Oral surgery

Tooth extraction involves the application of the appropriate force to separate the tooth from the socket and remove it from the bone. The extraction can be simple when the tooth is easily removed by applying forceps to the crown. It can be more complex when the crown is broken or decayed by cavities, and it becomes necessary to separate and remove the roots of single-rooted or multi-rooted teeth individually.

Surgical extraction is performed when, due to the curvature of the roots or the density of the surrounding bone, it is necessary to lift the gums, remove bone, and extract the remaining roots. A PRF (Platelet-Rich Fibrin) preparation can be placed in the socket of the extracted tooth to speed up and facilitate healing. This can be used alone or in combination with artificial bone substitutes, depending on whether the missing tooth will be replaced with an implant or a prosthetic restoration.

When is a tooth ready to be extracted?

When it cannot be treated using endodontic or endodontic-surgical procedures.
When it is a periodontally compromised tooth in the terminal stage of the disease.
When it needs to be removed before placing a fixed prosthesis or undergoing orthodontic treatment.
When it is out of alignment in the dental arch and its position threatens adjacent teeth or causes other issues.
When it is causing swelling or is the source of severe infections (such as an abscess) that threaten the patient’s health, it should be extracted as soon as possible.

Surgical extraction of a wisdom tooth

Wisdom teeth, or third molars, typically erupt between the ages of 18 and 25 and occupy the last position in the dental arch. The most common reasons for the lack of eruption or impaction of wisdom teeth are lack of space in the dental arch, irregular positioning of the tooth bud, or limited jaw growth.

The treatment for unerupted teeth depends on the assessment of the potential for eruption, the patient’s age, overall health, and the presence of symptoms. Unerupted teeth may not cause any issues, but if they do, they can lead to pain, ranging from mild to intense. Swelling may be present in the mouth and even externally, with difficulty opening the mouth and even signs of infection (such as fever, fatigue, etc.).

Surgical extraction of wisdom teeth is performed under local anesthesia, ensuring a painless procedure.

The duration of a surgical wisdom tooth extraction can never be precisely predicted, as it depends on several factors, such as the tooth’s position in the bone, the number and curvature of the roots, bone quality, and more. The complications that can arise from an impacted tooth include the following:

Pericoronitis – infection: The crown of the tooth is often covered by a part of soft tissue, and there is a space between it where food can get trapped, providing an ideal environment for bacterial growth. This part of the gum can become swollen and painful, and the unpleasant odor often results from pus draining from it. The swelling can spread to the cheek and lymph nodes.
Caries of the wisdom tooth or the adjacent second molar.
Root resorption of the neighboring tooth due to pressure from the wisdom tooth and its improper position.
Crowding and pushing of other teeth forward, indicating the need for extraction before orthodontic treatment.
Cysts or odontogenic tumors – These can occur if the follicle around a normally formed tooth in the bone cystically degenerates, leading to the formation of a cyst or tumor.

Wisdom teeth are also among the most commonly missing teeth in adults. There is an explanation for this. In the past, people had a much larger number of teeth. Over time, our jaws have changed, and today the last teeth in the group can be missing. For example, from the incisor group, lateral incisors are often missing, from the premolar group, the second premolar is often missing, and from the molar group, the third molar – wisdom tooth – is missing.

Due to a lack of space, wisdom teeth can become impacted (unable to erupt and trapped in the jaw) or semi-impacted (partially erupted), where they are covered by soft tissue in the mouth, with part still beneath and surrounded by bone. In the case of a semi-impacted wisdom tooth, pericoronitis (inflammation) often occurs because food gets trapped in the space covered by soft tissue. The symptoms of pericoronitis include pain, swelling, and in more complicated cases, limited mouth opening. This situation requires both extraction of the tooth and antibiotic treatment.

Many dentists, even when wisdom teeth do not cause any problems, tend to suggest wisdom tooth extraction to prevent future complications. For example, a cyst that may develop around an impacted wisdom tooth can destroy a large area of jawbone as it grows. Its growth, which may be completely asymptomatic, can threaten several teeth, and if it is very large, it could even lead to pathological fractures of the jaw. These are complications we, as dentists, do not want to see in our dental practices. These cysts, due to their asymptomatic growth, can be detected through an orthopantomogram during a routine dental check-up. They require surgical extraction of the tooth with the removal of the cyst, and a mandatory histopathological examination to determine whether it is truly a cyst and what type it is. Some aggressive forms can recur, so long-term follow-up is necessary.

Post-extraction instructions for teeth and wisdom teeth

After 20 minutes, remove the gauze the surgeon gave you to bite down on.
Cold compresses should be applied to the operated area externally (apply for 20 minutes, then rest for 20 minutes, and repeat for several hours).
Do not rinse the wound with water or other solutions (after tooth extraction, a clot forms in the socket, which can be washed away, causing painful and delayed healing).
Avoid eating while anesthesia is still active, as there is a risk of biting your lip or cheek, which could cause sores in the mucous membrane. A softer diet is recommended; for the first 24 hours, avoid hot food and drinks. Ice cream is recommended.
Do not smoke for 48 hours after the extraction, as nicotine and tar negatively affect the formation of the clot.
Avoid excessive physical activity and exercise for two to three days.
Mild bleeding is normal after wisdom tooth extraction. If bleeding persists, place a piece of gauze or two tea bags on the wound and apply pressure for 30 minutes. If it does not stop, contact your oral surgeon.
Pain relief can be taken as needed (such as Nimulid, Brufen, or Analgin – avoid medications containing acetylsalicylic acid). If pain persists after 48 hours, consult your surgeon.
Antibiotics are typically prescribed after wisdom tooth extraction (you will be given instructions on which antibiotics to take, how often, and for how long).
Stitches are removed after 6-7 days.
Regular oral hygiene should be maintained (use a soft toothbrush and gentle movements around the area of the stitches).

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