What is a Dental Extraction?

An extraction (as most of you will know) is the process of removing a tooth from your mouth. It is often referred to as ‘pulling a tooth’. Next to fillings and cleaning it is one of the commonest procedures performed by dentists.

Once a tooth is removed there is no going back, so it is important to consider the alternatives to an extraction and what you intend to do with the space.

What Types of Extraction are There?

There are three basic types of extraction:

• Simple extraction. The dentist is able to remove the tooth in a single piece- that is the whole tooth, the crown and all of the roots. This is by far the most common extraction procedure.

• Sectional extraction. This type of extraction only relates to teeth that have more than one root- that’s all upper and lower molars and the upper 1st premolar. Sometimes the tooth will not come out all in one piece because of the shape or directions of the roots, or because of the amount of decay in the tooth. In these circumstances, the roots of the tooth can be separated by cutting in between them with a bur. This allows each root to be taken out individually.

• Surgical extraction. If the tooth to be removed is particularly difficult, then a surgical approach may be needed. This is the case, if the tooth either hasn’t come fully through the gum yet (i.e. impacted), or has broken off below the gum line and the dentist can’t remove it by normal methods. The procedure involves reflecting your gum (raising a flap) to expose the bone that is holding in your tooth or root. Some of this bone will be then removed with a bur, just enough to allow the dentist to be able to lever out the tooth or root fragment. Sometimes the roots may also need to be separated as described above. The gum flap will then need to be replaced and held together by stitches, to allow healing. These stitches may be resorbable or they may not (meaning you would have to have them removed about a week later). Taking out stitches is very simple, pretty painless and takes only a few seconds to do. Occasionally, they fall out on their own in the meantime- this is generally not a problem.

The dentist will inform you after looking at the X-ray and examining your mouth, which approach is most likely and the anticipated cost of the extraction. Bear in mind, that sometimes, it is not until we (the dentist) make a start that we know the approach that is going to be necessary, and should the tooth awkwardly fracture when attempting a simple extraction, we might need to progress to a sectional or surgical extraction to remove it.

Who will do my Extraction?

Most extractions will be performed by your dentist; assume this is the case unless they advise you otherwise. General dentists are very good at handling the vast majority of things in everyday practise.

If the tooth is heavily impacted, or the risk of complications is high, (either because of your medical history, or how close the roots of the teeth lie to a particular anatomy such as a the ID nerve or maxillary antrum), they may decide to refer you to an oral surgeon to have the tooth removed.

They will base this judgment on the assessment, their experience and also the availability of specialist care. In some more remote areas, referral to an oral surgeon could mean a 5 hour car journey or more- this may still be the best way to go but each case will require consideration.

If you need sedation that your dentist doesn’t offer or a general anaesthetic for some particularly nasty wisdom teeth, then referral to the appropriate facility and surgeon will certainly be required.

Oral maxillo- facial surgeons are specialists in procedures that involve the head and the neck- this could be fractures, tumours, cysts, wisdom teeth and all matter of oral medicine related issues. Most are duly qualified in medicine and dentistry- at least now they must be- those who have been practising as oral surgeons for many years may not be. A dental surgeon is a ‘posh’ way of saying dentist and is not to be confused with a specialist oral surgeon.

One quick note on male and female dentists- extracting teeth. You would imagine that pulling teeth can require quite a bit of strength, but it is technique that is far more important. Size of biceps is not a substitute for experience and training. My tutor at Cardiff Dental Hospital; Dr Shelia Oliver was the perfect example of this- she really was a master of the forceps!