadequate boney support for an implant grafting assists in helping the bone re-grow. There are many options available for ridge preservation so it is important to discuss what your restorative plans are for replacing the lost tooth prior to choosing a graft material. We generally like to follow ridge preservation patients more closely than patients who do not have preservation. Will will often take and x-ray at 10-14 days post op then again in 3 months.
Occasionally ridge preservation will require a membrane to help maintain the graft material in place while your body heals itself. Membranes come in two types; resorbable and non-resorbable. Resorbable membranes are most often made out of collagen and non-resorbable usually out of titanium and/or teflon. Much like grafting materials each has it’s own indications and uses. Dr. Torrey will discuss this indications if a membrane is required. Sutures are always utilized when placing membranes and they will need to be removed after at least 10 days of healing.
After Extraction Home Care
Some bleeding may occur. Placing a piece of moist gauze over the empty tooth socket and biting down firmly for 45 minutes can control this. If bleeding lasts more than 2 hours make a cup of black tea and wring out the bag then place it over the socket for 30 minutes. The tannins in the tea will help stop the bleeding. Please call Dr. Torrey if the bleeding does not stop after 4 hours. All extraction patients will receive his cell phone number at the time of extraction.
Blood clots that form in the empty socket.
This is an important part of the healing process and you must be careful not to dislodge the clot.
- Avoid rinsing or spitting for 24 hours after the extraction.
- Avoid use of a straw, smoking or hot liquids.
Swelling is not typically experienced with routine tooth extractions however it will be often present with surgical or wisdom tooth removal. The application of ice over the area for 10-15 minutes on and off can help with the pain and swelling. A bag of frozen peas is the best thing to use. It can be placed back into the freezer between uses.
Pain and Medications
For most extractions just make sure you do your chewing away from the extraction site. Stay away from hot liquids and alcoholic beverages for 24 hours. A liquid diet may be recommended for 24 hours. After that resumption of a soft diet would be indicated for the next -3 days depending upon the level of surgery. We recommend that all foods with hulls and sharp edges be avoided such as tortilla chips, brown rice and popcorn.
Brushing and Cleaning
After the extraction avoid brushing the teeth near the extraction site for one day. After that you can resume gentle cleaning. Avoid commercial mouth rinses, as they tend to irritate the site. Beginning 24 hours after the extraction you can rinse with salt water (1/2 teaspoon in a cup of water) after meals and before bed.
The loss of the clot is known as “dry socket” and can be very painful. It requires attention immediately. Often it does not occur for 72 hours after extraction. Woman who smoke and/or are taking oral contraceptives are at a much greater risk of developing a dry socket.
Following the post extraction instructions will reduce the chances of developing dry socket. Dry sockets manifest themselves as a dull throbbing pain, which doesn’t appear until three or four days after the extraction. The pain can be moderate to severe and radiate from the extraction area. Dry socket may cause a bad taste or bad breath and the extraction site appears dry.
Dr. Torrey will apply a medicated dressing to the dry socket to soothe the pain.
After a routine extraction the socket should close within 4 weeks. If it was grafted it is often quicker. During that time it is important to keep food out of the healing area. If the area was not grafted the socket will take up to a year to fully mature and heal. Grafting help preserve that site and allows for quicker replacement of your own bone into the socket.