Reasons for dental extractions
There are many reasons why dental extractions are necessary, the main ones being tooth damage, due to breakage or decay especially when they are associated with toothache. Dental extractions are also referred to as exodontia or exodontics.
Sometimes wisdom teeth are impacted (stuck and unable to grow normally into the mouth) and may cause recurrent infections of the gum (pericoronitis). In orthodontics if the teeth are crowded, sound teeth may be extracted (often bicuspids) to create space so the rest of the teeth can be straightened.
Tooth extraction is usually relatively straightforward, and the vast majority can be usually performed quickly while the individual is awake by using local anaesthetic injections to eliminate pain. While local anaesthetic blocks pain, mechanical forces are still felt. Some teeth are more difficult to remove for several reasons, especially related to the tooth’s position, the shape of the tooth roots, and the integrity of the tooth.
Dental phobia is an issue for some individuals, and tooth extraction tends to be feared more than other dental treatments such as fillings. If a tooth is buried in the bone, a surgical or trans alveolar approach may be required, which involves cutting the gum away and removing the bone which is holding the tooth in with a surgical drill. After the tooth is removed, stitches are used to replace the gum into the normal position.
Immediately after the tooth is removed, a bite pack is used to apply pressure to the tooth socket and stop the bleeding. After a tooth extraction, dentists usually give advice which revolves around not disturbing the blood clot in the socket by not touching the area with a finger or the tongue, by avoiding vigorous rinsing of the mouth, and avoiding strenuous activity.
Sucking, such as through a straw, is to be avoided. If the blood clot is dislodged, bleeding can restart, or alveolar osteitis (“dry socket”) can develop, which can be very painful and lead to delayed healing of the socket. Smoking is avoided for at least 24 hours as it impairs wound healing and makes dry socket significantly more likely. Most advise hot saltwater mouth baths which start 24 hours after the extraction.
- Severe tooth decay or infection – (acute or chronic alveolar abscess, such as periapical abscess – collection of infected material (pus) forming at the tip of the root of a tooth.). Despite the reduction in worldwide prevalence of dental caries, it is still the most common reason for extraction of (non-third molar) teeth, accounting for up to two thirds of extractions
- Severe gum disease – which may affect the supporting tissues and bone structures of teeth
- Treatment of symptomatic impacted wisdom teeth – who have or cause certain diseases such as non-restorable caries or cysts
- Preventive/prophylactic removal – of asymptomatic impacted wisdom teeth
- Supernumerary teeth – which are blocking other teeth from coming in
- Supplementary or malformed teeth
- Fractured teeth
- Cosmetic – to remove teeth of poor appearance, unsuitable for restoration
- In preparation for orthodontic treatment – (braces)
- Teeth which cannot be restored endodontically
- Prosthetics – teeth detrimental to the fit or appearance of dentures
- Lower cost – compared to other treatments
Types of extraction
- Simple extractions – are performed on teeth that are visible in the mouth, usually with the patient under local anaesthetic, and require only the use of instruments to elevate and/or grasp the visible portion of the tooth. Typically, the tooth is lifted using an elevator, and using dental forceps, rocked back and forth until the periodontal ligament has been sufficiently broken and the supporting alveolar bone has been adequately widened to make the tooth loose enough to remove. Typically, when teeth are removed with forceps, slow, steady pressure is applied with controlled force.
- Surgical extractions – involve the removal of teeth that cannot be easily accessed, for example because they have broken under the gum line or because they have not erupted fully. Surgical extractions almost always require an incision. In a surgical extraction the doctor may elevate the soft tissues covering the tooth and bone and may also remove some of the overlying and/or surrounding jawbone tissue with a drill or osteotome. Frequently, the tooth may be split into multiple pieces to facilitate its removal.
Replacement options for missing teeth
Dental extractions in Poland
The cost of extractions in Poland are much less than in the UK. Typically, an extraction will cost £30 in Poland compared to £125 in the UK. Surgical extractions can cost as little as £65 compared to £295 (UK).