WHAT IS SIMPLE EXTRACTION?

Simple tooth extractions is a process of removing teeth without the need of surgical techniques. Generally, teeth that can undergo simple tooth extractions have straight roots and enough solid tooth structure extending through the gums to grasp and manipulate with the instruments. “Simple” implies that the tooth is not cut into pieces and no incision is made in the gum tissues to gain access to the tooth.

Simple tooth extractions are prescribed if teeth are too extensively damaged from decay or trauma to be fixable, or if they are infected and the patient is not a candidate for root canal treatment. Simple tooth extractions are also frequently prescribed when the teeth in one or both jaws are severely crowded, and straightening the teeth would require unnecessarily complex orthodontics with a compromised treatment outcome. Sometimes the decision to remove a tooth is based on cost, if the procedures required to restore it would involve significant expense. This is especially true if the likelihood of long-term success is not good.

THE PROCESS OF SIMPLE EXTRACTIONS

Before a tooth is extracted:

• The dentist will review your health history
• If you have replacement joints (for example, total knee replacement, hip replacement, etc.), you may be pre-medicated with antibiotics for the procedure
• If you have certain types of heart murmurs or replacement heart valves, you may also need to take an antibiotic pre-medication prior to the procedure
• If you take blood thinning medications, your dentist and/or physician may require you to suspend those medications temporarily to have any oral surgical procedures, including simple tooth extraction. This is due to the possibility for prolonged bleeding from tooth extraction sites
• If you are anxious about dental procedures, your dentist may recommend sedating you for the procedure

Anesthetic:

• The tooth to be removed is usually anesthetized by injecting local anesthetic around the nerve(s) that supply sensation to the tooth. Discomfort from the injection can be minimized by use of a topical numbing gel for a minute or two prior to the injection

Release of periodontal ligament fibers:

• Teeth are not normally fused to bone. Instead, they have a shock-absorbing ligament that suspends them from the bony tooth socket. The ligament is called the periodontal ligament, and the first step in removing a tooth is to release it. This can be done without trauma with a thin-bladed instrument called a periotome. To prevent the tooth from being swallowed or inhaled when it is removed, dentists will often place a “safety net” of gauze in the back of the mouth

Loosening and elevation of the tooth:

• The tooth is loosened (luxated) within its socket by applying leverage on the tooth with an instrument called an elevator. There are several types of elevators, depending on the type and size of tooth to be removed, and its location in the mouth

Forceps delivery:

• When the tooth is sufficiently loosened, a forceps is adapted to the tooth to remove it from the jaw

Minimize bleeding:

• When the tooth is out, the dentist will apply pressure directly to the tooth socket to minimize any bleeding. There are no major arteries in tooth sockets, so bleeding is generally minimal anyway

Post-operative instructions and care:

• Your dentist will give you specific post-operative instructions, taking into account your unique medical and dental situation. Oral, written, and/or video instructions are helpful. Although they may seem simple at the time of your appointment, questions frequently come up later

ADVANTAGES AND BENEFITS OF SIMPLE EXTRACTIONS

• Removal of infected teeth eliminates the source of the infection, and generally brings fairly rapid relief from pain and swelling.
• Removal of teeth from severely crowded dental arches provides more space in which to move the remaining teeth to straighten and better align the teeth from the upper and lower jaws.
• Removal of teeth having a questionable long-term prognosis can lead to a much more successful treatment outcome.

OTHER CARE THAT MAY BE NEEDED

The following procedures are all separate, billable procedures which may be recommended during or after the removal of teeth:

• Bone grafting, to prevent shrinkage (resorption) of the bony socket after tooth removal; Fixed bridgework, to replace the tooth (or teeth), and prevent shifting of the remaining teeth; 
• Dental implants, to replace the tooth (or teeth), preserve the bone and prevent shifting of the remaining teeth (while avoiding the need to alter any remaining teeth); Orthodontic treatment, to close spaces, straighten and align the remaining teeth; 
• Removable dentures, to replace missing teeth;
• Sedation, to allow the procedure to be performed more comfortably—especially on anxious, fearful, or special needs patients.

OTHER TREATMENT OPTIONS

If your tooth is infected, and it is not feasible to fix it, there may be no practical option to removing it. Treatment of recurring infections of known cause with antibiotics may not be considered medically responsible. This is because the bacteria that cause infections can develop resistance to repeatedly administered antibiotics, and the infections may become very difficult or impossible to treat, resulting in a potential life threat.

Root canal (endodontic) treatment can be an alternative to tooth removal for infected teeth. However, an evaluation of the restorability of the tooth should be taken into account before the cost, time, and potential discomfort of undergoing a root canal procedure are invested. If the tooth requires extensive procedures to restore, and isn’t expected to have a good long-term chance of success, extraction may be the better option.

Endodontic treatment may be recommended for infected teeth that have a poor prognosis if the patient is not a candidate for tooth removal.

WHAT HAPPENS IF I DO NOTHING?

Chronically infected teeth that have been recommended for removal can become acutely inflamed, resulting in severe pain, swelling, and numbness.

If the tooth that has been recommended for removal is infected, and the infection is not treated some other way (for example, endodontic therapy) the infection can spread and become life threatening. Infections of the upper teeth can ascend into the brain. Infections that cause swelling into the oropharynx can ultimately prevent air from reaching the lungs (suffocation). Infections can also spread along fascial planes of the neck toward the heart, lungs, and other organs with potentially grim implications.

If tooth removal has been recommended for orthodontic reasons, and the advice is not followed, a compromised orthodontic treatment outcome may result.

** PLEASE CONSULT WITH YOUR DENTIST FOR FURTHER INFORMATION ABOUT PROCEDURES, RISKS, COMPLICATIONS, ISSUES AND/OR ADVICE REGARDING YOUR CONDITION