| The Oral Health Clinic |

Extraction

What is it?

A tooth which is very decayed or damaged or loose because of gum disease may have to be extracted (taken out of your mouth).

Children’s teeth are sometimes taken out for “orthodontic” reasons to help the new or remaining teeth grow regularly or without being crowded.

What will my dentist do?

Some teeth are easier to take out than others because of the size, shape, position in the mouth or the shape of their roots. After working out the best way to take the tooth out, your dentist will discuss with you:

How long it will probably take;
How to make sure you don’t feel the extraction while it is happening;
For certain types of pain control, whether you should bring someone with you;
When it would be convenient for you to have the tooth removed, if not immediately; and
How your mouth should recover afterwards.

You might also discuss other treatment you need – for example, whether you may need an immediate replacement denture. If you wear a denture, this can be made ready with a new tooth the same visit. Or you may have to have a gap for a while and come back to have the denture changed or have a new denture.

While the tooth is being taken out:

You will be able to move your jaw as normal; and
You may feel some pressure as the tooth is eased out, but not any pain.

Afterwards:

The dentist will give you a pad to bite on, to stop the bleeding;
Sometimes stitches are used to help the mouth heal; and
The dentist will give you advise on:
- How to look after the hole where the tooth was while it is healing;
- How to control any pain when the anaesthetic wears off; and
- How to contact the practice if there are any problems.

What are the benefits?

Having a tooth taken out can end pain and infection and can sometimes be the only way to keep your mouth healthy.

What To Do After An Extraction

You need to look after yourself carefully after you have had a tooth taken out, as with any operation, to speed up healing and prevent infection. This advice is to help you know what to expect and do, as your mouth recovers.

General advice

For the first 24 hours, don’t drink alcohol, eat hot food or disturb the clot, which will have formed in the hole left by the tooth, because this may cause the socket to start bleeding again. Don’t smoke either, and avoid exercise for the rest of the day.
Don’t rinse your mouth for six hours after the extraction.
After six hours, rinse gently with warm salty water to keep the socket clean and continue to do this for up to a week after meals and before bed. Use half a teaspoonful of salt in a glass of water.
Brush your teeth normally with toothpaste to keep the whole mouth clean.
If you feel small pieces of bone working their way out of the socket, don’t worry – this is normal.
Some swelling or discomfort in the first two to three days is also normal.
Take painkillers if you need them (as you would for a headache). Ask your dentist for advice if you are not sure what sort to take.

If the bleeding does not stop

Your dentist may have given you a small supply of gauze in case this happens. If not, clean cotton handkerchiefs will do, but not paper tissue. · Roll some small firm pads about one cm by three cm – a size that will fit over the socket.
Keep sitting up and gently clear away any clots of blood around the socket wit the gauze or handkerchief.
Place a pad across the socket from the tongue side to the check and bite firmly on it for 10 to 15 minutes.
Take off the pad and check whether the bleeding has stopped. If it hasn’t use a fresh pad.

If the socket is still bleeding after two hours, contact your dentist.

Remember

If you follow these instructions, your mouth should heal normally, without becoming infected. But if anything in your mouth worries you, phone the practice for advice.

Wisdom Teeth

What are they?

Wisdom teeth are the last molar teeth to grow in at the back of the mouth, usually in the late teens or early twenties. When they grow in correctly they cause no problems and do not require treatment, but sometimes there isn’t enough space and the teeth become trapped or ‘impacted’. There are a number of problems associated with impacted teeth, which your dentist can identify.

Wisdom tooth growing incorrectly at the back of the mouth

What will my dentist do?

Watching how your teeth and jaw grow is part of your regular dental care. Do tell your dentist if you think there may be a problem.

X-rays can show where the wisdom teeth are in the jaw and how much room there is for them to come through, as well as showing if they are causing any damage to the teeth in front.
The x-ray will also show how simple or difficult it may be to take a wisdom tooth out. The dentist may refer you to a specialist to have your wisdom teeth removed.

As wisdom teeth are coming through, the surrounding gum becomes inflamed and sore. This is called “pericoronitis”. It may settle down or come and go over a period. It is usually better to remove a wisdom tooth after you have had pericoronitis because they often continue to cause trouble.

If you need to have a wisdom tooth removed, you should be able to fit it in with work or other commitments. Sometimes, all wisdom teeth are removed in hospital under general anaesthetic. You may need two or three days off work.

What are the benefits of removing wisdom teeth?

If you have wisdom teeth removed, there will be no more pain and infection.
It will stop any damage to the teeth in front.

What are the reasons for removing wisdom teeth?

Infection of the surrounding gum (pericoronitis). This can cause severe pain, swelling, inability to open the mouth fully, and general illness, sometimes with fever.
Decay of the wisdom tooth, or of the tooth in front against which it pressing. Food can also get packed into this area, causing a bad taste and smell.
Development of a cyst. This is a swelling that grows around the tooth. Cysts are generally painless unless they get infected. However they continue to increase in size unless the tooth is removed, and a large cyst can weaken the jaw.
Crowding of the other teeth. This has not been studied fully, but some dentists believe that pressure from wisdom teeth can cause an increase in crowding, especially in the lower front teeth.

The removal of wisdom teeth is a very common procedure, and most can be carried out in your dental practice. Patients are only referred to hospital if the dentist feels that the case requires specialist care, or if there are other health problems, which make hospital treatment necessary.

Because wisdom tooth removal can be a long procedure, we routinely offer intravenous sedation, which helps the patient to relax, and also have very little memory of the treatment. This is usually given as an injection in the back of the hand. As the patient is not asleep, the gums are also frozen in the normal way. (See Sedation information sheet for more details).

After Extraction

Some pain, bruising and swelling is common after this type of treatment. It is not possible to accurately predict how much swelling there will be as each person reacts differently, but it usually starts to go down by the third day, and is gone by the fifth day. Swelling can be minimised by the application of ice packs to the area. There may also be some difficulty opening the mouth fully, and a very soft diet is recommended for the first couple of days (e.g. soups or mashed/ blenderized food).

The socket where the tooth was extracted may continue to ooze a little blood for the first day. A small amount of blood can mix with saliva in the mouth and make the bleeding appear much worse than it really is. If necessary, bleeding can be reduced by biting firmly on a clean, damp handkerchief. There may be one or more stitches present. These are usually removed after about a week.

It is very important to try to keep the area very clean, to minimise the risk of infection. A mouthwash such as chlorhexidine (Corsodyl) can be used from the second day to reduce the build-up of plaque bacteria in difficult to reach areas.

Complications

Numbness. The wisdom tooth may be very close to, or even in contact with, the nerves that supply the lip, chin, cheek or tongue. The nerves can be bruised during the extraction, and this may lead to numbness or tingling in these areas. In the vast majority of cases this is temporary, but some can take weeks or months to return fully to normal. In a very tiny number of cases complete sensation does not return.

Infection. If the blood clot which forms in the socket is dislodged or damaged, the exposed bone can become infected, leading to a deep throbbing pain 2-3 days after surgery. This requires the attention of the dentist.

Sinus problems. The roots of upper molar teeth, and particularly upper wisdom teeth, lie very close to the air sinus in the cheekbone. Very occasionally the removal of an upper wisdom tooth can open the sinus cavity. Most heal without problems, but sometimes further treatment is needed to seal the hole.

Weakening of the jaw. Wisdom teeth tend to be found in the area where the jaw is narrowest. When the tooth is removed this area becomes more susceptible to fracture, until the socket is completely filled with bone. (This can take 12 – 18 months) This is a particular problem when the wisdom tooth has developed a very large cyst.

IF YOU HAVE ANY OTHER QUESTIONS, PLEASE ASK YOUR DENTIST

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