Frequently asked questions
Why do I need a tooth extraction?
Tooth extractions are performed for a wide variety of reasons, but mostly to remove teeth which have become unrestorable due to tooth decay, disease, or dental trauma, especially when they are associated with toothache or tooth mobility. It is rare that a prolonged tooth ache will eventually heal itself and not compromise the tooth. Your doctor will be able to make the determination whether the tooth is restorable by means other than extraction, such as endodontics, decay removal and fillings or other means. Some patients choose to extract the tooth regardless of other options in order to cut down on treatment cost. Whatever decision you take in consultation with your doctor will have one consequence or another. Often, attempts to postpone tooth extraction despite the diagnostic recommendation, will deteriorate your oral health condition even further and might lead to additional complications. The pain will typically persist, and it might even have an effect on your eating habits, mood, sleep and overall function. Although it is certainly preferred to restore the tooth by means other than extraction if possible, once the decision was made to extract the tooth – don’t hesitate.
How painful is a tooth extraction?
Tooth extraction is typically done with local anesthesia and so besides minor discomfort the extraction procedure itself should not be too painful. Following the extraction procedure, you will experience some pain that can be treated with over the counter medication such as ibuprofen (please consult with your doctor before taking any medication).
How long will the pain last?
Mild pain might persist for up to 24 hours after the extraction. This pain can be eliminated with over the counter pain medication. such as ibuprofen (please consult with your doctor before taking any medication).
What are the complications of a tooth extraction?
Most tooth extractions are straight forward. In some cases the tooth root structure, position of the tooth, location of the tooth or other indications might create certain complications during the extraction procedure. In addition, often the tooth will break during the procedure which will require the dentist to extract root tips and root fragments which will complicate the procedure. Often by taking proper x-rays and radiographs your doctor will be able to determine whether the procedure might be more complicated or more traumatic. In certain cases, your dentist might refer you to an oral surgeon or a specialist. Wisdom teeth and molars in general tend to have more complications and offer a greater challenge due to their anatomical structures.
What is post extraction dry socket?
When a tooth is extracted, blood flows into the extraction socket and forms a clot. That clot is important for the rebuild of the empty socket. In some cases, 2% - 5% of patients, that clot is dislodged. At that point the bone, nerve and other tissue becomes exposed which results is slower healing and pain. In certain cases, pain can become severe. This exposure can also lead to infection. Dry Socket can be treated by your dentist through site cleaning, disinfection and proper dressing. Sometime medication is prescribed to reduce inflammation and trigger healing. Dry socket can be avoided by properly treating the extraction socket right after the extraction by bone grafting the site and soft tissue management.
What happens after the tooth was extracted?
The extracted tooth will leave behind an empty socket which is the space that the tooth had occupied. The bone walls around that empty socket will begin to resorb over time since the area is no longer in function without the tooth. In fact, jaw bone resorption in such cases is quite drastic. Studies have shown that about 2-3 mm of bone width will be gone within the first 3 months post extraction and around 4-6 mm of bone height will go through same.
This bone loss in a post extraction site will have multiple effects:
Change your look and give you a more aged facial look.
Continue to reduce the bone mass that might impact adjacent teeth.
Continued bone dimensional change might affect the esthetics of prosthetics that you decide to get over that area. For example, a bridge might start to show “black holes” underneath it.
Continued bone loss will impact your options for future restoration. For example, dental implants require certain bone dimensions. If those dimensions are not there, it will require additional procedure called Ridge Augmentation in order to allow for dental implants placement.
How to avoid bone loss post tooth extraction?
In order to assure that the extraction site is well treated and restored to its original dimension, there are two main options:
Option 1 is to fill the empty socket with materials that are referred to as Bone Grafts. These powder like materials that act as a bone substitute. The idea is to fill the socket with such bone grafts to provide the scaffold for bone to grow into and around the particles. If done well, bone will remodel, fill the empty socket and support bone dimensions at the extraction site for the long term. See Socket Preservation or Socket Grafting for more information. Today it is possible to recycle your extracted tooth into bone replacement material that is highly predictable and biological. It has been shown to regenerate bone quickly and remodel the site to its original dimensions.
Option 2 is to place a dental implant (artificial tooth root) at the extraction site. The dental implant will integrate with the bone, and will provide the structure on which an artificial tooth can be manufactured. In many single tooth dental implants procedures bone graft is still required. See 'Single Tooth Implants' or 'Dental Implants' for more information.
My doctor said I might need BONE GRAFTING. What is that?
Bone grafting is a procedure where bone substitute is implanted adjacent to the jaw bone in order to repair a defect in an attempt to rebuild the bone to its original dimension and function. More specifically this is done in the following indications:
Tooth extraction - when a tooth is extracted, the bone around the original tooth starts to resorb and in most cases, that resorption is substantial. Without filling that void with bone substitute, the bone will continue to resorb and will affect function and esthetics.
Bone defect - many patients present a bone defect which usually seen as missing bone in certain areas of the jaw bone. If rehabilitation of these defects is required for a variety of reasons, it will be done using bone grafts.
Dental Implants - in order to place dental implants a certain volume and dimension of bone is required in order to assure surgical success. In cases where those dimensions are not there, it is possible to augment the bone using bone grafts to allow predictable placement of implants.
What does the recovery process look like?
Recovery from a tooth extraction procedure is typically not eventful. Some post procedure complications could occur (see complications) and some level of pain may be experienced. From an esthetic and biological recovery there are typically two paths. If the extraction procedure included bone grafting and tissue management then the recovery would achieve a full restoration of the extraction site as far as the bone volume maintained and soft tissue health. However, if bone grafting / tissue management was not done, then it is impossible to predict whether full restoration of esthetics and biology can be achieved. This is why it is highly recommended to bone graft the extraction site in order to achieve high predictability of full recovery.
What are the bone substitutes that are used?
There are a few types of bone grafts that are used for bone grafting procedures.
Autologous grafts are sourced from bone or tooth that are harvested from the patient. These represent fresh bone / dentin that holds biological properties that accelerate repair and help in regenerating new bone.
Allogenic graft are sourced from a human donor and processed to extract any genetic and organic matter.
Xenografts are bone substitutes that are sourced from animal bone, typically cow, horse or pig. These tend to not have biological factors but act as a good scaffold.
Synthetic grafts are grafts that are artificially made, typically from HA and TCP type minerals.
What is Dentin Graft?
Dentin graft is an autologous graft that is made during the procedure from the patient’s own extracted tooth using a device called the Dentin Grinder. Once the tooth is extracted, it is quickly converted in particles, cleansed and sterilized and then placed back into the extraction site or can be used for any other bone repair for the same patient. Autologous Dentin Graft is an innovative approach to bone repair that offers a highly predictable outcome, it shortens the healing time and sustains the grafted site for the long term. This procedure can reduce cost since the material used is the patient’s own tooth. Ask your dentist whether he is utilizing this biological approach for bone grafting.
What are the patient’s benefits for using their own tooth for graft?
There are many advantages the most important one is that there are no adverse reactions and a very smooth healing process since the process utilizes the patients own biology. Other benefits include a faster healing period (usually in half the time of conventional grafts) which in turn can speed up the implant procedure if that’s the final intention. Also, it can reduce the cost of the procedure. These clinical benefits are especially important for patients that have pre-existing conditions which often affect healing.
Another important benefit is that it eliminates the need for a second surgical procedure for harvesting bone from the patient since the extracted tooth is used instead.
What are Dental Implants?
A dental implant is a screw-like prosthesis usually made of titanium that is anchored into the jawbone with a small post emerging out of the gingiva to allow fixing an artificial tooth or bridge. The benefits of dental implants are great. They allow patients that has lost a tooth or multiple teeth to recover full function and esthetics without the need to resort to dentures or other removable apparatus.
Dental implant procedures are typically fairly simple and low risk. The procedure varies based on the specific approach taken by the dentist or based on the specific indication.
Dental implants can be utilized in patients where sufficient bone quality and quantity are present.
Will I need a dental implant after extraction?
Not necessarily. It will depend on a few factors. For example, if a wisdom tooth is extracted, a dental implant will typically won't be recommended although bone grafting the site will in order to maintain the bone in that region.
Should I get a dental implant right after extraction?
This should be discussed with your dentist. A number of scenarios might arise:
First, it is always your option to delay getting the implant for any time in the future. But keep in mind that as the bone resorbs over time due to lack of function, a dental implant placement in the future might be a much more elaborate procedure if the site hasn't been grafted right after the extraction.
If the site requires repair, your doctor might suggest bone grafting first and then implant placement at a later time after bone healing has been achieved.
If the site does have sufficient bone, your doctor might recommend an immediate implant placement at the time of extraction.
How long does a dental implant placement take?
This really depends on the location of where the implant will be placed, how many implants will placed, the experience and skill set of the doctor and the extent of site preparation and bone grafting that is needed. A single implant in the lower jaw (mandible) will typically take 20 - 40 minutes. An implant in the upper jaw (Maxilla) that might require sinus lift and grafting will take longer.
What is the recovery time for dental implants?
For most dental implant procedures, the recovery is fairly quick and usually eventless. After the surgery, some pain will be experienced that can be relieved with proper medication that will be prescribed to you by your doctor. Within 48 hours the pain will disappear. Your doctor will provide you with specific instructions for how to attend to the site and how to manage pain and site hygiene. A follow up visit will be required to observe site healing and to check on implant stability.
Are Wisdom Tooth extractions difficult?
Wisdom tooth extraction is a very common procedure. It is not necessarily difficult but it is an outpatient surgical procedure in most cases. You can expect some pain and swelling which can be mitigated with prescribed pain management medication. You can expect full recovery within 3-4 days. However, it is highly advisable to treat the extraction site and not leave it to heal on its own. The socket that is created due to the extraction can easily attract bacteria from food deposits as well as trigger bone resorption which can lead to multiple problems.
After extraction, How should the socket of a wisdom tooth be treated?
Wisdom tooth extraction should be followed with socket bone grafting. This should be done during the same extraction procedure. Bone grafting the exposed socket, or filling of the socket with a bone substitute, will eliminate numerous potential challenges that could stem from such procedure. The bone graft filled socket will prevent from food and bacteria settling in the socket. It will speed up healing and will help in generating bone that will naturally fill the socket and bring the bone to its original form. It will reduce the chance of developing a condition called 'dry socket'. It will also strengthen the bone at the site.
When a wisdom tooth is extracted, your dentist can use the extracted tooth itself and convert it into autologous graft, graft that is derived from your own tooth. That type of bone substitute will be more effective and safer than any other graft type. The recycled tooth holds regenerative as well as bioactive properties that will substantially help in speedy recovery of the jaw bone to full function and original dimension. For more information visit www.kometabio.com.
What is holistic dentistry and how it relates to extractions and dental implants?
Holistic dentistry is a clinical and lifestyle approach that focuses on the entirety of the body from a health perspective and not only on the specific pain site. It is also referred to as biological dentistry. Regardless of its name, the approach focuses on the use of biologically compatible materials with strong focus on natural materials for treatment, but also balanced nutrition and physical activity as a way to promote healing and general dental health.
When it comes to tooth extractions, holistic dentistry will pay close attention to how the extraction site is maintained and restored over time. Using the patient's own extracted tooth as the source for bone graft to fill that extraction socket is inline with this biological friendly approach and it is the preferred method for bone healing and long term site repair. The extracted tooth is both the patient's own biomaterial, it is immediately recognized by the body, it does not introduce any foreign materials and it instigates faster healing due to its biological properties.