Oral Health Care Zone for Grown-upss

Orthodontic Treatment

Extraction

The aim of extraction is to take out the designated tooth so as to remove the root cause of the oral problem, or to pave for the subsequent dental treatments.

Conditions leading to extraction include:


	A badly decayed/broken/fractured tooth that cannot be restored, or even turns into a breeding ground for bacteria
	An extremely mobile tooth resulting from severe periodontitis
	A tooth to be extracted for pathological reasons, e.g. a tooth involved in tumor
	A tooth fails to erupt in a right place and causes damages and inflammation to the nearby tissues
	A tooth that is abnormal in its appearance and structure
	A tooth to be extracted for orthodontic need



	A tooth that may bring about other health problems, e.g. a tooth with an exposed pulp will increase the chance of bacterial infection in the heart of a patient with rheumatoid heart diseases

Extraction methods


Non-surgical method
	This is suitable for most of the normally erupted tooth.
	Local anesthesia is given and that makes the tooth and the surrounding tissues numb.
	Then an appropriate forcep or dental instrument is used to rock the tooth gently and pull the loosened tooth out of the mouth.

Surgical method
	This is used when the tooth cannot be extracted by the usual dental instrument. This includes badly decayed/ fractured tooth, impacted tooth, crook-rooted tooth, tooth in inelastic surrounding bone (common in elderly persons), etc.
	Local anesthesia is given and that makes the tooth and the surrounding tissues numb or upon special conditions, general anaesthesia is administered.
	Then the gum is cut open and reflected. The covering bone is removed to expose the tooth. The tooth is then rocked, loosened and pulled out or depends on the tooth condition, it is cut into pieces and taken out bits by bits.
	The wound is rinsed and closed by sutures.
	About a week, the wound is inspected and sutures are removed by the dentist.

Points to note for extraction


	The dentist will assess and discuss the possible risks with the patient before proceeding extraction. Generally speaking, the risks are minimal. The most common risk is fracturing a tooth during extraction and may need surgical procedures to complete.
	In some special occasions, after extraction, a patient may bleed or may have wound swelling and pain continually or even may have wound infection. So he/she should seek for dentist’s help as soon as possible if the wound continues to have profuse bleeding, abnormal swelling and pain for more than three days without any sign of improvements, foul smell and pus running and if they have fever.
	In the very rare occasion, the nearby teeth, soft tissues or nerves may get damaged during extraction. If this happened, the patient needs referral to specialist, e.g. oral & maxillofacial surgeon for intensive care.
	If the patients have other systemic diseases, they should consult their medical doctors before extraction to understand whether extraction can be proceeded, whether they need to take antibiotic, steroid or adjust the dosage of anticoagulants, etc. in order to ensure extraction can be done safely.
Post-extraction care
Nowadays, the advancements in medical technology, anesthesia, analgesia and wound aftercare can greatly minimize the discomfort during and after the extraction.
	After extraction, we should bite on a gauze pack for 15 to 20 minutes to arrest bleeding from the tooth socket. Meanwhile we should swallow the saliva normally. In order to avoid bleeding from the socket again, the blood clot in it should not be touched or disturbed. Within 3 hours after extraction - Do not rinse the mouth - Do not eat hard or rough food Within 24 hours after extraction - Do not touch the blood clot by the tongue or fingers - Do not drink alcohol containing beverages - Do not attempt vigorous exercise If there is profuse wound bleeding, the patient should immediately see his/her dentist or depends on the bleeding severity, seek for emergency care in the A&E of the nearby hospitals.
	As the tissues nearby the extraction site are still numb for some time, in order to avoid hurting them, we should not eat within 3 hours after extraction, should not bite or unduly touch that areas until the sensation is fully back.
	It is normal to have some swelling in the extraction site and it would subside in about 3 days. We may follow the dentist’s instruction to take the medication or use cold pack to relieve it.
	We should take the prescription as instructed.
	As food debris would trap in the tooth socket, 24 hours after extraction, we should rinse the mouth with lukewarm water or saline when finishing eating in order to keep the wound clean.