Tooth Extraction - Tooth Removal

There are several reasons why a tooth may need to be extracted. To simplify, one can distinguish between destruction of the tooth crown (due to cavities or dental trauma) and tooth loosening caused by periodontitis. In both cases, pain can occur in the damaged tooth.

In cases of jaw inflammation, tooth removal is often the only treatment option. Such bone inflammations often occur with dead, root-treated teeth and can be detectable both radiographically and histologically. Wisdom teeth can also be prone to inflammation and may need to be removed in a wisdom tooth extraction procedure.

With deep cavities, it may lead to the breaking of the corresponding tooth. Patients may notice, for example in the mirror, a half-broken molar with dark cavities or a completely broken tooth with the remaining root (root fragment) in the jaw. A severely broken tooth is usually beyond saving and should be extracted.

Severe periodontitis (periodontal disease) results in the destruction of the tooth-supporting apparatus, causing affected teeth to become loose. The tooth moves easily under pressure, leading to the term “loose tooth.” Teeth with significant looseness often have deep gum pockets, forming a site of debris in the oral cavity. Stabilizing the tooth is usually not possible in most cases, necessitating tooth extraction.

A cyst is a type of jaw inflammation that often forms at the tip of the tooth root. Since the cyst at the tooth root often progresses chronically and painlessly, it is often discovered incidentally. Dead teeth with root canal treatment more frequently exhibit cysts than vital (living) teeth. Wisdom teeth can also be prone to inflammation and cysts, requiring a wisdom tooth extraction. The only way to treat a tooth cyst is by removing the affected tooth.

Before the tooth is extracted, local anesthesia is administered to the affected area. The anesthesia ensures that the patient feels no pain during the tooth extraction. The tooth is removed using extraction forceps and elevators. Controlled force is applied to release the tooth’s supporting fibers, known as Sharpey fibers, and the tooth is removed. Depending on the tooth’s anatomy and connection to the jawbone, it may take several minutes to half an hour to extract the tooth.

Incisors and premolars usually have only one root and require less force to be pulled from the jawbone. Additionally, incisors and premolars typically lack undercuts, making the need to section the teeth often unnecessary.

A molar has a tooth anatomy with two or three roots, making the extraction slightly more complicated. The tooth roots may be spread apart, forming undercuts. In such common cases, it is advisable to section the molar and separate the roots from each other. The roots are then individually removed from the bone socket. This method of tooth extraction with root separation is a gentle approach to preserve the bone as much as possible.

If the tooth is completely broken, the root fragment remains in the jawbone and must be removed by the dentist. To safely and completely extract the root fragment, it is often necessary to flap the gum open to gain a better view during the operation. It is crucial to remove root fragments completely to prevent tooth fragments from remaining in the jawbone, which could lead to bone infection.

In ankylosis, the tooth and jawbone are firmly fused together. There is no periodontal gap with Sharpey fibers; instead, the tooth and jawbone adhere to each other and are challenging to separate. Ankyloses are often found in dead teeth with old root canal treatments.

Removing ankylosed teeth requires more time and a cautious approach. The jawbone should be traumatized and abraded as little as possible. This can be achieved by separating the tooth and removing it in several fragments.

If the tooth is entirely within the jawbone, tooth removal is done through osteotomy. During osteotomy, bone tissue is removed to access the hidden tooth. After exposing the tooth, it is removed atraumatically and bone-sparingly. This approach is typically used in wisdom tooth extraction and should be performed only by a surgically experienced dentist or oral surgeon.

After tooth extraction, various complications can occur, which must be avoided. The blood clot, also known as the blood clot or blood plug, plays a significant role in the development of complications. It is crucial that a stable and dense blood clot forms after tooth extraction. The blood clot protects the wound from invading bacteria and is a vital part of the healing process.

Mild pain may occur in the first few days after tooth extraction. The pain should diminish daily and be completely gone within 5 to 7 days.

If you still experience severe pain 5 to 7 days after tooth removal, it may indicate that the blood clot has detached, leading to an infection in the wound. Wound treatment by your dentist may be necessary.

If pain persists 14 days after tooth extraction, it suggests a chronic inflammation that must be eliminated by the dentist. Pain from chronic inflammation can still be noticeable even after 6 weeks or several months.

If the tooth has been extracted and the bleeding does not stop, this is referred to as post-operative bleeding. Small bleedings in the first days after tooth extraction are normal and nothing unusual. In case of more severe bleeding, simply apply a clean, moistened cotton cloth and press it on the bleeding area for approximately 30 minutes. If bleeding does not stop, contact your dentist.

If the blood clot detaches from the wound edges, the alveolus can be infected by oral bacteria, resulting in a painful bone infection in the jaw.

Another jaw infection that can develop after tooth extraction is known as FDOJ/NICO. This is typically a chronically painless inflammation, also known as a “silent inflammation”.

A dry socket, or alveolitis sicca, occurs when the blood clot detaches and is washed away from the wound. The patient complains of severe pain and notices a hole in the jawbone, an open tooth socket that does not close. If a dry socket has developed, dental treatment is essential.

After a dental procedure, there can be a rare occurrence of swelling in the soft tissues, resulting in a swollen cheek. The swelling may or may not be accompanied by pain. In general, the more careful the tooth extraction process, the less swelling occurs. A traumatic approach during the procedure leads to more pain and swelling afterward.

During tooth extraction, nearby anatomical structures such as nerves, the sinus cavity, or other teeth can be injured. A preoperative 3D cone-beam computed tomography (CBCT) provides information about the three-dimensional anatomical situation in the surgical region, helping to avoid injuries.

After tooth removal, a sense of malaise may occur. The reason is an increased introduction of bacteria into the bloodstream during tooth extraction (bacteremia). This is generally not problematic, and the malaise should subside after a few days. Similarly, the more pronounced the tissue trauma during the procedure, the stronger the malaise afterward. Various measures, such as a minimally invasive approach, complete removal of inflammation, and thorough tissue disinfection, can minimize malaise after tooth extraction.

To prevent complications after tooth extraction, various surgical measures are necessary. These measures aim to stabilize the blood clot, disinfect the wound, and promote wound healing.

When a damaged tooth needs to be extracted, there is often inflammation at the root tip. To avoid complications, this jaw inflammation should be completely removed. Subsequently, the empty tooth socket is thoroughly curetted (cleaned with a hand instrument or ultrasound) to remove any remnants of the tooth-supporting apparatus (Sharpey fibers).

Using the A-PRF (Advanced Platelet-Rich Fibrin) method creates an autologous wound dressing that seals the wound edges, prevents the detachment of the blood clot, and prevents oral bacteria from entering the alveolus. These A-PRF membranes are placed in the wound, forming a stable and inflammation-free fibrin seal. At Alpine BioDental, we use A-PRF in all surgical procedures.

To avoid infection of the surgical wound, wound disinfection is advisable. Ozone provides an effective method of disinfection after tooth extraction. Additionally, with the help of ozone, the tissue can be enriched with oxygen, promoting blood clot stability.

A minimally invasive, atraumatic approach during surgery is a crucial prerequisite for avoiding postoperative complications. Both the gums and the jawbone should be considered. Various gentle cutting techniques, atraumatic techniques for soft tissue flap elevation, tooth extraction itself, and minimally invasive approaches to wound closure should be employed.

The wound edges should be adapted with sutures to enable primary wound closure. This allows the mucosal wound to heal as quickly as possible, protecting the bone from infections. Correct suturing techniques should be used to avoid unfavorable tension and pressure on the gums.

Through accompanying surgical measures and atraumatic surgical techniques, we can often avoid the use of antibiotics. In rare cases, the administration of an appropriate antibiotic is necessary. It takes 1 to 2 hours for the administered antibiotic to begin working and exert its antibiotic effect on the tooth or tooth socket.

As a patient, you can also positively support wound healing after a tooth extraction. Several essential points should be considered. The following outlines what you can do to optimize the healing process.

To expedite wound healing and rebuild lost tissue, the body requires essential building blocks, vitamins, minerals, and trace elements in sufficient quantities.

Important substances and building blocks include vitamin D3, vitamin K2, vitamin C, magnesium, calcium, zinc, silicon, boron, and omega-3 fatty acids. Amino acids and nucleotides also play a crucial role in bone and gum regeneration.

These building blocks and co-factors should be supplied through a balanced, natural, and wholesome diet, supported by appropriate supplementation.

Smoking can significantly impair wound healing and lead to complications. The wound needs at least 7 days to fully close. Therefore, you should refrain from smoking in the first 7 days after tooth extraction.

If you start smoking, for example, 6 hours after tooth extraction, the risk of postoperative wound infection significantly increases.

After a tooth extraction, you can resume eating once the local anesthesia has worn off. Please be cautious during the first 7 days to avoid traumatizing the sensitive wound areas. We recommend a soft diet, such as soups, porridge, or puree. Be careful with hard foods like bread (hard crusts) or nuts.

The question often arises why dairy products should not be consumed after tooth extraction. The reason is the assumption that lactic acid bacteria may impair wound healing and minimize the effectiveness of antibiotics. However, this assumption has not been proven in studies. After tooth extraction, you can slowly start eating normally after about 7 to 10 days.

Caffeine and tannins from coffee can narrow blood vessels and worsen blood circulation in wounds. Good blood circulation is essential to provide all the necessary building blocks and stem cells. After tooth extraction, the consumption of coffee should be discontinued for at least 2 days, preferably a week.

After tooth extraction, you should refrain from exercise for at least 7 days. Physical shocks can dislodge the blood clot and lead to complications. Additionally, the body needs plenty of rest, recovery, and sleep for regeneration – exercise is counterproductive in this situation.

There are some simple yet effective home remedies that can optimize wound healing:

Brushing your teeth can potentially harm the fresh and sensitive blood clot. Use only a very soft toothbrush and avoid brushing the wound areas for approximately 3 to 4 days. The remaining areas can be brushed as usual.

After tooth extraction, a gap remains that ideally should be closed. While leaving the gap is possible, it comes with various disadvantages and risks. Especially in the front, the tooth gap should be closed immediately after tooth removal with a temporary restoration. At Alpine BioDental, we use fixed temporary restorations with high aesthetics.

Ideally, the waiting time between tooth extraction and implantation should be zero – the tooth is extracted and immediately replaced with a ceramic implant in a single appointment. Such a procedure is also referred to as an immediate implant. It is crucial that the healthy surrounding bone is fully preserved and not removed under any circumstances.

If immediate implantation is not possible, for example, due to significant bone infections, waiting for 2 to 4 months may be necessary before inserting the dental implant.

With a dental bridge, the neighboring teeth are ground down (prepared) and used as abutments for the bridge. Grinding weakens and traumatizes the teeth and should be avoided if possible. Just like a dental implant, it is a fixed prosthesis.

The denture is an affordable, removable dental replacement for the gap but comes with various disadvantages. This solution should also be avoided if possible.

After tooth extraction, the tooth gap can be left untreated. However, this decision carries some risks that you should be aware of:

To avoid later complications, a specialist should carefully assess whether leaving the tooth gap is acceptable.

Tooth extractions are common dental procedures, and many patients have experienced such a procedure. Both before and after tooth extraction, patients have various questions, which we address in this section.

The information listed contains relevant topics and is intended to provide a better understanding.