Distinctive Dentistry

Tooth Extraction

Person smiling

Tooth extraction, also known as exodontia, is the process of pulling out a tooth from its socket in the bone. For the good of your dental health, Dr. Noelle may recommend a tooth extraction if the tooth is broken or damaged by decay and cannot be saved with a filling, crown, or other dental treatment. In an emergency situation, Dr. Noelle will extract a tooth if it is due to severe tooth infection and pain.

Other Situations When Tooth Extraction is Recommended

Dr. Noelle may also recommend a tooth extraction under the following circumstances:

Compromised immune system. If your immune system is compromised (after receiving chemotherapy or having an organ transplant), the risk of infection in a particular tooth may be reason enough to pull the tooth.

Crowding. If your teeth are crowded, sound teeth may be extracted to create space so the rest of the teeth can be straightened. Similarly, if a tooth cannot break through the gum (erupt) because there is no room in the mouth for it, Dr. Noelle may recommend pulling it. This crowding may be due to a malposed tooth or supernumerary teeth (hyperdontia). A malpositioned tooth is one that has grown in a faulty position, whereas supernumerary teeth refer to a condition where there are more teeth present in the oral cavity than the normal number.  

Impacted tooth/infection. An impacted tooth, such as a wisdom tooth (the third and final set of molars that most people get in their late teens or early twenties), sometimes gets stuck and cannot grow normally in the mouth. This may cause recurrent infections of the gum tissue around wisdom teeth (pericoronitis).  

Periodontitis/Gum Disease.  People with unhealthy gums that start receding and forming pockets are at risk for bacterial growth. Bacteria can seep inside the gums and cause an infection, leading to the decay of gums and even the tooth. The gums can become so weak that the base for tooth attachment can become fragile, and the tooth can fall out or must be pulled.

Trauma.  Tooth extraction is recommended for patients who have fractured their jaw in an accident where the teeth are directly involved in the line of fracture.  

Traumatic avulsion of a tooth is the complete displacement of the tooth from its socket due to the fracture of the alveolar bone, while intrusion is the displacement of the tooth into the alveolar bone. These conditions may require an extraction. 

How Tooth Decay Damages a Tooth

Tooth decay can damage a tooth when it extends to the pulp (the center of the tooth containing nerves and blood vessels). When this happens, bacteria in the mouth can enter the pulp and cause an infection. Usually, this can be corrected with root canal therapy, but when an infection is so bad that not even antibiotic treatment can cure it, Dr. Noelle will have to pull your tooth to prevent the spread of infection.

Risks Associated with Tooth Extraction

Although tooth extraction is a safe procedure, patients with certain medical conditions are at higher risk for developing a severe infection because the procedure can allow harmful bacteria into the bloodstream. Gum tissue is also at risk of infection. Therefore, you need to go over your medical and dental history (as well as any medications or supplements you might be taking) with Dr. Noelle before you have a tooth extraction. You should also let her know if you have any of the following medical conditions:

  • Artificial heart valves
  • Damaged heart valves
  • Congenital heart defect (CHD)
  • Impaired immune system
  • Liver disease (cirrhosis)
  • Artificial joint replacement (hip or knee)
  • History of bacterial endocarditis
  • Rheumatic heart disease
  • Diabetes
  • Pregnancy (When a woman is pregnant, they are immunocompromised. Tooth extraction can lead to infection or even trauma.)
  • Nephritis

If you have any of these conditions, Dr. Noelle may have you take antibiotics before and after the extraction to lower your risk of infection.

Tooth Extraction Procedure

A tooth extraction procedure starts with a local anesthetic to numb the affected area where the tooth will be removed. For a simple extraction where the tooth can be seen in the mouth, Dr. Noelle will loosen the tooth with an instrument called an elevator and will then remove it with forceps. If you have a broken or impacted tooth, Dr. Noelle will need to do a surgical extraction, cutting away gum and bone tissue that covers the tooth and using forceps to grasp the tooth to gently rock it back and forth to loosen it from the jaw bone and ligaments that hold it in place.  

Once the tooth has been removed, a blood clot forms in the socket. Gauze is then packed on top of the socket, and the patient is instructed to bite down on it to help stop the bleeding. In some instances, stitches may be required to stop the bleeding.

Complications That Can Develop After Tooth Extraction

Dry socket is a painful dental condition that sometimes happens after you have a permanent tooth removed. After the procedure, the blood clot in the socket fails to develop, or it dislodges or dissolves before the wound has healed. If this happens, underlying bone and nerves are exposed, resulting in intense pain. 

Signs of Dry Socket

Patients can get dry socket within 2 to 4 days after tooth extraction. The signs and symptoms of dry socket may include:

  • Severe pain within a few days after tooth extraction.
  • Partial or total loss of the blood clot at the tooth extraction site.
  • Visible bone in the socket.
  • Unpleasant taste in your mouth.
  • Bad breath or foul odor coming from your mouth.

If you think you have developed a dry socket, call our office to schedule an emergency follow-up appointment. Dr. Noelle will likely place a sedative dressing over the socket for a few days to protect it while a new clot forms.

Side Effects of Tooth Extraction

Possible side effects after tooth extraction may include

  • Soreness in the extraction site. 
  • Pain radiating to other portions of the mouth like adjacent teeth, gums, and even the face. This type of pain is known as referred pain. 
  • Moderate swelling to the tissues, both hard and soft, surrounding the extraction site. 
  • Bruising may also occur and may take weeks to disappear completely.  Bruising is more common in older people or people on aspirin or steroid therapy. 

Recovery From Tooth Extraction

After tooth extraction, it may take 3-4 weeks for the soft tissue within the extraction site to heal fully. Following the procedure, Dr. Noelle will provide you with aftercare instructions, which may include:

  • Taking painkillers and analgesics for pain relief.
  • Keeping gauze pads in place for up to 3-4 hours after the extraction.  If they become blood-soaked, change the pads and bite into them to absorb any remaining blood from the extraction.
  • Applying an ice bag to the affected area immediately after the procedure to reduce swelling.
  • Resting for at least a day after the procedure and avoiding strenuous activity for 24 hours.
  • Avoiding rinsing or spitting forcefully for 24 hours after the extraction to avoid dislodging the clot that forms in the socket.
  • Rinsing your mouth with a solution made of a 1/2 teaspoon of salt and 8 ounces of warm water after 24 hours. The saline solution has antiseptic properties to prevent the gums from developing an infection.
  • Avoiding hard or extra chewy foods, giving your mouth time to relax and heal.
  • Avoiding drinking from a straw for the first 48 hours.
  • Refraining from smoking, as it can inhibit healing and increases risk of dry socket.
  • Eating soft foods, such as bananas, custard, soup, pudding, yogurt, or applesauce the day after the extraction. Gradually adding solid foods to your diet as the extraction site heals.
  • Propping your head with pillows when lying down, as lying flat may prolong bleeding.
  • Brushing and flossing your teeth and brushing your tongue while avoiding the site of extraction.
  • Avoiding talking to give the extraction site time to heal. Talking moves the mandible, which may prolong bleeding.

Tooth Extraction at Distinctive Dentistry in Clackamas

If you are having a dental emergency that may require tooth extraction, call Distinctive Dentistry at (503) 698-4884 to schedule an appointment.