Last-resort treatment for teeth that have no other option.
A single tooth extraction is the end of the road for that tooth. It is the final treatment available for a tooth and is the last resort in dental care. Keeping a natural tooth is better than any of the available replacement options, even implants. However, the health of the entire mouth and the patient has to be considered when contemplating different treatments. Even finances are an important consideration. There are several reasons to remove a single tooth or multiple teeth; decay, gum disease, wisdom teeth, orthodontic spacing, infection and to prevent complications prior to cancer treatments.
Of course, the best reason to extract a tooth is to eliminate infection. A beneficial side effect of removing a tooth is also the elimination of pain. When an infection is present, infected teeth can spread bacteria throughout the body. Bacteria from mouth infections have been found in the heart, on joint replacements and even in the brain. After an extraction, the body can heal itself and remove the offending bacteria. If you are concerned whether antibiotics are needed, please ask Dr. Bergman. He will treat your concern as he would his own family.
It should be noted that there are negative side effects of removing teeth. The bone supporting the tooth will inevitably collapse without the mutual support of the tooth. Gums will recede. Facial structures will become unsupported if enough teeth are removed. Remaining teeth will drift into the spaces left by the extracted teeth. Periodontal pockets can develop as the adjacent teeth drift and rotate out of position. Opposing teeth will erupt into the missing space causing malalignment of the bite. Hence, procedures are necessary to replace the extracted tooth. Leaving a gap is not a viable long term option. The only teeth that universally do not require replacement are wisdom teeth and teeth removed for orthodontics.
Removing a tooth is a very common procedure. In most situations, the expertise of an Oral Surgeon is not necessary. Dr. Bergman has taken hundreds of hours of advanced surgical training and is able to serve a wider population of needs because of it. There may be times when Dr. Bergman advises treatment with an Oral Surgeon but those are the exceptions and not the rules.
Here is an overview of the main reasons for tooth removal:
Large, Deep Decay or Infection – By far the most common reason to remove teeth is because of large amounts of decay and tooth infection. Around 66% of all extractions fall under this category. When the tooth nerve is affected by decay, the tooth will not heal on its own. Treatment of some sort is needed. When the general structure of the tooth is not strong enough to support biting and chewing, the tooth will need to be removed.
Broken teeth – Sometimes teeth break in a way that repair is not possible. When a crown or root canal cannot fix the problem, an extraction is needed. If the break is too deep or involves a large portion of the tooth below the gumline, extraction is also necessary.
Periodontal Disease – Tens of thousands of teeth are removed each year because the gums and bone holding the teeth have been destroyed from periodontal disease. The cause of the disease is bacteria invading the gums and being left to fester. The most common starting points are in between the teeth. Simply put, people do not like to floss and so bacteria will sit in between the teeth for long periods of time. By the time a tooth has to be removed for gum disease, the situation is advanced and there is no good treatment except extraction. The gums and bone are usually so eroded that the tooth even moves with slight pressure.
Too Many Teeth –Extra teeth are more common than you might think. Baby teeth may not come out. Genetics are involved. Extra teeth that are not baby teeth are called supernumerary teeth. When there are too many teeth in the jaw, the teeth will come out to the side, rotate out of place, and sometimes not come in at all. The teeth need the space on the arch and an extraction can allow the teeth to naturally erupt in the correct position.
Orthodontics – Teeth require enough space to move into the proper positions. If the alignment cannot be achieved with the existing space or jaw expanders, teeth may need to be removed.
Wisdom Teeth – “Predicated on the best evidence-based data, third molar teeth that are associated with disease, or are at high risk of developing disease, should be surgically managed.” “If there is not adequate room for them to erupt and be maintained in the mouth, it is wise to have them removed before such problems as infection and/or possible damage to neighboring teeth, occur.” AAOMS Jun 23, 2016 and White Paper, Management of Third Molar Teeth
An extraction can be simple or complex. The factors that generally determine the complexity of the procedure are the number of roots, the position of the roots, the density of the bone, the brittleness of the tooth, the amount of the tooth visible, and the medical condition of the patient. Simple local anesthetic is all that is required for a tooth extraction, unless preferential conditions are present. Contrary to popular belief, a tooth is most effectively removed when it is compressed first for 15-20 seconds. This damages the thousands of ligaments holding the tooth root in place. Instruments are then used to mobilize the tooth and further sever the periodontal ligament. Instruments can then be used to rotate and remove the tooth.
Complex extractions involve separating the roots that are divergent, removing surrounding bone, and exposing buried tooth pieces. Healing is often slower with complex extractions but not necessarily. The principles of tooth removal are the same as with a simple extraction.
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