Dental extractions

Dental & Wisdom Teeth Extractions in the Prince Edward, ON, Area

Picture on the left look familiar?  Don't let it be you.  Most of the time we can address the removal of a non-restorable tooth well before it gets to this point.  To that end, we recommend regular visits to your general dentist.  Your dentist should always be the quarterback for your dental health and they will be able to give you options for a tooth that may be in rough shape.  At times there may be no other option than the extraction of a tooth (e.g. impacted teeth or teeth so far broken down they are beyond repair).

 

In any case, Dr. Zechel and his staff will treat you as the individual that you deserve to be treated as.  We will discuss options for your best care and comfort.  

 

Below is some more information relative to extraction procedures:

Wisdom teeth:

 

Wisdom teeth are the last set of teeth to erupt in the oral cavity.  Many questions are posed in terms of these teeth.  

 

Q:  Why don't Wisdom teeth simply erupt like the other teeth in my mouth and what are "impacted teeth"?

A1:  There are a couple of reasonable theories put forward to explain this:

-  One theory suggests there is a trend toward smaller jaws and this may be diet-related. We know that while jaw size is influenced by the environent - as are all bones - teeth are genetically pre-programmed for one size.  If the environment has failed to allow for a large jaw in the context of larger Wisdom teeth, there will be a jaw size-tooth mismatch.  

-  A second theory holds that dietary changes in recent civilizations uses less chewing forces and this results in less tooth side-to-side abrasion allowing for less overall room in the mouth for the wisdom teeth.

A2:  See figure on right.  Basically, an "impacted tooth" is one that is "stuck".  It may be stuck in gum, bone, a combination of both.

 

 

Q:  What is the "ideal age" to remove impacted wisdom teeth?

A:  Although teeth generally develop along a bell-curve of age, the picking of the timing for wisdom tooth removal can be an art in itself.  If the tooth is too small and/or too impacted, it may mean more jaw bone needs to be removed in order to remove the tooth.  On the other hand, if one waits too long, the tooth's roots may be substantially long and pose an issue to certain other anatomical structures such as the mandibular nerve or sinuses. 

 

Typical 14-15 year old's deeply impacted wisdom tooth with small roots away from nerve

Typical 16-17 year old's impacted wisdom tooth with small roots approaching the nerve

Typical 20+  year old's impacted wisdom tooth with roots potentially through the nerve

Q:  What are the potential consequences of not getting my wisdom teeth removed?

A:  Any of the below issues have been known to occur with the retention of either impacted or erupted wisdom teeth:

​​        Infection:

   if only part of the tooth is exposed or the wisdom tooth is touching the back of the tooth in front of it;

        Damage to adjacent teeth and/or soft tissue;

        Tooth decay:

   if the tooth is simply not reachable or traps plaque;

        Periodontal disease:

   for the same reason as above;

   also, studies have demonstrated that the regrowth of bone where

the wisdom tooth was removed is more complete if the wisdom

teeth are removed before the age of 25;

        Receeding gums;

        Loosened teeth;

        Bone loss;

        Tooth loss;

        Jaw weakening:

   jaw fractures commonly occur through the area of the wisdom tooth

during trauma;

        Development of cysts or tumours:

   as the cells that cause these are found around the unerupted tooth

crown;

        Interference with dental treatment:

   orthodontia in later life typically can't begin until wisdom teeth are

removed;

   dental decay in the second molar may not be able to

get fixed until the wisdom tooth is removed)

 

 

 

 

 

Q:  What are the expected post-operative effects of having wisdom teeth removed?

A:  Everyone has their own predilection toward healing.  Some patients experience many or all of

the the below while others experience few or even none.  If you recently had surgery and require

instructions click HERE.

Bleeding (usually ends within a few hours);

Swelling (usually peaks within 72 hours and resolves rapidly from there);

Discomfort (usually maintainable at around a 3 out of 10 if medicines are appropriately taken);

Limited jaw opening (usually follows along with swelling);

Bruising (usually some yellow-tinged skin that is back to normal by the 7th-10th day);

 

Q:  What are some of the adverse effects that can occur after the removal of wisdom teeth?

A:  The following have been known to occur and are listed in order of likely occurrence:

Dry socket (more likely in: difficult extractions, poor oral hygiene, smokers);

Infection (more often seen during the 3rd or 4th week after extraction);

Re-operation to debride or clean-up the extraction site;

Leaving behind part of the wisdom tooth or root (possibly intentional to preserve adjacent structures);

Damage to adjacent teeth (unlikely, though possible, depending on the proximity of the wisdom tooth to other teeth);

Injury to the nerves around the wisdom teeth which could lead to partial, complete temporary or permanent numbness to the

lips, chin, gums, teeth, tongue/taste.  The overall incidence depends on the study and is in the range of 1:700 and around 1:2000 for tongue nerve problems.

Development of a communication between the mouth and the sinuses/nose resulting in a sensation of air into the mouth from the nose or fluids in the nose from the mouth (very rare and usually heals on its own);

Jaw fracture (extraordinarily rare - 1:10,000 or less);

Severe bleeding possibly requiring hospitalization.

 

 

 

 

 

 

 

 

 

 

 

 

Wisdom tooth complications

Non-restorable teeth:

 

Unfortunately, by the time your dentist has referred you to our office, one or more of your teeth is/are typically no longer restorable.  What that means is that your dentist has determined that the tooth is likely either fractured beyond repair (e.g. vertical root fracture), decayed beyond a point of restorability and/or periodontally compromised beyond health:

Periodontal disease severely compromising tooth

Tooth decayed beyond repair

Fractured tooth beyond repair

 

Q:  Do you really PULL the tooth out?

A:  Taking out a tooth is the same principle as taking a post out of the ground.  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Q:  My tooth is gone.  Now what??

A:  Typically this is a discussion best had with your general dentist.  However, in general your options are:

1.  Do nothing (this may be an option depending on if there is a tooth opposing the lost tooth and also on where the tooth is)

 

2.  Have your general dentist fabricate a Removable Prosthetic Denture - Partial Denture (this may

be a better option when there are other missing teeth in that jaw and there is good tooth support

for the partial)

 

3.  Have your general dentist fabricate a Fixed Prosthesis - Bridge (this is a reasonable option when there is a tooth behind and in front of the tooth removed and those teeth could benefit from a crown (e.g. have large fillings))

 

4.  Place an implant either immediately at the time of extraction (sometimes but not always possible) or place an implant after a brief (2-3 month) healing period with the plan of having a crown placed on the implant.

Tooth is wiggled back-and-forth, around-and-around

Removable Partial

           Denture

Fixed Bridge

Single Tooth Implant

Periodontal disease:

 

The loss of bone around teeth is essentially akin to the loss of the foundation around a house.  Your dentist and possibly periodontist have likely done all they can to retain the support but may be unsuccesful due to:

 

  • Genetic predisposition

  • Bacterial aggression

  • Smoking

  • Diabetes

  • Immune compromise

 

 

 

Q:  Why not hold on to my loose teeth as long as I can?

 

A:  There may be a point where the teeth are no longer sustainable.  Keeping teeth in this state of advanced or aggressive bone loss places the patient at risk for localized, regional, or systemic infection.  Depending on the underlying disorder(s), this could be very serious.

 

 

Q:  Can I get implants to replace my teeth?  After all, implants are not "teeth", right? They can't get "periodontal diease", right?

 

A:  Not entirely true.  Implants can still succomb to the same disease process whereby the body destroys the bone around the implant in response to bacteria.  There is also a suggestion that the aggressiveness of this "peri-implantitis" is correlated with a patient's level of periodontitis.  For this reason, it is recommended that periodontal disease be kept under control if implants are placed.

 

 

Q:  So implants aren't an option for me at all?  I have to live with dentures that flop around?

 

A:  Luckily, no.  If the teeth are removed or periodontitis is strictly controlled, implants can be placed to:

  • Retain a denture (help keep it in) while still enabling the patient to remove it at will;

  • Support a denture (the denture is "screwed" down to the denture);
     

Realistically, this can be a lot better than living with dentures (usually the lower denture) that can end up being 'spit out' when talking or eating.  Often two implants strategically placed in the lower jaw is all that is necessary to make the world of difference between an embarrassing denture situation and self-confidence.