Dental Extractions

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A dental tooth extraction is the removal of teeth from the alveolar bone of the mandible and maxilla. Dentists perform dental extractions for a wide variety of reasons, but most commonly to remove teeth which have become unrestorable through tooth decay, periodontal disease or dental trauma, especially when they are associated with toothache. Sometimes wisdom teeth are impacted (stuck and unable to grow normally into the mouth) and may cause recurrent infections of the gum called pericoronitis. In orthodontics if the teeth are crowded, sound teeth may be extracted in a last resort situation to create space so the rest of the teeth can be straightened.

Reasons for Extraction:

• Severe infection or tooth decay
• Overcrowding
• Severe Gum Disease
• Orthodontic Treatment
• Broken Tooth/Teeth
• Fractured Root(s)

There are two main types of tooth extractions for different circumstances: 

A simple tooth extraction and a surgical tooth extraction. A simple dental extraction is performed when the tooth is visible and can be easily accessed. It may need to be removed because of tooth decay, injury, or to make room for orthodontic treatment. 

A surgical extraction is used when a tooth has broken off at or below the gum line or has not fully erupted. In this situation, access to the tooth is required through the gingiva, and sometimes bone to gain access to remove the tooth. 

"Wisdom teeth" are the last teeth to erupt within the mouth, start coming in around age 17-25.  The extraction of one or more third molars is a relatively common procedure. When they align properly and gum tissue is healthy, wisdom teeth do not have to be removed. Unfortunately, this does not generally happen. The extraction of wisdom teeth is necessary when they are prevented from properly erupting within the mouth. They may grow sideways, partially emerge from the gum, and even remain trapped beneath the gum and bone. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to successfully erupt. 

These poorly positioned impacted teeth can cause many problems. When they are partially erupted, the opening around the teeth allows bacteria to grow and will eventually cause an infection. The result is swelling, stiffness, pain, and illness. The pressure from the erupting wisdom teeth may move other teeth and disrupt the orthodontic or natural alignment of teeth. The most serious problem occurs when tumors or cysts form around the impacted wisdom teeth, resulting in the destruction of the jawbone and healthy teeth. Removal of the offending impacted teeth usually resolves these problems. Early removal is recommended to avoid such future problems and to decrease the surgical risk involved with the procedure.

If you do not have enough room in your mouth for your third molars to fully erupt, a number of problems can happen. These include:

• Infection: The most frequent clinical problem we see is pericoronitis, (a localized gum infection). Without enough room for total eruption, the gum tissue around the wisdom tooth can become irritated and infected, resulting in recurrent pain, swelling, and problems with chewing and/or swallowing.
• Damage to the adjacent teeth: If there is inadequate room to clean around the wisdom tooth, the tooth directly in front, the second molar, can be adversely affected resulting in gum disease, bone loss around the tooth, and/or decay.
• Disease: Non-infectious diseases may also arise in association with an impacted wisdom tooth. Cysts are fluid-filled “balloons” inside the jawbone that develop as a result of impacted teeth and slowly expand destroying adjacent jawbone and occasionally teeth. They can be very difficult to treat if you wisdom teeth are not removed in your teenage years. Although rare, tumors can be associated with the delayed removal of wisdom teeth.
• Crowding: Impacted wisdom teeth may contribute to crowding of your teeth. This is most noticeable with the front teeth, primarily the lower front teeth and is most commonly seen after a patient has had braces. Many factors cause teeth to crowd after braces or in early adulthood. Retained, impacted wisdom teeth may be a contributing factor.
• Wisdom teeth are easier to remove when the patient is younger, since their roots are not completely formed, the surrounding bone is softer, and there is less chance of damaging nearby nerves or other structures. Removal of wisdom teeth at a later age becomes more complicated as the roots have fully developed (may involve the nerve), and the jawbone is denser.

Whether it is aimed at preventing future problems or needed to alleviate a condition you already have, the extraction of wisdom teeth can be an effective treatment. But, as with all medical procedures, its benefits must be weighed against the small risk of complications, and should be discussed in detail.