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ORAL SURGERY

The removal of teeth from the dental alveolus (socket) in the alveolar bone, is called a tooth extraction. These are performed for various reasons, but the most common ones are in order to remove teeth which can no longer repair themselves from tooth decay, periodontal disease, or dental trauma. The type of procedure is decided on a case by case basis. After a clinical examination and x-ray, the dentist determines which method is suitable. This can either be a simple extraction or a surgical procedure if needed. The two methods of pulling or extracting teeth are: 1.Simple extractions – performed on visible teeth, with local anesthetic, and only require instruments to elevate and grasp the tooth. The tooth is lifted then rocked back and forth until the periodontal ligament has been broken and the supporting bone widened enough to make the tooth loose. When teeth are removed with forceps, steady pressure with controlled force is applied.

  1. Surgical extractions – are necessary when the tooth cannot be accessed easily. Usually it is because it has broken under the gum line or it may not have fully erupted. The doctor will elevate the soft tissue over the tooth and bone, and may remove a portion of the surrounding jawbone tissue with a drill. If needed, the tooth will be split into pieces to make it easier to remove. These extractions will be done under the influence of either local or general anesthetic.

To stop the bleeding after an extraction, a bite pack applies pressure. The general advice for post extraction care is to not disturb the socket by touching it, avoiding vigorous mouth rinsing, and avoiding strenuous physical activity. If dislodged, the blood clot can cause bleeding to start again. Another painful possibility is the development of alveolar osteitis, or “dry socket”. Extractions and Antibiotics In order to reduce the risk of complications post-extraction, some dentists will prescribe antibiotics. This can help to reduce the risk of infections by up to 70% and lower the chance of dry socket developing. There is much evidence to support this, though the use of antibiotics doesn’t appear to have any direct effect on preventing the onset of fever, swelling, or truisms. Post-extraction healing As expected, after the removal of a tooth, bleeding is a common occurrence. Biting on a gauze swab helps to apply pressure and form a blood clot in the socket. It is recommended that patients refrain from talking as it can remove the pressure and prolong the bleeding. If you don’t understand why that happens, it’s similar to applying inconsistent pressure to a wound on your arm. Sometimes, clotting disorders are discovered because of a tooth extraction, though it is rare. Oral surgeons sometimes scrape the socket walls to encourage bleeding in the hopes that this will lower the risk of dry socket, though there is no evidence of this. As healing progresses, the chance of bleeding is reduced. Upper skin cells cover the clot and it takes about 10 days to fully heal over. Neutrophils and macrophages become involved as it comes time to respond to the inflammation. Next is the proliferative and synthesizing phase, which is when the estrogenic cells from the bone marrow in the alveolar bone proliferate. After 10 days, bone formation begins. Within 10 – 12 weeks, the socket outline no longer appears on an x-ray.   Replacement options for missing teeth After the extraction of a tooth, there is usually a gap left. If the patient wishes to fill this gap, there are a few different options. The dentist and patient will consult together to come to an agreement on the desired method.

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