Who is an oral surgeon?

An oral surgeon is a dental specialist who specializes in surgery of the oral and facial region. An oral surgeon extracts teeth, performs surgeries involving the jaw bones, etc.

Why are teeth extracted?

Teeth may need to be removed for a variety of reasons. Below are some examples.
Very large cavity/ caries that cannot be restored with cements.
Periodontal diseases or in simple words diseases of the gums.
Fractured or broken teeth
Teeth that are traumatized leading to infection and inflammation of the pulp.
Teeth that fail to erupt or are unable to erupt into the mouth and are deep inside the bone. They are called impacted teeth and may have to be removed.
Abscessed teeth are teeth in which the infection has spread to the underlying bone.
Teeth that are abnormal in development i.e., structure, shape, size, etc.
Teeth that are involved in cysts or tumors.
Ectopic teeth that have erupted in a wrong place.
Sometimes the orthodontist may remove some teeth to correct crooked teeth.

How is a tooth extracted?

There are two basic methods of tooth removal. The first method requires dental forceps and is suitable for the majority of teeth that have erupted. In this method the tooth is held at its neck by forceps and rocked gently to expand the surrounding bone socket. This action can be likened to removing a post set in the ground by rocking it sideward. So, much depends upon the elastic nature of the surrounding bone. In young patients the bone is elastic and thus expands easily. In older patients the bone is more mature and is resistant to expansion. The second method is reserved for those teeth whose roots either cannot be gripped using the forceps or the roots are of odd shape and defy all efforts to remove them by using forceps. In this method, the gums are cut open and the bone around the tooth is cut to allow removal of the teeth

Does it pain while removing a tooth?

Extractions are done after administration of local anesthesia that makes the tooth and the surrounding tissues numb. Thus extractions need not be painful. But a feeling of pressure may be experience by the patient during the procedure. This is often coupled with fear and anxiety which makes the patient feel some sort of pain

Why does the dentist ask me to bite on a gauze pack after extraction?

Soon after extraction the dentist will ask you to bite on a gauze pack for about 15 minutes. This helps in stopping the bleeding that occurs after extraction and helps in forming a clot. During this period, the patient is asked not to open the mouth or talk.

Do I need to take off from work after extraction?

It is usually advisable to avoid demanding physical work or exercise for the remainder of the day as such activities may restart the bleeding.

What care should be taken after extraction?

The following care should be taken after extraction: a) Bite on a gauze pack for 15-20 minutes. b) Take rest and avoid physical activities. c) Avoid eating till the numbness of the anesthesia persists. d) Avoid warm food as it can result in bleeding. In addition soft food is advised. e) The dentist may advise cold fomentation for some patients to reduce the inflammation and swelling. f) After 24 hours warm saline mouthwash helps in keeping the wound clean. g) Avoid biting the lips/cheeks.

What are sutures and why are they given?

Sutures are stitches which maybe given after an extraction. These stitches help in approximating the gums close together and therefore restrict the size of the wound. Sutures also help in controlling the bleeding.

Should sutures be removed?

Sutures are of two types: absorbable and non-absorbable. The absorbable sutures are broken down by the enzymes in the human body. So they just dissolve in a few days and need not be removed. The non-absorbable sutures need to be removed after 7-10 days.

What is local anesthesia or LA?

Local anesthesia is temporary loss of sensation to pain and other sensations such as pressure, temperature and touch in a localized area of the tissue. This is done by injecting a local anesthetic drug around the tooth being extracted. The teeth, lips and tongue become numb so the patient does not feel the pain during the procedure. This numbness lasts for a few hours. Most extractions are done under local anesthesia.

What is general anesthesia?

General anesthesia is reversible loss of consciousness along with loss of all sensation. General anesthetic drugs also help in controlling pain and relax the muscles of the body. General anesthetics are used in complicated surgical procedures that may take a long duration and when the surgery is done in multiple sites. They are also useful in unco-operative patients.

Why does it bleed after extraction?

Once the tooth is extracted a wound is created and therefore bleeding occurs. The bleeding stops once a stable clot forms. But in some patients minor seeping of blood may be seen for a day or two after extraction and their saliva may be tinged with blood. This need not be a cause for worry to the patient. However profuse bleeding must be brought to the notice of your dentist.

What happens after a tooth is removed?

After a tooth is removed, it leaves behind a socket in the bone that was occupied by the roots. This socket gets filled with blood, which soon forms a clot. In a few weeks time the clot slowly reorganizes into bone and fills the socket.

Why is the wisdom tooth removed so often?

The wisdom teeth are the third molars, which are the last teeth in the dental arch. The teeth usually erupt between 18 and 25 years of age. In many individuals, the wisdom teeth remain in the bone as they may not have adequate space in the dental arch to emerge out. This condition is called impaction. In addition the third molar may erupt in abnormal inclination thus affecting the health of the adjacent teeth. So the wisdom teeth need to be removed often.

Why is it difficult to remove the wisdom tooth?

The wisdom teeth are often inside the bone and therefore cannot be removed easily by using the forceps. In addition their position and angulation may be abnormal. They often require surgical extraction by cutting open the overlying gums and cutting the bone around the teeth.

Why does a swelling appear after extraction?

Some extractions are followed by appearance of swelling. This is nothing to worry about, as it is a part of the normal healing process. In reaction to the extraction, the tissues show an inflammatory reaction to heal the wound created by the removal of the tooth. Swelling is a part of the normal inflammatory process. However the dentist may advice you to have cold fomentation over the area to reduce the swelling.

What is dry socket?

Dry socket is a condition characterized by onset of pain and foul odor a few days after the extraction. This occurs due to lysis or dislodgment of the clot that forms after the extraction leaving behind the bony socket that is very sensitive and tender. The socket may also get infected. This is one of the rare complications of extraction.

Why does the tooth break sometimes during the extraction?

Teeth are embedded in bone. The principal behind extraction is that the tooth is held by forceps and rocked from side to side to allow the bony socket to expand. In patients who are aged, the bone is very hard and mature and does not easily expand. In addition the teeth also become brittle with age or may have been weakened due to dental decay. The two factors, namely weakened teeth and brittle bone may result in breaking of the tooth during extraction. The small piece of tooth left behind can be removed by appropriate root forceps or may require surgical opening of the gums and cutting of the bone to remove the broken fragment.

Should the gums be cut while extracting some teeth?

Those teeth that cannot be gripped by a forceps or are embedded inside the bone may require cutting of the gums and the overlying bone to remove the teeth. This is called surgical method of extraction.

Can extractions be done on a patient having medical problems?

The dentist must be informed of any medical problems that you may have or had in the past. There are certain systemic problems, which may require certain precautions during the dental treatment so as to avoid complications. In some cases the dentist may require consent from your physician before he can extract.

Can extraction be done on a heart patient?

Usually extractions may not pose any problems for heart patients. However the dentist may require your physician's consent. In addition prophylactic antibiotics may be prescribed prior to the extraction as a precautionary measure. Some sedative may also be prescribed prior to the extraction.

Can extraction be done on a diabetic patient?

Patients who have their diabetes under control by diet and medication can undergo extraction. However the dentist may give you a prophylactic antibiotic prior to the procedure. He would also advice you to have normal food and medicine before the appointment. Sedative may also be prescribed.