Hey everybody, it's Dr. Jon from Boulder Canyon Dental. I get a lot of questions about what a tooth extraction is. Today, I'm going to go over some of those common questions so that you have a better idea about dental extractions.
What is a dental extraction?
A dental extraction is simply where we remove a tooth from its socket in your jawbone.
What are reasons tooth extractions may be necessary?
Some common reasons that a tooth extraction may be necessary can be due to fracture, decay, periodontal disease, severe pain, trauma, or crowding. Some common indications of why a tooth extraction would be recommended would be tooth pain, decay, gum disease, trauma, or even tooth crowding.
When would a dentist recommend wisdom tooth extractions?
A dentist would typically recommend wisdom tooth extractions if there's no room in the mouth, if they're currently causing you pain, if they're misaligned or angled, causing damage to adjacent teeth, or if there's infection, crowding, or gum disease. A dentist may recommend getting a wisdom tooth extraction if that wisdom tooth's position is misaligned to where it's affecting the adjacent teeth negatively, if that tooth is currently causing pain, if there's infection, if there's overcrowding, or if there's lots of decay.
When would braces require tooth extractions?
Sometimes, orthodontists will ask us to take out some teeth to help ease tooth movement for braces. At our office, the last thing we want to do is take out a natural healthy tooth, so it's important to talk with your orthodontist and see if expansion or any other options are available before we take out a natural tooth. But in some cases, there's just no room, and if that's the case, we do need to take those teeth out comfortably. We usually don't need grafting in that procedure, and that way the braces can move the other teeth into those positions.
When do I need bone grafting?
I get asked, "When do I need bone grafting? What is bone grafting, and why do I need it?" Bone grafting is simply a particulate material that replaces the hole in the socket. When we replace that material in the socket, it acts like a scaffold that will allow your bone cells to grow across. That way, once you're done healing, that socket is no longer a hole; it's not filled with tissue but with solid bone.
What is ABC?
At Boulder Canyon Dental, we always want to increase healing naturally and decrease post-operative pain from any surgery. Since 2016, we've implemented a procedure called autologous blood concentrate (ABC). This involves drawing a little bit of blood from your arm, not a lot, and spinning it to make a plasma liquid and a fibrin membrane from your own cells. That plasma liquid can then hydrate the bone graft material so that it's almost as good as your natural bone. Once we place that into your socket, the plasma acts like a glue, helping stabilize the graft. Additionally, we take that fibrin membrane, put it over the hole, and then secure it with stitches so that you're almost healing like it's your own cells from day one.
What is a GTR?
In some cases, when we take a tooth out, whether it was due to infection or any other reason such as fracture, sometimes one of the walls of bone is missing. Since tissue grows much faster than bone, it's important to protect the socket so that tissue doesn't replace our bone. Our ultimate goal is to grow bone back, so in cases where we are missing that wall, we place something called a GTR, or guided tissue regeneration. This involves a collagen membrane that we tuck in between the tissue and the socket so that tissue can't get into the site. Once that membrane is tucked, we pack it full of our graft material, and over about four to six months, the collagen membrane will slowly break down. By that point, our bone has already grown.
What are the steps to getting a tooth extracted?
At our office, the tooth extraction appointment starts with phlebotomy, where we draw a couple of vials of your blood and spin it in our centrifuge to make autologous blood concentrates (ABC). This creates our plasma layer, which we use to rehydrate your graft material, and a fibrin membrane that we use to cover the hole so that you don't have a hole after your procedure. Once we draw the blood, we place a topical anesthetic, and then anesthetize the area with local anesthetics such as lidocaine, Septocaine, or Marcaine, so that you are comfortable and feel no pain during the procedure. If you have some anxiety leading up to this appointment, make sure to discuss it during the consultation. We have nitrous oxide and oral conscious sedation as options to make it easier for you. Once the area is comfortably numb, we safely remove the tooth, preserving as much of the bony anatomy as possible. If the socket needs grafting, we place the graft material, repair any defects with GTRs (collagen membrane) as needed, and then cover the hole with the fibrin made from your own cells. We place a couple of stitches, which will be removed about two weeks later.
What is a dry socket?
A lot of times, patients are really scared about extractions, not necessarily because of the extraction itself, but because of something called a dry socket. A dry socket is when, after a tooth is removed, a blood clot forms to seal the wound, but that blood clot is lost or disrupted, exposing bare bone. It can be an extremely painful condition, sometimes leading to infection, and it can take weeks to recover. The best way to avoid getting a dry socket is by grafting the site with your cells, as discussed, using your own plasma, bone graft, and fibrin from your own blood. This creates a like-for-like site that enhances wound healing naturally. Using more of your own cells reduces the likelihood of disrupting or losing the clot. Other factors to consider in avoiding a dry socket include following our post-operative instructions. If you've misplaced them, we always keep a copy on our website for review. Some medical conditions can compromise bone healing, increasing the chances of a dry socket. During the consultation, it's important to review your medical history so we can understand the risks post-operatively and help you plan accordingly without much interruption.
Will I need a dental implant after my extraction?
In most cases, if you're getting a tooth extracted, it is well recommended to replace that tooth with a dental implant. The last thing we want is to start losing teeth slowly over time, which puts more pressure on other teeth in the area and potentially compromises them down the road. It's always a good idea to think about the endgame and discuss implants when planning to take a tooth out.
How long does it take to recover from a tooth extraction?
Typical recovery from a tooth extraction initially takes about 72 hours. During this time, we recommend taking it easy and avoiding rigorous activity. We have a bunch of other little restrictions that we recommend to make it more comfortable, which you'll find in your post-op care instructions. Usually, after 3 days, the discomfort subsides, and you can return to your daily routine. However, in some instances, around days 5 to 7, there can be an increase in pain, which is part of the natural healing process. If you're overly concerned, feel free to call our office for a follow-up. After two weeks, we do a typical check-up appointment to ensure proper healing and remove any stitches. By that point, the wound is fully secured, and you can resume your normal activities.
Will I have pain after my extraction?
The number one question I get is, "How much is this going to hurt?" Avoiding pain after the extraction involves following our post-medication instructions and finishing any medications recommended prior to surgery. During the procedure, we minimize trauma and inflammation, which helps with post-op discomfort. By using your own cells and following instructions, most patients only need a little ibuprofen or Tylenol for the first few days.
I hope I've been able to answer a lot of your questions about tooth extractions today. If you have any additional questions or are ready to take action, please give us a call at (970) 514-0662. I'm here to help.