Many dental practices don’t get involved with tooth extractions, wisdom teeth, and bone grafting. But at Deeter Dental, our extensive experience allows us to provide these three oral surgeries for our patients.
The need for pulling a baby tooth is far more typical than a permanent adult tooth. Baby teeth may become overly decayed due to lackadaisical hygiene; they may be badly damaged from a fall or other trauma; or they may not be cooperating with the permanent teeth that need to descend, so they need some help getting out of the way. We try and keep the baby teeth, if possible, as they help maintain spacing for the permanent teeth to follow. But extracting baby teeth is a pretty simple process, as their roots aren’t very strong.
Reasons for Tooth Extraction
There are a number of reasons a permanent tooth can need extraction. The most common reason is the health of the tooth. If a permanent tooth has so much decay or is so badly damaged from trauma that it can’t be saved with a root canal and/or crown, it may need to be extracted.
These are the typical reasons a permanent tooth may need extracting:
- Excessive decay
- Excessive damage
- Crowding — permanent teeth may be pulled to make room as part of orthodontic treatment
- Infection — If decay has entered the tooth pulp infection will spread. This can usually be addressed by a root canal, but if the infection is severe enough the tooth may need extraction to prevent the spread of infection.
Tooth Extraction Procedure
In most cases when extracting a permanent tooth, an injection of local anesthetic is sufficient to numb the area and keep you from feeling any pain. If we’re pulling more than one tooth, general anesthesia may be used.
Using forceps, we then grasp the tooth and gently rock it back and forth to loosen the roots and ligaments holding it in place. To think of a similar situation, picture a tent stake. When removing it, you may not be able to pull it straight out, but first must push it back and forth a bit to make a bigger pocket around the stake. The same is true when we extract a tooth.
Once the tooth is removed, we usually don’t place stitches (especially with just a single tooth). Instead, we have you bite down on a gauze pad that is packed into the socket. Your bite pressure helps stop the bleeding, allowing a blood clot to form.
Is a tooth extraction painful?
The anesthetic we apply takes care of any pain. You will feel pressure during the extraction process, but not pain. The two sensations are transmitted by different nerve fibers and the pain transmitters have been lulled to sleep with anesthetic.
Recovery after tooth extraction
You can expect some discomfort after your extraction, but it usually is mild. Taking anti-inflammatory drugs such as Advil or Motrin usually is sufficient to handle the pain, which is more aching than acute. Applying an ice bag to the cheek outside the area where the extraction occurred will keep swelling down.
You’ll need to keep your gauze pad in place for three to four hours. If the bleeding is more involved, you’ll need to change the gauze periodically. Limit your activity for at least 24 hours, so that blood flow through the mouth and head doesn’t accelerate. Avoid rinsing or splitting forcefully for 24 hours to avoid dislodging the blood clot from the tooth socket. When lying down keep your head elevated as this helps limit bleeding.
After the first 24 hours, you can rinse your mouth with a solution made of ½ teaspoon salt and 8 ounces of water. Don’t smoke, as it inhibits healing. Eat soft foods for the first day or so, and gradually add back solid foods.
Wisdom Tooth Removal
Having your wisdom teeth removed is an almost universal rite of teenage passage. Unlike most dentists, we don’t make you head over to an oral surgeon to remove your teenager’s wisdom teeth — we handle that for you at Deeter Dental.
What are wisdom teeth?
Wisdom teeth are classified as the third set of molars. They are also known as vestigial organs, leftovers of our prehistoric past that no longer have any function in our bodies today. Wisdom teeth join your appendix and tailbone in this group.
When we had three sets of molars instead of the current two, it made sense to have the extra chomping teeth. Our diets consisted of leaves, roots, nuts, and some very tough meat. All of this required far greater chewing power and caused greater wear and tear on our teeth. To make room for this extra set of molars, prehistoric jaws were longer than our current jaws.
Fast-forward to today, our diet is much softer and easier to chew, so our wisdom teeth are no longer needed. The problem is, they didn’t get the memo, and they still try and make their way down into our mouths. These are the ages when the three sets of molars generally come in: the first set erupts around age six, the second set at age 12, and the third set (wisdom teeth) somewhere between the ages of 17 and 25.
Reasons for wisdom tooth Removal
We can get away with our tailbone and appendix, but the arrival of our wisdom teeth is invariably bad news. If we still had longer jaws everything would be fine, but our modern shorter jaw length means there isn’t any room for a third set of molars. So, when your wisdom teeth come down they become impacted (blocked) by the other teeth. They can come in sideways, pushing on the adjacent teeth. They sometimes are surrounded by bone. Often one wisdom tooth will partially erupt, creating pockets in the gums that are perfect places for bacteria to thrive.
Although you may know someone who has their erupted wisdom teeth in place, people like that are very, very rare. For the rest of us, the wisdom teeth simply cause the other teeth to be pushed out of position and other dental issues, and they need to be extracted.
When should I have my wisdom teeth extracted?
Extracting the wisdom teeth is better done sooner than later. They may wait to erupt until a person is in his or her mid-20s, but you shouldn’t wait until they erupt to remove them. Why? When a teenager is between the ages of 15 and 18 the wisdom tooth roots are only two-thirds formed. But if you wait, the roots fully develop, making extraction that much more difficult.
Wisdom teeth extraction is considered minor surgery. X-rays show us when the wisdom teeth are descending, which is another reason to be diligent with your twice-yearly professional cleanings and exams at Deeter Dental. At a certain point, they will begin to either erupt or start pushing on the other teeth. That’s the time to remove them. It would be easy if they had all erupted, but that is very rare. Instead usually half the teeth are impacted. Often they’ll need to be broken to get them out to minimize the impact on the surrounding gum tissue and the jawbone.
Recovery after wisdom tooth removal
Your teenager will need about a week to get back to his or her old self after surgery. He or she will resemble a chipmunk for the first few days, depending on how many of the teeth were impacted (this creates more swelling). This swelling is normal. When you return home, there will be some bleeding. The patient will need to bite down firmly on a piece of gauze for about 45 minutes. Believe it or not, a moistened tea bag is also effective, as the tannic acid in the tea helps blood clots form. Repeat the process until the bleeding stops. If you have heavy bleeding, you need to call us.
Pain is usually manageable with over-the-counter options. Depending on how difficult it was to remove your wisdom teeth, we may prescribe pain medication. Either way, most pain will go away after a couple of days.
Avoid rinsing or spitting for 24 hours after your extraction. Don’t use a straw (sucking actions are bad), and avoid any hot liquids. These can break down and dislodge the clot. Swelling will happen, but can be kept manageable with an ice pack. Apply it for 10 minutes, and then follow with 20 minutes off. This only has value for the first 24 hours.
As with any surgery, infection is the main potential complication, but if the patient rinses with saltwater and keeps his or her mouth relatively clean this risk can be minimized. You may have heard about “dry socket,” but its occurrence is also rare. This happens when the initial blood clot that forms when after-surgery bleeding has stopped becomes dislodged or dissolves. When this happens there is a direct line to the jawbone and the surrounding nerves. As you would expect, this is very painful, but treating it is not difficult.
We are big fans of dental implants at Deeter Dental. We feel they are far and away the best solution to replace a missing tooth. A dental implant consists of three parts: the titanium screw-shaped implant, the post, and the artificial tooth. For the implant to be successful, the patient needs to have sufficient jawbone mass to adequately support the titanium implant, which is screwed down into the socket of the former natural tooth. If the patient has been missing the tooth or teeth for some time, he or she may have experienced some bone loss, which occurs when teeth are missing above an area of the jawbone. In these cases, we may need to perform a bone graft in the area to build up the jawbone mass before placing an implant.
Who would need a bone graft?
When a person is missing a tooth or a series of teeth for a period of time, their jawbone begins to deteriorate, a process known as resorption. The jawbone stays healthy thanks to the teeth. When you bite and chew, you generate a serious amount of bite force energy. This energy travels into the teeth and down through the tooth roots into the jawbone, where it initiates a process of the jawbone continually building new bone cells to replace old cells. This keeps the jawbone healthy and strong. It begins to deteriorate as soon as it doesn’t receive that energy when a tooth is missing. That’s why you may have noticed that people who have lost all of their teeth often appear as if their jaw is retreating backwards.
At Deeter Dental, Dr. Lucas Deeter is an implant specialist. During your consultation for a potential dental implant, he will use the 3D imaging capability of our Cone Beam CT Scanner. This will show just how much jawbone mass you have at the potential implant location or locations. If the mass is insufficient to support the implant, you will need a bone graft.
Bone Grafting Procedure
Dr. Deeter uses a special bone grafting material called xenograft. He places the grafting material into the empty tooth socket. This stops the surrounding alveolar bone from resorbing any more. Then, through a process called “guided tissue regeneration,” the human body is fooled into believing the graft material is natural bone and it begins to resorb it and replace it with new bone growth. The graft material acts somewhat like a platform for nearby bone to grow upon, with the new bone eventually replacing the graft material
This is called a socket graft and is one typical method used. In cases where jawbone loss is more severe, different methods may be needed to build larger amounts of bone mass. If the back molars are involved, the sinus cavity may provide the grafting site. The grafting approach taken by Dr. Deeter will depend on the location in the mouth, the degree of bone loss, and whether the grafting takes place immediately after removing a tooth or if some time has passed since tooth loss.
Once the graft material is placed, the patient needs to wait several months while the graft creates enough new bone to adequately support the implant.
bone grafting Recovery
Usually the only discomfort comes from closing up the gums that may have been opened to access the jawbone. This can usually be managed with anti-inflammatory, non-steroidal medications like ibuprofen. We likely will also schedule a round of antibiotics to protect against infection.