Kinder, Gentler Tooth Extractions


Have you been told that you need to have a tooth pulled?  If so, you may find it reassuring to know that the phrase “tooth pulling” doesn’t really describe the careful process by which a damaged, diseased or displaced tooth is gently removed from the mouth. So in case you’re a little behind the times on modern tooth extraction techniques, here’s a quick guide.

There are several reasons why a tooth might need to be extracted. Some of the most common include: untreated decay that has damaged or destroyed a large part of the tooth structure; severe periodontal (gum) disease causing the tooth to become detached from its supporting tissues; a deep crack or fracture of the tooth below the gum line; crowding, a condition where there isn’t enough space in the jaw for all the teeth to erupt (emerge from the gums) properly; and an impacted molar, where a tooth that hasn’t yet fully erupted threatens to damage adjacent healthy teeth. Before recommending an extraction, other treatment alternatives are considered; in some cases, however, removing the tooth remains the best option.

Depending on the complexity of the extraction, the procedure may be performed by a general dentist or a specialist, such as an oral surgeon. Front teeth, which generally have only one root, are comparatively easier to remove; back teeth (molars) usually have multiple roots, which makes their extraction a little more challenging. But modern dentistry has a number of special tools and techniques that can help make this routine procedure quick, effective, and pain-free.

You may think that teeth are anchored firmly into the jawbone – but this isn’t really the case. Instead, they are held in their bony sockets by a hammock-like net of elastic fibers called the periodontal ligament. In a simple extraction of a tooth with one root, your dentist will use special tools to carefully manipulate the tooth, causing those fibers to disconnect and allowing it to be removed. Of course, you’ll be given an anesthetic first, so you won’t feel anything!

If the tooth has multiple roots or other complicating factors, the extraction may be more involved. It’s possible that the tooth could be removed in several pieces, to make extraction easier and cause less tenderness at the extraction site. If you need multiple teeth removed, it’s convenient to have them extracted at the same time… but also more complex. In these cases, your dentist may recommend a deeper level of anesthesia, such as conscious sedation or general anesthesia. Anti-anxiety medications or sedatives may also be helpful in either type of extraction — especially for patients who are fearful of dental procedures.

The extraction is successful when the tooth comes out; however, your treatment doesn’t end there. In many instances, the empty socket is filled with bone grafting material before it is closed up; this helps give the body a head start at regenerating bone in the jaw, while preventing excessive shrinkage of the surrounding bone. After the procedure is over, your dentist will give you instructions on how to care for the area over the next few days. You may be advised to take prescription or over-the-counter pain relievers/anti-inflammatory medications, and sometimes antibiotics or other medications. Ice packs applied to the face (for 5 – 20 minutes on and 5 – 20 minutes off depending on your own doctor’s instructions) can also help relieve swelling and ease any discomfort. So if an extraction becomes necessary, remember that these days, it’s not “like pulling teeth.”


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