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Dental Extractions

There are a number of reasons why your general dentist might recommend that you have a tooth, or even several teeth, extracted. Listed below are some of these reasons:

A tooth extraction might be indicated if repairing a damaged tooth is not practical.

Broken, cracked, or extensively decayed teeth can be extraction candidates.

Some teeth will have extensive decay (dental caries) or will have broken or cracked in such an extreme manner that an extraction is the best, or at least a reasonable, solution. A number of factors come into play with any specific situation and, in some cases, the obstacles presented might be so formidable that a repair for the tooth is simply not possible. In other cases the cost of needed dental treatment or a questionable long-term success of the treatment may be the reason an extraction is suggested.

Teeth that are unsuitable candidates for root canal treatment should be extracted.

Some teeth may require treatment of the nerve space that lies within them in order to be repaired. While most teeth typically are candidates for root canal treatment there can be complicating factors that remove this option. If this is the case, and root canal treatment cannot be performed, then extraction of the tooth is indicated.

Teeth associated with advanced periodontal disease (gum disease) may need to be extracted.

By definition, teeth that have advanced periodontal disease are teeth whose supporting bone has been damaged. As periodontal disease worsens, a tooth is supported by less and less surrounding bone, often to the point where the tooth becomes loose. In those cases where significant bone damage has occurred, and a tooth has become excessively mobile, extracting the tooth may be the only option.

Malpositioned or nonfunctional teeth may need to be extracted.

Some teeth are extracted because they are malpositioned. For example, when wisdom teeth come in they sometimes lie in a position that is a constant source of irritation to the patient’s cheek (by either rubbing against the cheek or causing the person to bite it). As a solution, a dentist may suggest that the offending wisdom teeth be extracted.

Some teeth might be extracted because they provide very little service to the dental patient but are at significant risk for becoming problematic. A common example is a wisdom tooth that has come in but has no matching tooth to bite against. Wisdom teeth are typically in a region of the mouth that is hard to clean, thus placing them and their neighboring tooth at greater risk for decay and periodontal disease. Depending on the precise circumstances, your general dentist may advise you that removing a nonfunctional tooth is in your best long-term interest with regards to maintaining good oral health.

Impacted teeth are often extracted. Impacted teeth are teeth whose positioning in the jaw bone is such that they cannot erupt into normal alignment. Impacted teeth are malpositioned and, because they are malpositioned, they are typically nonfunctional. This combination of factors makes impacted teeth common candidates for extraction.

Tooth extractions may be required in preparation for orthodontic treatment (braces).

Orthodontic treatment attempts to perfect the alignment of a patient's teeth within the confines of the size of a person's jaws. Especially in those cases where a large discrepancy exists between the size of a patient's jaws and space is required for the improved alignment of his/her teeth, some strategically located teeth may need to be extracted.

What to expect before the tooth extraction procedure is performed.

Dr. Grecco will need to examine your teeth and mouth before a determination can be made that a tooth extraction is warranted. As a part of this examination he will need to take an x-ray (radiograph) of the tooth in question. This x-ray will allow Dr. Grecco to evaluate the internal aspects of the tooth as well as the tooth's root portion and the bone surrounding it.

The information obtained from this clinical examination and the x-ray will help him formulate a diagnosis, and determine if the tooth should be extracted. If an extraction is indicated, depending on the anticipated difficulty of the procedure, Dr, Grecco may recommend general anesthesia or IV sedation during the treatment.

During your pre-extraction examination Dr. Grecco will collect relevant medical information from you as well. Make sure to report if you have had any problems with any previous tooth extractions, if you have any bleeding problems, and identify any and all medical conditions you have, both treated and untreated.

Make sure that Dr. Grecco is aware of all of the medicines and supplements that you take (prescription, over-the-counter, and herbal). Some common medications may cause complications with tooth extractions. For example, aspirin retards the blood clotting process (ibuprofen, ginko biloba, and ginseng can have an effect on clotting as well). People who have taken bisphosphonate drugs (such as Fosamax®) can be at greater risk for complications associated with tooth extractions.

If infection is present your dentist may have you take antibiotics before treatment.

If examination shows a significant level of active infection is present (primarily evidenced by the presence of swelling) Dr. Grecco may recommend that you take an antibiotic for several days before the tooth extraction procedure is performed. Doing so will make it less likely that complications, either during the extraction procedure or the subsequent healing process, will occur.
Any antibiotics that are prescribed for you should always be taken as directed. Failure to do so can lead to the development of bacterial resistance to the antibiotic. If you have any problems associated with taking your antibiotics (including the development of a generalized rash or itching) you should report them immediately.

Other reasons it might be necessary for you to take antibiotics before a tooth extraction.

Tooth extractions (as well as many other types of dental procedures) can place certain dental patients at risk for developing a bacterial infection subsequent to treatment. In these cases it is mandatory that the dental patient take antibiotics before the dental procedure is performed to reduce the risk of this occurring. Some of the types of medical situations that may require "prophylactic" antibiotics include:

  • Certain cardiac conditions.
  • Prosthetic joints.
  • Patients on renal dialysis.

This list is not all-inclusive and the opinions of doctors and organizations that formulate these recommendations and guidelines for patients are constantly evolving. An important part of your examination is to collect that information concerning your medical history which can help us make a determination about what precautions (if any) are needed for your precise situation. In some instances Dr. Grecco may need to consult with your physician before he can determine exactly what precautions are appropriate.