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Simple and Multiple Extractions

A dental extraction is the removal of a tooth from the mouth. Extractions are performed for a wide variety of reasons, including tooth decay that has destroyed enough tooth structure to render the tooth non-restorable. Extractions of impacted or problematic wisdom teeth are routinely performed, as are extractions of some permanent teeth to make space for orthodontic treatment.

Extractions are often categorized as "simple" or "surgical".

Simple extractions are performed usually under local anesthesia, on teeth that are visible in the mouth 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  dental forceps that rock the tooth back and forth until the periodontal ligament (ligament that surrounds the tooth root) has been sufficiently broken and the supporting alveolar bone has been adequately widened to make the tooth loose enough to be removed. 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, either because they have broken under the gum line or because they have not erupted fully. Usually the extractions of the root canal treated teeth are complicated due to fracture of these brittle teeth during the process.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.

Removing teeth, while not a particularly pleasant experience, is a routine and uncomplicated procedure in the hands of an expert. Dr Burlacu has additional training in oral surgery and it is certainly easier in her experienced hands to perform this procedure. Believe it or not, there is a real art and “feel” involved in tooth removal, making it both uncomplicated and relatively simple and therefore inconsequential for a patient on the receiving end.

To ensure the extraction is “simple” in the professional sense, involves proper assessment and diagnosis beforehand, in particular of the shape and status of the tooth or teeth to be removed, and the surrounding bone in which they are encased. Routine radiographic (x-ray) examination will allow that determination. In addition Dr.Burlacu will also take a thorough medical and drug history, to both ensure that you are healthy enough to undergo this minor surgery, and that you have normal blood clotting and wound healing mechanisms.

Another important factor in making an extraction procedure “simple” is recognizing what to do if there are any minor complications. For example, if a tooth root is brittle it may fracture due to previous trauma and/or a root canal treatment. This may require some surrounding bone removal to access and remove the fractured root fragments. While this complication may sound dramatic, it is not - and is routinely encountered and planned for by an experienced practitioner.

Immediately after tooth removal it is normal to place sterile gauze over the socket for 10-20 minutes with gentle pressure to control bleeding while a clot forms. Some small sutures (stitches) may also be placed over the socket to help control bleeding.

As for your after surgery care, you will receive instructions for cleaning and caring for the extraction site. You may also be provided with any or all of the following: antibiotics, anti-inflammatory (swelling control) and analgesic (pain control) medication, usually of the acetaminophen/ibuprofen family of drugs as well as saline or antibacterial mouth rinses.

Tooth extraction is usually carried out with local anesthesia, numbing the teeth to be removed together with the surrounding bone and gum tissues. In addition at Access Dental Center oral sedation medication or nitrous oxide  can be used to render the experience anxiety free, relaxing and amnesic. This is usually required for more complicated or multiple tooth extraction. By the time the sedation medication has worn off you won't even know it has been done.

Because it is important, all the potential risks, benefits and possible outcomes of tooth removal are reviewed with you beforehand, so you know what to expect. We hope that this puts your mind at ease and addresses your question.