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Dental extraction

life science Maturity 11-13 Next article →

A dental extraction, also known as exodontia, is the clinical removal of a tooth from its socket. This socket is a space within the alveolar bone called the dental alveolus.

Pulled tooth
Pulled tooth

Dentists perform these procedures for many different medical reasons. The most common cause is severe tooth decay, which accounts for up to two-thirds of all extractions. Other causes include periodontal disease, which is severe gum disease that affects supporting bone. Dentists may also remove teeth due to dental trauma or if a tooth cannot be fixed through endodontic treatment.

Abscessed tooth periapical radiograph
Abscessed tooth periapical radiograph

There are two primary categories of extraction: simple and surgical. A simple extraction is performed on teeth that are clearly visible in the mouth. During this process, the dentist uses instruments to elevate and grasp the visible part of the tooth. They apply slow, steady pressure to expand the socket. Once the periodontal ligament—the tissue connecting the tooth to the bone—is broken, the tooth is removed.

Dental-Extraction-Forceps
Dental-Extraction-Forceps

In contrast, a surgical extraction is required when a tooth is difficult to access. This often happens if a tooth is impacted, meaning it is stuck under the gum. In these cases, the dentist may make an incision in the mucosa and periosteum. They might also use a drill or an osteotome to remove surrounding bone to reach the tooth.

Before the procedure begins, the dentist must ensure the patient feels no pain. They use local anesthetics to numb the tooth and surrounding tissues. One method is infiltration, where the anesthetic is injected near the root tip. This allows the medicine to penetrate the bone and reach the nerve bundle. Another method is a nerve block, such as an inferior alveolar nerve block. This technique numbs a larger area, such as all the lower teeth.

Common anesthetics used in the UK include lidocaine and articaine.

Specialized instruments are essential for a successful extraction. Forceps are the most common tool and function similarly to pliers. Different shapes of forceps exist for upper and lower teeth, or for specific teeth like molars. The dentist uses the beaks of the forceps to grip the root securely. They then apply pressure along the long axis of the tooth. To loosen the tooth, the dentist may move it toward the cheek side, known as the buccal side, and then toward the tongue, called the lingual or palatal side.

Dental extraction forceps
Dental extraction forceps

For lower molars, a "figure of eight" movement may be used.

Other tools help manage the socket and the ligament. Elevators, such as the Coupland or the Warrick James, are used to expand the socket and lift the tooth. Luxators are even sharper instruments. They are used to carefully cut the periodontal ligament between the tooth and the bony socket.

Dental luxator set
Dental luxator set

If a tooth is very complex, such as a molar with curved roots, it may even be split into multiple pieces. This technique helps facilitate removal while minimizing trauma to the tissues.

Molar cut up during extraction - 2018-08-29 - Andy Mabbett -
Molar cut up during extraction - 2018-08-29 - Andy Mabbett -

After the tooth is removed, achieving haemostasis—the stopping of blood flow—is the next priority. Patients typically bite on sterile gauze to apply firm pressure to the wound. This pressure promotes the formation of a blood clot at the base of the socket. It is vital that patients avoid hot food and drinking through straws for 24 hours. The negative pressure from a straw can dislodge the new clot. If the clot is lost, it can result in a painful condition called a dry socket.

DrySocket
DrySocket

Bleeding from soft tissues can be managed with sutures or chemical agents like silver nitrate. Bony bleeding may require bone wax or electrocautery.

Recovery involves managing common side effects like swelling, bruising, and pain. Some patients may experience trismus, which is the inability to open the mouth as wide as usual. Surgical extractions of wisdom teeth carry specific risks, such as temporary or permanent numbness in the lip, chin, or tongue. This happens if the inferior alveolar nerve or lingual nerve is affected.

Swollen face, post-dental-extraction
Swollen face, post-dental-extraction

Despite these risks, extractions remain a necessary part of dental care, including orthodontic preparations to create space for crowded teeth.

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🖼️ Images & Media (14)
File:Abscessed tooth periapical radiograph.jpg
Abscessed tooth periapical radiograph.jpg
File:US Navy 050326-N-0357S-021 Cmdr. Mark Roback, a Navy dentist from the Military Sealift Command (MSC) hospital ship USNS Mercy (T-AH 19), speaking to his patient through an interpreter, tells her that the injection he is giving.jpg
US Navy 050326-N-0357S-021 Cmdr. Mark...
File:Dental-Extraction-Forceps.jpg
Dental-Extraction-Forceps.jpg
File:Dental luxator set.jpg
Dental luxator set.jpg
File:Extracted Wisdom Tooth.jpg
Extracted Wisdom Tooth.jpg
File:Pulled tooth.jpg
Pulled tooth.jpg
File:Dental extraction forceps.jpg
Dental extraction forceps.jpg
File:Molar cut up during extraction - 2018-08-29 - Andy Mabbett -.jpg
Molar cut up during extraction -...
File:Exodontia - One hour later.jpg
Exodontia - One hour later.jpg
File:Syringe 2.jpg
Syringe 2.jpg
File:Swollen face, post-dental-extraction.jpg
Swollen face, post-dental-extraction.jpg
File:Hematoma Edema 01.jpg
Hematoma Edema 01.jpg

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