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by Dr. Thomas E. Cooke DDS Raleigh Cary NC

When a tooth gets into a condition where it cannot be repaired, it needs to be removed – this is known as dental extraction or oral surgery .Teeth may be extracted to create more room in the mouth for orthodontics (braces). Wisdom teeth are routinely removed because they contribute to infection and overcrowding of the mouth. When the nerve of the tooth becomes damaged a root canal is recommended, but when the amount of tooth structure above the jaw bone is minimal the tooth may need to be removed.

When a tooth fractures, a crown is typically recommended, but when there is not enough tooth structure to build a crown, the tooth is said to be non-restorable and has to be removed. If these non-savable damaged teeth are not removed they can cause continued pain and can also damage the teeth around them. There are an estimated 20 million teeth that are extracted yearly in the United States.

Wisdom teeth extractions
Not all wisdom teeth need to be removed. If a wisdom tooth has room in the mouth and functions like the other teeth with no gum problems, then the wisdom tooth could remain in the mouth. Sometimes wisdom teeth that are under soft tissue (the gums) or hard tissue (bone) can be problem teeth and they are extracted. These teeth can allow for infection and or crowding.

Routine and complex dental extractions
A routine dental extraction consists of an exposed tooth. It is removed with local anesthetic and with instruments called forceps and elevators. These exposed teeth are basically loosened and then removed. A complex dental extraction is removing an impacted tooth or a tooth with curved roots. This usually requires cutting through the gums and removing a portion of the jaw bone to give more room for the tooth. These teeth may need to be cut into sections prior to being removed. Stitches are typically placed after this extraction.

Aftercare
The aftercare of an extraction basically targets important things to do to allow for proper healing. A blood clot is critical to the success of aftercare. Patients are told not to drink with straws, spit, rinse, or smoke for 24 hours after an extraction. Exercising is also not recommended for 3 to 5 days after an extraction. Eating after an extraction is sometimes a challenge. Soft foods for the first 2 days is recommended. Chewing away from the extraction site is important. Brushing the teeth is important, but not around the clotting area for 5 days.

Healing
The soft tissue around the extraction site usually closes in about 10 days. Most of the jaw bone will fill in the hole where the tooth was in about 6 weeks and this will be completed in about 6 months. It is important to treat infections in this are right away to allow for proper healing.

Risks
When you have any surgery, there are always some potential risks. Tooth extractions for the most part go without complications but some of the following may occur. Dry sockets are when the blood clot does not properly form. The bone under the clot becomes disturbed by food and bacteria and this is very painful.Other infections can also occur and this will require antibiotics to allow for proper healing. Jaw fractures, jaw joint pain,and temporary numbness from nerve irritation can also occur. These last three complications are very rare.

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