Surgery

A tooth extraction may be required for numerous reasons, including the following:

• extensive tooth decay, unsalvageable through endodontic treatment,
• extreme trauma or fractures,
• extensive gum disease, unsalvageable through periodontal treatment,
• overcrowding of teeth,
• extra or nonfunctional teeth,
• in preparation for future dental work, such as braces or dentures,
• as part of a medical treatment, such as organ transplant, radiation, or chemotherapy.

Often, patients may choose to extract a tooth with extensive decay rather than opting for root canal treatment, even if it is a viable, conservative option. This is most commonly due to the initial monetary cost of each procedure. However, a discussion of the long-term cost-benefit of the two procedures may prove otherwise when considering the long-term effects of having missing teeth and the cost of future restorations with dental prostheses.

The reasons for tooth extraction should be discussed with your dentist.

An uncomplicated tooth extraction involves the removal of a tooth which is visible in the oral cavity. A local anesthetic is usually administered. Then, a dental elevator and dental forceps are used to separate the tooth from the periodontal ligament and lift it out from the bone and gums.

Sometimes, an uncomplicated extraction will not work to remove a tooth, as in the following cases:

• The tooth may have decayed or fractured to the point that there is insufficient material above the gum line to grip for an uncomplicated extraction.
• It may become evident during an uncomplicated tooth extraction that the attempt to remove a given tooth might result in trauma to or the loss of a neighboring tooth.
• The tooth may be impacted and still under gums and bone, as commonly the case for the extraction of third molars (or wisdom teeth).

Complicated tooth extraction is performed under local or general anesthesia. Once the area for surgical extraction is sufficiently clean and numb, an incision is made into the gums to access the tooth. Depending on the depth of the tooth, bone tissue may also need to be removed. The tooth may be removed in one piece or in sections. The space from where the tooth was removed is then cleaned, and the gum flap is closed with sutures.

The third molars, commonly referred to as wisdom teeth, are the last teeth to erupt, growing in during the late teenage years or early twenties.

Frequently, wisdom tooth extraction is recommended upon analysis of X-rays showing the alignment and predicted growth pattern of the third molars.

Most often, the third molar is misaligned or impacted which may eventually cause damage to the neighboring teeth, bone, and nerve. In this case, extraction is often recommended early, before the root fully develops and the bone hardens, so as to minimize pain and complications.

Another reason wisdom tooth extraction would be recommended is due to the growth of the tooth. Occasionally, the third molar does not grow in fully, allowing easier access for bacteria to develop around the tooth and gum line.

Often, cleaning around the third molar is difficult, which may cause tooth decay and cavities, leading some dentists to recommend extraction as a preventive measure. However, wisdom tooth extraction is not necessary if the third molar fully erupts with proper alignment and healthy surrounding gum tissue.

Impacted wisdom tooth extraction is one of the most commonly performed complicated tooth extractions. Under local or general anesthesia, an incision is made into the gums. Bone covering the tooth is removed. Then the tooth is extracted either in one piece or in sections. The space is cleaned, and the gums are closed with sutures.