Emergency Tooth Extractions: What To Expect

See what you can expect when an emergency tooth extraction is needed.

Why Might I Need an Extraction?

For the most part, dentists prefer that we keep our natural teeth whenever possible but there are some situations where a natural tooth cannot be saved. Aside from the quite common need for wisdom tooth removal, many patients may also require tooth extraction(s) due to infection, severe tooth decay, broken teeth, or excessive tooth crowding in preparation for orthodontic care. If you are experiencing dental pain, you should contact your dental office right away to set an appointment. After an exam, your dentist will be able to provide you with treatment options.

Infection

Arguably one of the worst sensations one can experience is that from an infected (abscessed) tooth. The pain from an infected tooth can be very acute, leaving the victim unable to focus or even sleep. In many cases, facial swelling will accompany the pain, making the whole situation even worse.

Tooth abscesses can develop when, due to a crack, chip, break, or deep cavity in a tooth, bacteria are able to get to the pulp and the root of the tooth. A pus pocket can develop below the tooth root or on the side of the gum, putting pressure on the nerves.

Though an abscess might be drained and infection treated with antibiotics, the infection is likely to return unless the tooth is treated. The only two treatment options for this kind of infection are root canal treatment and extraction. Preserving the tooth with root canal treatment is 90+% successful. The tooth will likely need a crown so the total cost of care can be quite expensive. Some choose to have the tooth removed. There are also some instances where an abscessed tooth is damaged beyond repair, so the dentist may immediately recommend an emergency extraction.

When it comes to extracting an infected tooth, the dentist may first send the patient home with a prescription for antibiotics and pain management recommendations. Though the last thing one might want to do is delay treatment, if the infection is severe enough, this step may be critical, as active severe infections can reduce the effectiveness of the local anesthetic the dentist would use to numb your mouth before the extraction.

Severe Tooth Decay and Broken Teeth

A tooth that is broken off, cracked in half, or severely decayed may also require an emergency extraction.

Granted, there are some cases where a broken or severely decayed tooth can be restored through a root canal or other treatment, but in those cases where the damaged tooth cannot be saved, the dentist will recommend an extraction.

What Happens During an Extraction?

• Prior to performing an extraction, your dentist will first review your medical history and medication list to determine if there are any risks in performing the procedure.
  • Those who take blood thinners, for example, may have to stop taking them for a number of days to reduce the risk of excessive bleeding after the extraction.
  • At this time, x-rays will be taken so the dentist can see the condition of the tooth below the gums and the position of the tooth in order to determine if they feel comfortable performing the extraction or if a referral to an oral surgeon is needed.
• Once ready for the extraction, your dentist will administer a local anesthetic, like Novocain or lidocaine in order to numb the area.
  • Patients who tend to be anxious about dental work may also opt for a sedative like nitrous oxide (laughing gas).
  • If the extraction is being performed at an oral surgery office, the surgeon may recommend general anesthesia or IV sedation in addition to local anesthetic, though this level of sedation is not always necessary.
• After the patient is sufficiently numb or sedated, the dentist may loosen the tooth with a tool called an elevator if a simple extraction is needed or make a small incision next to the tooth if a surgical extraction is needed.
  • The dentist may need to split the tooth or remove some bone if the tooth does not loosen easily.
• Next, the dentist will remove the tooth using dental forceps.
  • If a surgical incision was made to remove the tooth, sutures may be placed to help the gum tissue heal properly.
• Lastly the dentist will place gauze over the extraction site.

What Should I Do After an Extraction?

After an extraction, patients should follow the after-care instructions as closely as possible. These instructions should explain:

• How long to keep the gauze on the extraction site
• When bleeding should stop
• Instructions on how to keep the area clean

If the site continues to bleed for longer than expected per the dentist's directions, the patient should notify their dentist/surgeon right away.

After an extraction, a normal part of the healing process includes the development of a blood clot at the extraction site. It is important that this blood clot remain at the extraction site as it serves as protection from bacteria and food particles getting into the empty tooth socket, thus preventing a secondary infection and the dreaded dry socket. More importantly, the blood clot acts as the foundation, scaffolding to help your body form new bone.

To prevent this blood clot from being dislodged, patients should avoid sucking anything for 24 hours, including: cigarettes, drinking straws, and candy. The sucking action itself can suck the blood clot right out of the tooth socket. Extraction patients should also avoid vigorously rinsing their mouths, brushing the teeth next to the extraction site, and high intensity exercise for a period of time, as all of these activities increase the risk of losing that very important blood clot. Any complications experienced after an extraction should be reported to the dentist or surgeon immediately.

Can My Dentist Perform an Extraction?

Many general dentists do perform simple extractions right in their clinics and some even perform extractions that are more complicated. However, there are instances when a dentist is likely to refer the patient to an oral surgeon, instead:

• If the tooth is broken off to the root
• If the dentist feels that the extraction may be too complex to be completed in the clinic
• If the patient has complicated dental anatomy
• If the tooth structure is so weak that there is a high risk for the tooth to break off while attempting an extraction