Tooth Extraction (Oral Surgery)

Some of the reasons for pulling a tooth include:

– Tooth decay
– Broken tooth
– Wisdom teeth growing improperly
– Crowding
– Infection

Yes! Dental surgeons will apply one of two types of tooth extractions: simple or surgical dental extraction. The simple procedure is applicable when the tooth is very loose and ready to simply be pulled with minimal risk for complications. A surgical extraction will require an oral surgeon or oral maxillofacial surgeon to make a small incision into the gums to remove the impacted wisdom tooth, or one that is half emerged and still rooted under the gum line.

Before extracting the tooth, the dental practitioner will take an X-ray to determine the best technique to remove the problem tooth. He or she will also consider the patient’s medical history to ensure minimal risk and complications. X-rays effectively identify any complications, such as the presence of an infection or tumor prior to having the surgery.

Common complications include risk of infection, temporary pain, and possible dry socket – all of which can be avoided when patients properly follow their aftercare instructions. After a surgical dental extraction, patients are given prescribed antibiotics and painkillers to prevent infections and to reduce temporary pain.

During a simple dental extraction, patients may be given a couple of minor instructions, like not using a straw for a day and taking OTC meds if there is any pain; these instructions will help to ensure the gums have proper time to heal. Overall, the risk of developing complications is very low, and most patients recover well after their recommended downtime.

Each patient’s downtime and recovery period is determined by the type of procedure performed, as well as the patient’s medical history. For simple extractions, patients have little downtime, averaging 24-48 hours to allow the clot in the socket to do its job in the healing process. For surgical removals, downtime is longer, and may last up to a full week, depending on the type of surgery and tooth removed. Overall, a proper recovery process and following instructions are both required to allow gums to properly heal.

Yes! Patients should heed the dental surgeon instructions to ensure faster healing. It especially helps to have another responsible adult to help ensure the patient correctly follows instructions during the recovery process.

On the day of the surgery, cool and soft food is recommended, such as applesauce, cottage cheese, or yogurt. Hot foods may disturb initial clot formation in the extraction sites. Following the day of the surgery, it’s best to avoid crunchy foods such as popcorn, nuts, and potato chips which break up into little pieces and can get packed down into the extraction sites. If you had dental implants placed, please avoid chewing hard foods with the implant itself for 6 weeks or the healing of the implant will be compromised.

The best regimen for acute pain control after wisdom tooth removal is a combination of non-narcotic and narcotic pain medication. If you have no kidney or liver problems, the best combination is 600mg of Ibuprofen every six hours used in combination with the prescribed narcotic medication every six hours. If you put each medication on a separate schedule, you can take the Ibuprofen, then three hours later take the narcotic, three hours later take the Ibuprofen, etc. Alternating between these medications every three hours allows you to maximize your pain control, minimize unwanted side effects of the medication (nausea), and prevent overdose of either medication. If you have medical problems, please consult with your surgeon or medical doctor before starting a regimen like this. Also, make sure you are well hydrated if you are taking Ibuprofen for longer than 24 hours. Please contact our office if you have been on this pain control regimen for longer than 3 days.

The term “dry socket” refers to a condition called alveolar osteitis, or a premature breakdown of the blood clot present in an extraction site. Smoking, poor oral hygiene, and over-excursion in the post-operative period can contribute to this condition, but sometimes there is no obvious cause. Typically, “dry socket” presents itself 3-5 days after the surgery with increased pain, foul odor and taste, and bad breath. This condition is very easily treatable and requires that we wash out the socket and place a medication dressing, which provides pain relief usually within an hour after placement. These medicated dressings typically are replaced every 2-3 days in our office until the condition subsides in one to two weeks. If you are experiencing symptoms consistent with “dry socket,” the best solution is to call our office when it opens in the morning at 7:30 am so we can arrange to have you seen that day for treatment.

Believe it or not, some bleeding after tooth extractions is beneficial – good blood flow usually means good healing. The purpose of the gauze that you were given is to apply firm, consistent pressure to the extraction sites for 45-60 minutes at a time. If you have gauze in your mouth and you are not biting down firmly, the gauze is doing no good. Likewise, taking the gauze in and out every five minutes to look at it just tends to stir up more bleeding. If your mouth is rapidly filling up with blood and the above measures are not helping to slow down the bleeding, call our office for assistance. Also, it is not unusual to notice small episodes of bleeding for several days after having teeth removed; simply bite on gauze again in the area of bleeding if you experience bleeding in the days after your surgery.