We believe that every tooth is precious and one of the main goals of modern dentistry will always be the prevention of tooth loss. All possible measures should be taken to preserve and maintain your teeth because the loss of a single tooth can have a major impact upon your dental health and appearance. However, it is still sometimes necessary to remove a tooth. Some of the reasons for doing so can be seen below:

	Severe Decay
	Advanced periodontal disease
	Infection or abscess
	Orthodontic correction
	Mal-positioned teeth
	Fractured teeth or roots
	Impacted teeth

Extracting teeth is made less difficult when the general principles of oral surgery are understood and practiced. If your dentist has recommended that a tooth be extracted, the following information will help you get through the first few days after your extraction. Should anything occur that seems out of the normal, do not hesitate to call your dentist.

	Pain management must be addressed. Various pain management techniques must be used including: medical management (pre-surgical and post-surgical medications), regional nerve blocks, and local nerve blocks.
	The top (coronal) 1/3 of the alveolar bone surrounding the tooth has 2/3rds of the holding power.
	Periodontal fibres are not designed to withstand slow, continuous torque.
	Multi-rooted teeth are transformed into single-rooted teeth.
	Gingival preservation is paramount.
	Complete extraction of root confirmed by radiograph.
	Closure of alveolus to maintain blood clot.

The techniques of extraction include surgical and non-surgical procedures. Following a close study of your radiographs your dentist will be in a position to advise you on which is the best procedure for you.

Non - Surgical Extraction

This method will be suggested when the affected tooth is already loose. Non-surgical extraction is performed by placing gentle traction and rotation on the affected tooth with dental forceps or needle holders. Excess tissue is removed as carefully as possible so as to avoid fracture. Once clean, the alveolus can be filled with osteoinductive materials, impregnated resins, or the newer bone morphogenic materials. After filling, the alveolus is sealed. Following the procedure we will try and make you as comfortable as possible by providing home care support including antibiotic therapy, pain management, and dietary advice.

Surgical Extraction

Surgical extraction is performed on non-mobile teeth with normal or near normal attachment levels. If your dentist has studied your radiographs and concluded that extraction is necessary the next step will be the creation of a surgical flap. Your highly skilled oral surgeon will make a precise incision providing room to remove the alveolar bone. Following this the surgeon will isolate and gently elevate the roots of your tooth. After sufficient bone removal and elevation, the tooth root should become mobile. Small dental forceps or needle holders are used to grasp the tooth crown and then rotate the tooth on its long axis. Your surgeon will rotate the tooth to the point of resistance for 20 to 30 seconds. The rotation is then reversed and again held for 20 to 30 seconds. By using slow, continuous forces, the fibres are torn and the tooth becomes loose enough for gentle traction to remove it from its socket.
After the roots have been successfully removed, a post-extraction radiograph will confirm that the operation has been successful. The alveolus can then be treated and sealed in the same way as practiced in the non-surgical extraction.

 

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POSTOPERATIVE INSTRUCTIONS

	Do not disturb the wound as this may cause irritation, infection and/or bleeding.
	Chew on the opposite side for 24 hours and keep anything sharp from entering the wound (i.e. eating utensils etc.)
	Avoid smoking as this will promote bleeding and interfere with healing.
	Do not brush your teeth for the first 8 hours after surgery. After, you may brush your teeth gently, but avoid the area of surgery.
	Avoid all rinsing for 24 hours after extraction. This is to ensure that the blood gets a chance to clot. This is essential to proper wound healing. Disturbance of this clot can lead to increased bleeding or the loss of the blood clot. If the clot is lost, a painful condition called dry socket may occur.
	You may use warm salt water or mild antiseptic rinses after 24 hours but only if prescribed by your dentist.
	Do not spit or suck through a straw as this will promote bleeding and may dislodge the blood clot causing a dry socket.
	When you leave the office, you will be given instructions regarding the control of postoperative bleeding. A dressing will be placed on the affected area and you will be asked to change this every 20 minutes or so depending on the amount of bleeding that is occurring. We will provide you with a package of gauze to take with you. Should you need to use the gauze at home, remember to roll it into a ball large enough to cover the wound. If you have used up all of the gauze and the bleeding persists you may fold a tea bag in half and bite down on it. Tea contains Tannic Acid, a styptic, which may help to reduce the bleeding.
	You will probably experience some discomfort but this is normal following surgery. Analgesic tablets (i.e. Aspirin, Tylenol etc.) may be taken under your dentist's direction. Prescription medication, which may have been given to you, should also be taken as directed. If the pain persists, please call your dentist.
	To help prevent swelling, you may apply an ice pack or a cold towel to the outside of your face during the first 12 hours. Try applying the pack alternately, 20 minutes on then 20 minutes off. Continue this process until you begin to feel more comfortable.
	Eat normal regular meals as soon as you are able after surgery. Cold, soft food such as ice cream, yogurt or soup may be the most comfortable for the first day. It is also important to drink plenty of fluids but remember to avoid using a straw.
	If the pain or bleeding is persistent and you feel that there may be a problem please do not hesitate to call your dentist.