Dentists and oral surgeons perform tooth extractions for many reasons. Nearly 85 percent of Americans will have one or more of their wisdom teeth removed. Patients also might need extractions due to advanced decay, damage including cracked roots, or to make space for dental prosthetics or braces.
Tooth extraction is done using one of two types of procedures. If the tooth is visible in the mouth and easily accessible, it usually is pulled via a simple extraction with forceps. This procedure can occur in your regular dentist’s office, typically with the aid of a local anesthetic that will numb the area, so you don’t feel any pain.
However, if the dentist cannot see or access the problem tooth, a surgical extraction is necessary. Though some dentists will perform surgical extractions in the office, it is more typical for an oral surgeon to complete them. Most patients are placed under oral or IV sedation, where they will remain awake and relaxed for the procedure but will not remember it.
Simple extractions typically cost less than surgical ones and are usually between $75 and $200 per tooth. Surgical extractions can range between $800 and $4,000 per tooth. Costs vary significantly by region, insurance plans, and the type of anesthesia the dentist or surgeon uses.
Though the concept might seem extreme to a dental or orthodontic patient, tooth extractions are relatively standard procedures that many dentists and oral surgeons will perform thousands of times in their careers. Here are some of the most prevalent reasons a person might need to have a tooth extracted.
Traumatic Injury
Sudden and significant damage to a tooth might necessitate an extraction. Accidents and sports injuries are the most common causes of traumatic damage, including the loosening or breaking of a tooth. A tooth that breaks at or near the gum line might not have enough remaining surface to attach a restoration such as a crown. Every athlete playing a contact sport should wear a mouthguard to avoid injury to the teeth, lips, and gums. Additionally, mouthguards provide shock absorption, which minimizes trauma to the jaw and neck in the event of significant impact.
Impacted Teeth
An impacted tooth occurs when there is no room for the tooth to grow, and the tooth never erupts at the gumline. Your dentist will diagnose an impacted tooth using X-ray technology. Based on how far the tooth is from the surface and its positioning relative to your jawbone, the dentist can determine whether the tooth poses a risk of infection or not. Wisdom teeth are the most likely to become impacted. Prehistoric humans had much larger jaws than we do because they needed three sets of molars to tear through tough foods. As our jaws have become smaller, wisdom teeth have less room to grow.
Overcrowding
Overcrowding occurs when your mouth is not large enough to accommodate all your teeth into proper alignment. Tooth extraction in an overcrowded mouth generates additional space to align the remaining teeth. This often occurs in conjunction with orthodontic treatment, especially in younger patients. In some cases, lingering baby teeth will need to be extracted before orthodontic treatment can begin. In other instances in which the wisdom teeth are impacted, the orthodontist prefers to remove the second molars so that the third molars (wisdom teeth) can fit in their place after the alignment of the existing teeth is corrected.
Fractured Root
Root fractures are vertical cracks in your tooth that begin at the root and run toward the top of the tooth. They typically go unnoticed until an infection builds in the surrounding bone and gum, and the patient begins to experience pain. Root fractures occur most often in weak teeth, such as those treated with root canals and other restorative treatments. In their weakened states, the teeth can succumb to persistent grinding and clenching of the jaw or a bite into a hard food surface. In some cases, second root canal procedures can repair the fracture, but this is not viable in most cases, and an extraction is needed.
Periodontal Disease
According to the American Dental Association, more than 47 percent of adults older than 30 in the United States suffer from chronic periodontitis. Its advanced stages cause the degeneration of the tissue, ligaments and bone that support the teeth. As these structures deteriorate, the teeth become loose and eventually will fall out on their own. Untreated, periodontal disease can contribute to significant health problems, including heart disease, dementia, stroke, diabetes, rheumatoid arthritis, respiratory diseases and life-threatening blood infections. A tooth that has loosened from periodontal disease typically needs to be extracted, and the gum treated aggressively.
Tooth Decay
Tooth decay is the process that causes cavities—areas where plaque has eroded the tooth, creating a slight depression or hole. If left untreated, tooth decay progresses through the enamel to the inner portion of the tooth known as the dentin and eventually reaches the center, or pulp, of the tooth. At this point, it is still typically salvageable through a root canal treatment to remove the infected pulp. Damage past this point will require an extraction. As long as you visit your dentist regularly (typically every six months to one year), he will spot decay before it progresses to this point. However, orthodontic patients need to be incredibly diligent about keeping up with hygiene appointments, as your braces make it easier for your mouth to accumulate the plaque and tartar that cause cavities to form.
Medical Issues
Immunocompromised patients are more likely than healthy patients to require extraction if a tooth becomes infected. Certain medications and disease treatments such as chemotherapy also can damage the teeth, making them more vulnerable to conditions that require extraction and more likely to experience rapid progression of these issues.
Recovering from a Tooth Extraction
It usually takes just a few days to recover after tooth extraction. After the appointment, you will need to bite down on gauze pads for a few hours to reduce bleeding and aid in clot formation. You also will apply an ice pack to your cheek directly after the procedure to reduce swelling. The dentist or surgeon will send you home with either prescription painkillers to take over the next 24 hours or will instruct you on over-the-counter pain relievers you can purchase. You also may be prescribed antibiotics. Take all your medications exactly as directed.
The dentist will instruct you not to rinse your mouth for the first day or two after the procedure. You can brush and floss your other teeth normally, but avoid the extraction site. After this time, you may begin rinsing with warm saltwater. You can eat soft foods within hours following the procedure, but do not drink through a straw for the first day. If you are a smoker, it is crucial to refrain from the habit for the first few days after the extraction. The chemicals in cigarettes will inhibit your body’s healing process and make complications such as infection more likely.
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