Surgical extraction of an impacted molar. NIDCR.

A dental extraction is the removal of a tooth from the mouth. Extractions are performed for a wide variety of reasons. Tooth decay that has destroyed enough tooth structure to prevent restoration is the most frequent indication for extraction of teeth. Extractions of impacted or problematic wisdom teeth are routinely performed, as are extractions of some permanent teeth to make space for orthodontic treatment. Image File history File links DentalSurgicalExtraction. ... A humans visible teeth. ... male human mouth The mouth, also known as the buccal cavity or the oral cavity, is the orifice through which an organism takes in food and water. ... This article is about dental caries in humans. ... Wisdom teeth are third molars that usually appear between the ages of 16 and 24 (although they may appear when older, younger, or may not appear at all). ... Orthodontics is a specialty of dentistry that is concerned with the study and treatment of malocclusions (improper bites), which may be a result of tooth irregularity, disproportionate jaw relationships, or both. ...

History

Historically, dental extractions have been used to treat a variety of illnesses, as well as a method of torture to obtain forced confessions. Before the discovery of antibiotics, chronic tooth infections were often linked to a variety of health problems, and therefore removal of a diseased tooth was a common treatment for various medical conditions. Instruments used for dental extractions date back several centuries. In the 14th century, Guy de Chauliac invented the dental pelican, which was used through the late 18th century. The pelican was replaced by the dental key which, in turn, was replaced by modern forceps in the 20th century. As dental extractions can vary tremendously in difficulty, depending on the patient and the tooth, a wide variety of instruments exist to address specific situations. An antibiotic is a drug that kills or slows the growth of bacteria. ... A renowned French surgeon of the 14th century, Guy de Chauliac (1300-1368), was the physician for Pope Clement VI. In Avignon, France, he attended to the Pope and survived an infection of the Black Plague. ... Collection of dental keys, circa 1825. ... Plastic forceps are intended to be disposable Forceps are a handheld, hinged instrument used for grasping and holding objects. ...

Reasons for tooth extraction

The most common reason for extracting a tooth is tooth damage such as breakage or fracture. Some other possible reasons for tooth extraction are as follows:

• Extra teeth which are blocking other teeth from coming in.
• Severe gum disease which may affect the supporting tissues and bone structures of teeth.
• Severe tooth decay, caries or infection.
• In preparation for orthodontic treatment (braces)
• Insufficient space for wisdom teeth (impacted wisdom teeth).
• Receiving radiation to the head and neck may require extraction of teeth in the field of radiation.
• As a means of torture.

Periodontal disease is the name for bacterial infections of the gums in the mouth. ... Types of teeth Molars are used for grinding up foods Carnassials are used for slicing food. ... Caries is a progressive destruction of any kind of bone structure, including the skull, the ribs and other bones. ... Braces Dental braces (also known as orthodontic braces) are a device used in orthodontics to correct alignment of teeth and their position with regard to bite. ... Wisdom teeth are third molars that usually appear between the ages of 16 and 24 (although they may appear when older, younger, or may not appear at all). ...

Types of extraction

An extracted 3^rd molar that was horizontally impacted.

Extractions are often categorized as "simple" or "surgical".
Image File history File links Extracted_Wisdom_Tooth. ... Image File history File links Extracted_Wisdom_Tooth. ... Wisdom teeth are third molars that usually appear between the ages of 16 and 24 (although they may appear when older, younger, or may not appear at all). ...

Simple extractions are performed on teeth that are visible in the mouth, usually under local anaesthetic, and require only the use of instruments to elevate and/or grasp the visible portion of the tooth. Typically the tooth is lifted using an elevator, and subsequently using dental forceps, rocked back and forth until the periodontal ligament has been sufficiently broken and the supporting alveolar bone has been adequately widened to make the tooth loose enough to remove.
Plastic forceps are intended to be disposable Forceps are a handheld, hinged instrument used for grasping and holding objects. ...

Surgical extractions involve the removal of teeth that cannot be easily accessed, either because they have broken under the gum line or because they have not erupted fully. In a surgical extraction the doctor may elevate the soft tissues covering the tooth and bone and may also remove some of the overlying and/or surrounding bone tissue with a drill or osteotome. Frequently, the tooth may be split into multiple pieces to facilitate its removal. The gingiva (sing. ... The mandible (from Latin mandibÅ­la, jawbone) or inferior maxillary bone is, together with the maxilla, the largest and strongest bone of the face. ... An osteotome is a wedge-like instrument used for cutting or marking bone often called a chisel; used with a mallet. ...

2 extracted teeth from a 14 year old boy, compared against a £1 coin.

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Complications

An example of swelling 1 day after the extraction.

1. Infection: although rare, it does occur on occasion. The dentist may opt to prescribe antibiotics pre- and/or post-operatively if he/she determines the patient to be at risk.
2. Prolonged bleeding: The dentist has a variety of means at his/her disposal to address bleeding, however, it is important to note that small amounts of blood mixed in the saliva after extractions are normal--even up to 48 hours after extraction.
3. Swelling: Often dictated by the amount of surgery performed to extract a tooth (e.g. surgical insult to the tissues both hard and soft surrounding a tooth). Generally, when a surgical flap must be elevated (i.e. and the periosteum covering the bone is thus injured), minor to moderate swelling will occur. A poorly-cut soft tissue flap, for instance, where the periosteum is torn off rather than cleanly elevated off the underlying bone will often increase such swelling. Similarly, when bone must be removed using a drill, more swelling is likely to occur.
4. Sinus exposure and oral-antral communication: This can occur when extracting upper molars (and in some patients, upper premolars). The maxillary sinus sits right above the roots of maxillary molars and premolars. There is a bony floor of the sinus dividing the tooth socket from the sinus itself. This bone can range from thick to thin from tooth to tooth from patient to patient. In some cases it is absent and the root is in fact in the sinus. At other times, this bone may be removed with the tooth, or may be perforated during surgical extractions. The doctor typically mentions this risk to patients, based on evaluation of radiographs showing the relationship of the tooth to the sinus. It is important to note that the sinus cavity is lined with a membrane called the Sniderian membrane, which may or may not be perforated. If this membrane is exposed after an extraction, but remains intact, a "sinus exposed" has occurred. If the membrane is perforated, however, it is a "sinus communication". These two conditions are treated differently. In the event of a sinus communication, the dentist may decide to let it heal on its own or may need to surgically obtain primary closure--depending on the size of the exposure as well as the likelihood of the patient to heal. In both cases, a resorbable material called "gelfoam" is typically placed in the extraction site to promote clotting and serve as a framework for granulation tissue to accumulate. Patients are typically provided with prescriptions for antibiotics that cover sinus bacterial flora, decongestants, as well as careful instructions to follow during the healing period.
5. Nerve injury: This is primarily an issue with extraction of third molars, however, can technically occur with the extraction of any tooth should the nerve be in close proximity to the surgical site. Two nerves are typically of concern, and are found in duplicate (one left and one right side): 1. the inferior alveolar nerve, which enters the mandible at the mandibular foramen and exits the mandible at the sides of the chin from the mental foramen. This nerve supplies sensation to the lower teeth on the right or left half of the dental arch, as well as sense of touch to the right or left half of the chin and lower lip. 2. The lingual nerve (one right and one left side), which branches off the mandibular branches of the trigeminal nerve and courses just inside the jaw bone, entering the tongue and supplying sense of touch and taste to the right and left half of the anterior 2/3 of the tongue as well as the lingual gingiva (i.e. the gums on the inside surface of the dental arch). Such injuries can occur while lifting teeth (typically the inferior alveolar), but are most commonly caused by inadvertent damage with a surgical drill. Such injuries are rare and are usually temporary, but depending on the type of injury (i.e. Seddon classification: neuropraxia, axonotmesis, & neurotmesis), can be prolonged or even permanent.
6. Displacement of tooth or part of tooth into the maxillary sinus (upper teeth only). In such cases, almost always the tooth or tooth fragment must be retrieved. In some cases, the sinus cavity can be irrigated with saline (antral lavage) and the tooth fragment may be brought back to the site of the opening through which it entered the sinus, and may be retrievable. At other times, a window must be made into the sinus in the canine fossa--a procedure referred to as "Caldwell luc".

Image File history File links A picture of a mockup of the Fat Man nuclear device, from http://www. ... Image File history File links A picture of a mockup of the Fat Man nuclear device, from http://www. ... An infection is the detrimental colonization of a host organism by a foreign species. ... An antibiotic is a drug that kills or slows the growth of bacteria. ... For other uses, see Bleeding (disambiguation). ... Edema (BE: oedema, formerly known as dropsy) is swelling of any organ or tissue due to accumulation of excess fluid. ... The periosteum is an envelope of fibrous connective tissue that is wrapped around the bone in all places except at joints (which are protected by cartilage). ... Sinus may refer to: In anatomy, where a sinus is a sac or cavity in any organ or tissue: Paranasal sinus, an air cavity in the cranial bones, especially those near the nose Sinus (anatomy), description of the general term Anal sinuses, the furrows which separate the columns in the... Molars are the rearmost and most complicated kind of tooth in most mammals. ... The premolar teeth or bicuspids are transitional teeth located between the canine and molar teeth. ... The maxillary sinus is the largest paranasal sinus. ... Radiography is the creation of radiographs, photographs made by exposing a photographic film or other image receptor to X-rays. ... Granulation tissue is the tissue that replaces a fibrin clot in healing tissue. ... Nerves (yellow) Nerves redirects here. ... The inferior alveolar nerve is a branch of the mandibular nerve, which is itself the third branch (V3) of the fifth cranial nerve, the trigeminal nerve (cranial nerve V). ... The Lingual Nerve is a branch of the mandibular nerve from the fifth cranial nerve, the trigeminal nerve (CN V3), that supplies the mucous membrane of the anterior two-thirds of the tongue. ... The trigeminal nerve is the fifth (V) cranial nerve, and carries sensory information from most of the face, as well as motor supply to the muscles of mastication (the muscles enabling chewing), tensor tympani (in the middle ear), and other muscles in the floor of the mouth, such as the... Saline may refer to: Salinity Saline (medicine) Saline, Michigan Saline, Scotland - a village in the burgh of Fife, Scotland. ...

See also

• Tooth abscess
• Dental x-ray
• Gum disease
• Wisdom tooth

// A tooth abscess or root abscess is pus enclosed in the tissues of the jaw bone at the tip of an infected tooth. ... An X-ray picture (radiograph), taken by Wilhelm Röntgen in 1896, of Albert von Kollikers hand X-rays (or Röntgen rays) are a form of electromagnetic radiation with a wavelength in the range of 10 to 0. ... Periodontal disease is the name for bacterial infections of the gums in the mouth. ... Wisdom teeth are third molars that usually appear between the ages of 18 and 20 (although they may appear when older, or fail to appear at all). ...

External links

• When Might a Person Require a Tooth Extraction?