A common question we get asked is, “Will my extraction be difficult?”
There are a number of signs, which can suggest it may be a difficult extraction and these are discussed below. However, sometimes there is just no telling until you make a start and even then unexpected complications can occasionally arise that make life harder. See the previous chapter on Risks and complications of extractions
for more information.
I have had situations where it looks simple and I know that the instant that I grip the tooth, it is not going to want to leave you, and other times where extensively broken down teeth that spell t.r.o.u.b.l.e. come out simply in a matter of moments.
The vast majority of teeth are removed fairly simply by a general dentist. Sometimes, the actual pulling part of the procedure takes less time than the ‘going numb’ bit and the ‘getting you to stop bleeding bit’ afterwards.
How difficult an extraction is will depend on you, your mouth, the tooth and the dentist. Here are some factors to think about:
As you get older, your bone tends to be less forgiving and more brittle which can mean fractures become slightly more likely to both teeth and jaw.
(ii) Ethnic background
. Heavily built men, particularly those from the Caribbean and the African continents, have very solid dense bone that can make for a real workout.
The further back and the smaller your mouth, the more difficult the extraction is for the dentist. If the tooth is very out of position, then it can often not be gripped in the usual way. Impacted wisdom teeth
, particularly lower third molars are often tricky because of their position at the back of the mouth. The size of the tongue and position of the other teeth will also have an impact on the amount of space for putting the instruments in.
(i) Lone standing molar.
If a tooth has been standing on its own for some time and taking a lot of force- perhaps as support for a partial denture it can undergo a process called ‘ankylosis’ where the ligament (suspension for the tooth) becomes increasingly replaced by the bone, fixing it very firmly to the jaw and making its removal much more difficult. This can often be seen on the X-ray.
(ii) Type of extraction procedure.
A surgical extraction is going to be more difficult than a sectional extraction and in turn, that is more difficult than a simple extraction. Indeed, depending on the situation it may be necessary to go from one approach to the other if complications arise.
. The tooth may be impacted- meaning not fully through the gum. This most commonly occurs with wisdom teeth but also with canines and other teeth that may have gone off track for one reason or another, when trying to come through.
(iv) Large abrasion cavities
can be caused by excessive tooth brushing
, extensively filled teeth and those which are cracked or showing signs of fracture. These are all more likely to fracture during extraction.
(v) Root filled teeth
. Having had the nerve supply removed during the root canal procedure
, the teeth become much more brittle and prone to fracture. Most of the more difficult teeth I have removed (aside from wisdom teeth) have been root filled, since they often decide to come out in a lots of pieces.
(vi) Lots of decay
. Extensive dental caries
throughout the tooth will make the tooth very weak and more likely to fracture. The site of the decay is also important. If it is where the forceps are placed, then the extraction is immediately trickier and fracture more likely.
. If your tooth is already moving because of bone loss from gum disease
, the extraction is likely to be very simple. Sometimes this movement can be because of a fractured root, in which case the tooth is certainly going to come out in two parts- the top bit will be easy but the bottom half of the root may be trickier and require a surgical approach.
If the tooth looks particularly difficult, the dentist may refer you to an oral surgeon to remove it. This is generally the case with difficult impacted teeth such as a hard wisdom tooth. I say 'hard', because we take wisdom teeth out all the time ourselves, but what we ( general dentists) decide to attempt will depend on our experience, abilities, feelings about your comfort, the tooth or teeth that need to be removed, and the risk and potential for complications.