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Tooth Extraction: Simple vs. Surgical Tooth Removal

Even with proper dental care, teeth age and can decay or break. Many damaged teeth can be repaired with fillings or crowns, but when the damage or decay is excessive, the tooth should be removed. A tooth extraction may not seem complicated, but tooth removal should only be performed by a professional – and in most cases, during a visit to an oral surgeon.

  • Impacted wisdom teeth
  • Severe decay
  • Serious broken or fractured teeth

Simple Tooth Extraction

Some extractions can be done without making any incisions or using special techniques. This is called a simple extraction, and it may be performed by a general or family dentist or an OMS. Patients in need of a more complicated tooth extraction are most likely to be referred to an OMS. When a tooth is broken or decayed, there may not be enough tooth above the gumline, or it may be too fragile to remove intact. The tooth’s shape, size and position also affect whether it is removed with a simple or more involved extraction.

Surgical Tooth Extraction

When a dental professional refers a patient to an Oral and Maxillofacial Surgeon for tooth extraction, it is to ensure the tooth is removed or managed with the highest level of expertise. Some impacted teeth do require only partial removal or no removal at all, and that decision is made with the expertise of an OMS. Surgical tooth extraction may occur under some form of sedation or anesthesia at the office of an OMS. The time required to perform the procedure will depend on many factors:

  • Position of the tooth
  • Length and curvature of the root(s)
  • Thickness of bone surrounding the tooth
  • The patient’s physical health

When gum tissue covers the tooth, an incision is required to expose the tooth for removal. Similarly, if bone covers part of the tooth, the surgeon will remove bone to fully expose and extract the tooth. If an incision is needed, sutures may be placed to aid with healing. With the exception of wisdom teeth, dental implants are recommended for the replacement of extracted teeth to prevent bone loss and improve functionality. Surgical tooth extraction is simply the first step on the road to improved oral health.

Do I Need an Oral Surgeon to Remove a Tooth?

While simple tooth extractions can occur in a general dentist’s office, patients with impacted wisdom teeth or severely damaged or decaying teeth require surgical tooth removal by an Oral and Maxillofacial Surgeon. Additionally, patients with certain medications or health issues may necessitate a referral to an OMS.

Root Canal Treatment

When a pulp is extracted out of a decayed tooth and the canal treated and filled the gap in a manner that it may be compatible with a physiologic reaction, we all expect to get a satisfactory and successful outcome. However, many times the treatment is carried out in such a way that it antagonizes the biologic processes of repair, which leads to have many failures and arise the need for the revision of previous non-surgical root canal treatment.

The Need of Revision Re-RCT Treatment –

The need for revision of previous non-surgical root canal procedure is quite common in today’s practice of endodontics. The starting of recurrent pathosis can be because of some technical inadequacies in the previous treatment.

Fortunately the label of root canal failure is not the basis of extraction. In the revised treatment your dentist (Endodontist) should commit to perform all aspects of treatment to higher level. These cases are more difficult and may have some compromised situations. With good handling of these cases and clinical expertise success rate could be above 90% in such cases.

It can be pretty difficult for an Endodontistto admit that he/she has failed in the previous treatment and needs to revise the Re-RCT at no extra cost or refer the patients to a more capable specialist. It is easier to condemn the tooth and reap the rewards of impending implants than to commit to perform the revision of previous non-surgical root canal procedure at a higher level. However, it should not be in this way. If a previous procedure of Re-RCT is failed, the Endodontist should not hesitate in accepting the truth and go for the revision treatment.

The purpose of revision Re-RCT treatment is to use higher techniques and tactics for the successful revision of failed treatment. The revision of Re-RCT treatment tends to be more daunting and typically involves the compromised circumstances. Furthermore, the treated teeth that require revision have undergone extensive restorations and need specific access techniques which were not commonly needed for initial treatment. The revision treatment focuses on the successful removal of restorative and root canal filling materials. After removing the restoratives, professional techniques are applied for cleaning, reshaping, disinfecting and reobturating the canals.

Recommendations for Removal of Existing Restorations –

Whether initial treatment or revision, in general, root canal treatment does not require the removal of existing crowns. The patients can prefer to preserve satisfactory restorations. However if due to existing crowns, the ability to revise the previous Re-RCT is compromised, it behooves the clinician to go for the dismantling of the restoration.Revision of previous Re-RCT can sometimes be accomplished while preserving the existing restoration. So, it is not always essential to dismantle the crown. Crown or restoration removal turns to be an unavoidable necessity when recurrent caries is found to extend well under the crown margins and is often the etiology of periapical pathosis.

Following a thorough discussion of the revision treatment of previous non surgical root canal treatment options and potential outcomes, the patients can expect to get the satisfactory and successful result of revision Re-RCT issues and enjoy an improved oral health.

Why Do My Gums Bleed When I Brush My Teeth!

One of the most common scenario seen while routine brushing at one point of our lives or another. This should not be taken lightly as it could be a simple injury due to brushing hard as the bristle of the brush could be too hard or frayed. Or, it could be a sign of gum disease, i.e. Gingivitis.

Gingivitis is the inflammation of gums i.e. red, swollen gums that may bleed while brushing and will cause bad breath.

The most common cause of Gingivitis is Plaque buildup on teeth. Plaque is a naturally occurring biofilm formed by bacteria adhering to the tooth and gums. Gingivitis can be caused by improper oral hygiene as the bacteria and plaque continue to infect gums.

Plaque is usually cleaned by brushing but if the area near the neck of the tooth is not brushed well plaque mineralizes to form tartar/calculus. This allowed even more plaque to adhere to the tooth hence, leading to severity of gum disease.

To diagnose the cause of bleeding gums you need to visit a dental professional to rule out gum disease. Dental professional will advise you an oral prophylaxis/ scaling and polishing to remove plaque and deposits to return gums to healthy state. The dentist also teaches you correct technique of brushing, flossing to clean effectively and minimize plaque buildup for future. Dentist also recommends follow up to evaluate and recommends quarterly or semiannual cleanings depending on situation.

Gum disease treatment is important if lead untreated could lead to periodontal disease and teeth can get loose and fall out eventually.

Other causes of gingivitis are smoking, chewing tobacco, crooked, rotated, and overlapping teeth. Also seen due to hormonal changes in puberty, pregnancy, menopause as the vascularity to gums increases. Stress, mouth breathing, poor nutrition e.g.: high carb diet and reduced water intake can cause gingivitis. Diabetes and certain medications also cause gingivitis. Other non-plaque induced bleeding is seen in blood disorders, leukemia, clotting disorders. Aspirin allergy, vitamin C deficiency causes bleeding gums. Dentures, braces if irritate gums cause bleeding gums.

Again the dentist can help diagnose the cause and treatment can be made to stop symptoms.

Dr Husna Vhora

BDS, PGDEMS

General Dentist

Dry Socket

In normal conditions after extraction of a permanent tooth, a blood clot is formed at the site by granulation tissue, then gradually replaced by fibrillar bone and finally, replaced by mature bone.

If that blood clot is dislodged or disintegrated too early there is not an appropriate healing and it causes the clinical condition known as “Dry Socket” or alveolar osteitis.

The main symptoms of dry socket are severe pain and foul odor without suppuration in the mouth. Usually, pain and swelling after a tooth extraction get better over the course of a week, when dry socket occurs the symptoms generally set in on the second or third day after the surgery, get significantly worse, and they may last from 10 to 40 days.

The pain may feel like covering the whole side of the mouth or face. The affected extraction site is initially filled with a dirty gray clot that is then lost and leaves a bare bony socket (dry socket). The diagnosis is confirmed only by a dentist or oral surgeon.

The patient may be extra sensitive to cold drinks, since soft tissues and ending nerves are exposed. On post extraction evaluation of the patient, severe pain is the main complaint and on inspection of the socket the exposed and extremely sensitive bone is observed.

The prevalence of dry socket is between 1% to 3% of all extractions, and most commonly after removal of wisdom teeth, and is most frequent in the lower jaw and posterior areas. The overall prevalence is highest between 20 to 40 years of age, although the likelihood of developing alveolar osteitis appears greatest for extractions in the 40 to 45 years old age group.

The patients with the highest risk of developing dry socket are those who:

  • Don’t follow adequately post-surgery instructions, e.g. make strong sucking movement ore remove gauze from the extraction site too early, make vigorous mouth rinsing
  • Have preexisting infections, such as periodontal (gum) disease
  • Smoke, because blood supply is reduced in the mouth
  • Have a traumatic tooth extraction surgery
  • Have denser jaw bones
  • Take oral contraceptives, as certain hormones may increase this risk
  • Prior history of alveolitis

Treatment may include:

  • A radiograph of the affected area should be taken to check for the possibility of retained root tip or a foreign body
  • Cleaning of the extraction site with warm saline solution and placing a medicated dressing in the socket
  • Changing the dressing daily until the pain diminishes and the socket begins to heal
  • Giving a special mouthwash, antibiotics, or prescription pain medication

Every case of dry socket is different. Only a dentist can evaluate personal risk factors for dry socket. To prevent dry socket, it’s very important t to follow dentist’s instructions for recovery.

About Author:

Crossroads Dental Clinic is one of the most modern clinics in Dubai and the best dental clinic in Deira having highly experienced and professional dentists. Our services include from Orthodontics to modern cosmetic dentistry like Wisdom teeth removal, braces, veneers, dental implants and Invisalign dentist services. Looking for the best dentist in Dubai for your dental concerns? Well, you found us now. Visit our Clinic near Deira City Centre and we make sure you get a world-class and painless dentist experience at the best cost in Dubai.

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