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What to know about tooth extraction

An oral surgeon, not a dentist, may extract a tooth when the situation is more complicated. In many cases, they extract third molars or wisdom teeth.

The dentist or surgeon will numb the tooth first to make the person more comfortable. While a tooth extraction may still be unpleasant, it can be key for relieving dental pain and preventing future problems.

In this article, we outline the different types of tooth extraction and why people need them. We also describe preparation and what to expect after the procedure.

What is tooth extraction?

A tooth extraction is the removal of a tooth.

Dentists and oral surgeons remove teeth for various reasons. Some examples include:

  • dental cavities
  • gum disease
  • dental infections
  • trauma or injury to the tooth or surrounding bone
  • wisdom teeth complications
  • preparation for a dental prosthesis
  • žpreparation for dental braces, if the teeth are very crowded
  • baby teeth not falling out at the proper age

Types

The right type of tooth extraction depends on the tooth’s shape, size, position, and location in the mouth.

Dental surgeons may classify extractions as simple or surgical. A simple extraction involves a tooth that is visible above the gums and that a dentist can remove in one piece.

A surgical extraction is more complicated and involves the removal of gum tissue, bone, or both. The surgeon may need to remove the tooth in pieces.

Wisdom teeth are the last to erupt and usually the first to require extraction because in many people, they are impacted. This means that they have not fully emerged from the gums.

Wisdom teeth extraction is a common procedure in oral surgery.

Preparation

A person will have a consultation with their dentist or oral surgeon prior to the extraction.

During the consultation, the doctor will ask for a thorough medical history. They will also ask about any medications that the person is taking.

Some people need to stop or start taking certain medications in the days leading up to the surgery, depending on the amount of teeth, bone, or both to be removed.

A person may also receive certain medications on the day of the surgery.

Stopping blood thinners

Many people take blood thinning medication to prevent the formation of blood clots in vessels. These medications can lead to more bleeding during surgery.

A dental surgeon can usually control bleeding at the site of the extraction by:

  • using topical clotting medications on the gums
  • packing the tooth socket with foam or dissolvable gauze
  • stitching up the extraction site

Using gauze and applying pressure after the procedure can also help stop bleeding.

However, anyone who takes blood thinners should let their dental surgeon know during the consultation.

In order to tell whether the person should temporarily switch to a different blood thinner or stop taking this type of medication, the surgeon may need to see the results of a recent blood test.

Typically, people do not need to stop taking blood thinners prior to tooth extractions. Anyone considering stopping this treatment should consult their dentist or physician first.

Starting antibiotics

In a few circumstances, a dentist may prescribe antibiotics before a tooth extraction.

For example, they may do so to treat dental infections with widespread symptoms, such as a fever or malaise, along with local oral swelling.

Toothaches without swelling do not require antibiotics. Always take antibiotics exactly as directed by a doctor, and avoid unnecessary use.

A person may need antibiotics if they have a high risk of infective endocarditis, an infection of the heart valves or the interior lining of the heart chambers.

According to the American Heart Association (AHA), people with certain heart conditions have an increased risk of developing this infection following dental surgery.

The AHA and American Dental Association recommend, therefore, that people with any of the following take antibiotics prior to dental surgery to reduce the risk of infection:

  • a prosthetic cardiac valve
  • a history of cardiac valve repair with prosthetic material
  • a cardiac transplant with structural abnormalities of the valve
  • certain congenital heart abnormalities
  • a history of infective endocarditis

Anesthesia during surgery

The person will receive an injection of local anesthetic close to the site of the extraction. This will numb the area so that the person will not feel any pain. The numbness will continue for a few hours after the surgery.

A person can request additional anesthetic or sedative medication to minimize anxiety during the procedure. The dentist or surgeon may offer:

  • nitrous oxide, also known as laughing gas
  • an oral sedative medication
  • intravenous, or IV, sedation
  • general anesthetic

A person who receives general anesthetic will be completely asleep during the procedure.

Some dentists do not have the options above at their offices. If a person requires any of these, they should let their dentist know during the consultation, and the dentist may refer them to an oral surgeon.

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Teeth: Names, types, and functions

Teeth are made up of different layers — enamel, dentin, pulp, and cementum. Enamel, which is the hardest substance in the body, is on the outside of the tooth. The second layer is dentin, which is softer than enamel, and the deepest layer inside the tooth is pulp, which consists of nerves and blood vessels. Cementum is on the root of the tooth and is beneath the gums.

The number and types of teeth a person has changes as they age. Typically, people have two sets of teeth during their life — primary, or baby teeth, and permanent, or adult teeth. In this article, we look at the teeth that children and adults have, as well as their functions.

Humans have the following types of teeth:

Incisors

Incisors are the sharp teeth at the front of the mouth that bite into food and cut it into smaller pieces. They are flat with a thin edge. They are also called anterior teeth.

Both children and adults have eight incisors — four central incisors at the front of the mouth, two on each row, with one lateral incisor positioned on either side of them.

Canines

Canines are the sharp, pointed teeth that sit next to the incisors and look like fangs. Dentists also call them cuspids or eyeteeth. Canines are the longest of all the teeth, and people use them to tear food.

Both children and adults have four canines. Children usually get their first permanent canines between the ages of 9 and 12. The lower canines tend to come through slightly before those in the upper jaw.

Premolars

Premolars, or bicuspids, are bigger than the incisors and canines. They have many ridges and help chew and grind up food. Adults have eight premolars. The first and second premolars are the molars that sit next to the canines.

Young children do not have premolar teeth. These first appear as permanent teeth when children are 10–12 years old.

Molars

Molars are the biggest of all the teeth. They have a large, flat surface with ridges that allow them to chew food and grind it up. Adults have 12 permanent molars — six on the bottom and top jaw, and children have eight primary molars.

The last molars to erupt are wisdom teeth, or third molars, which usually come through between the ages of 17–21. These sit at the end of the row of teeth, in the far corners of the jaw. Some people do not have all four wisdom teeth, or the teeth may stay unerupted in the bone and never appear in the mouth.

Sometimes wisdom teeth can become impacted, which means they can become trapped under the gum and are unable to come through properly.

Wisdom teeth that only come through halfway or are in the wrong position can increase the risk for infection or damage in surrounding areas. It is essential to see a dentist if people have any issues with their wisdom teeth.

People may experience mild discomfort when their wisdom teeth start pushing through the gums, but anyone feeling a lot of pain or has swelling should see a dentist.

A dentist may need to remove wisdom teeth if a person has tooth decay, pain, or an infection. People do not need these teeth for chewing, and they are difficult to keep clean because of their position far back in the mouth.

Number of teeth

Children have 20 primary, or baby, teeth. Primary teeth first start to appear when babies are around 6 months old. Children usually get all their primary teeth by the age of 3.

These teeth gradually fall out, and 28 permanent teeth replace them. Sometimes, permanent teeth push the baby teeth out, but typically, permanent teeth come through the gums at the back of the mouth behind the last baby tooth in the jaw.

The first permanent teeth to erupt through the gums are four first, or ‘6-year’ molars, so-called because they usually come through when a child is about 6 years old.

The first baby teeth to fall out are the lower central incisors. The adult central incisors tend to erupt around the same time as the first permanent molars around age 6-7.

Usually, people have lost all of their baby teeth by around the age of 14.

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