Dental extractions (or “exodontia”) are one of the most common procedures done by dentists. In this procedure, a tooth is pulled out of the alveolar bone and gums. Procedural dental extractions date back to the 14th century, in which a couple of antique apparati for pulling of teeth, called the “dental pelican” and “tooth keys” were used without the need for anesthesia, making the patient feel excruciating pain and often lead to uncontrolled bleeding because of the lack of X-rays. Nowadays, modern technology has introduced instruments and precautionary tools (such as the X-ray) and drugs (anesthesia) to promote precision of tooth extractions, without the cringing pain felt by the patient. Forceps are the most common tooth extraction instruments, and come in a variety of models, each with its own respective pulling power-designed for both children and adults.
There are a variety of reasons on why some teeth should be extracted from the alveolar bone (or the socket) from which they are connected:
1. Tooth decay or infections that have made their way into the pulp of the tooth, causing severe pain.
2. Hanging baby teeth that are blocking the eruption of permanent teeth.
3. Orthodontic appliances (like braces) may require the extraction of teeth (like first and second premolars) so that the teeth being pulled in will have a place to rest.
4. Infected teeth caused by successive chemotherapy treatments.
5. Wisdom teeth (or the third molars) are usually pulled out because of an impacted tooth caused by the former’s eruption. Either way, the patient can decide which tooth to pull out: the wisdom tooth or the impacted tooth.
Wisdom teeth extractions have different procedural extractions. The overall success of a wisdom tooth extraction depends on the position and location of the wisdom tooth.
There are two types of extractions:
Simple extractions are performed with use of the traditional anesthesia/dental forceps tandem. Often done on teeth that have already erupted or are visible in the mouth, the periodontal ligament is first rocked and removed from its attachment to the alveolar bone, making the tooth loose and disconnected from any bone and gum tissue, and then finally pulling it out of the gums.
Surgical extractions are usually done on teeth that have not been fully erupted or are in an awkward position not easily accessible to the dentist’s advantage. The dentist incises the gum of the patient, making the tooth accessible and drills or uses an osteotome to remove the tooth and its root.
There have also been both common and unprecedented risks associated with tooth extractions, which usually happen when the patient has not been X-rayed and when the dentist lacks the experience of pulling out teeth:
1. Accidental damage to neighboring or adjacent teeth.
2. Dental infections
3. Post-operative swelling is commonly attributed to the extraction of a second or third molar and usually subsides a few days after the operation.
4. An incomplete extraction that leaves the root of the tooth attached to the alveolar bone.
5. A sinus hole caused by the removal of an upper molar. The hole usually heals in three week’s time, but if it hasn’t shown any sign of healing in that span of time, accompanying surgery may ensue.
6. Nerve injury caused by accidentally hitting or breaking the inferior alveolar nerve, resulting temporary to permanent numbness of the tooth.
7. Dry socket (alveolar osteitis) is a common phenomenon that occurs a few days after a wisdom tooth extraction. This happens when the normal blood clot activity within the tooth extraction site is hindered by the exposure of the alveolar bone to the air in the mouth. The expected duration of the pain is between 2-5 days.