Dental extractions may be necessary for a number of reasons. Most common is gum disease and widespread decay. Teeth are often extracted for orthodontic purposes, to make room for the correct alignment of other teeth. Injury may result in loose or shattered teeth; occasionally these can be saved but often extraction is the best course. Buried teeth, which have not erupted, may also need to be extracted. There are two ways in which dentists may extract teeth, and both require at least a local anaesthetic. One method is a simple extraction, using forceps and elevators to sever the supporting periodontal membrane and expand the bony socket prior to removal of the tooth.
Occasionally the dentist may extract a tooth surgically. This method is often used to take out buried or impacted teeth, buried roots, or teeth that have become brittle following root canal therapy. Some teeth have curved or hooked roots and can only be removed by this method. After the anaesthetic has taken effect the gum surrounding the tooth is cut and a flap of tissue is lifted to reveal the jaw bone. This is then drilled away until the tooth can be removed. The flap of tissue is then stitched back in place. Difficult or multiple surgical extractions are often carried out under a general anaesthetic. Healing following an extraction generally causes few problems. Occasionally if the socket becomes infected a condition called ‘dry socket’ can cause discomfort. The socket must be cleansed and packed and the dentist may prescribe antibiotics. Dry socket is most common following extraction of impacted wisdom (third molar) teeth.
The emergence of wisdom teeth, usually between the ages of 17 and 21 years, often causes problems. Because of their location at the very back of the mouth, they may be difficult to clean thoroughly and are therefore prone to decay. Another common problem is an impacted wisdom tooth, that is, it is trapped by the tooth next to it and cannot emerge fully. The gum forms a pocket around the tooth in which food debris may collect, go bad and cause a painful infection. Treatment involves giving an atibiotic to clear the infection followed by extraction, sometimes under general anaesthetic in hospital.