Tonight I will talk about the indications for tooth extraction. Paying a visit to your dentist does not necessarily mean that the tooth should be extracted. Extraction is one of the last resort when restoration cannot be done also for the following reasons.
- Indications for removal of teeth
Perhaps the most common and widely accepted reason to remove a tooth. Is that it is so severely carious that it cannot be restored. The extent to which the tooth is carious and is considered to be non restorable . It is a judgment call to be made between the dentist and the patient.
–Pulpal necrosis .
A second, closely aligned rationale for removing a tooth is the presence of pulp necrosis or irreversible pulpitis that is not amenable to endodontics. This may be the result of a patient declining endodontic treatment. Or of a root canal that is tortuous, calcified, and untreatable by standard endodontic techniques.
Also included in this general indication category is the endodontic failure.In this situation, endodontic treatment has been done, But has failed to relieve pain or provide drainage
–Severe periodontal disease
A common reason for tooth removal is severe and extensive periodontal disease. If severe adult periodontitis has existed for some time ,excessive bone loss and irreversible tooth mobility will be found. In these situations the hypermobile teeth should be extracted.
Patients who are about to undergo orthodontic correction of crowded dentition frequently require the extraction of teeth to provide space for tooth alignment.
The most commonly extracted teeth are the maxillary and mandibular first premolars.Second premolars or a mandibular incisor may occasionally require extraction for this same reason
Teeth that are malopposed or malpositioned may be indicated for removal in several situations.If they traumatize soft tissue and cannot be repositioned by orthodontic treatment, they should be extracted.
A common example of this is the maxillary third molar, which erupts in severe buccal version, and causes ulceration and soft tissue trauma in the cheek.
Another example is malopposed teeth that are hypererupted because of the loss of teeth in the opposing arch. If prosthetic rehabilitation is to be carried out in the opposing arch, the hypererupted teeth may interfere with construction of an adequate prosthesis
A clear but uncommon indication for extraction of teeth is a tooth that is cracked or has a fractured root .The cracked tooth can be painful and is unmanageable by a more conservative technique. Even endodontic and complex restorative procedures cannot relieve the pain of a cracked tooth
Occasionally, teeth interfere with the design and proper placement of prosthetic appliances; such as full dentures, partial dentures, or fixed partial dentures. When this happens, preprosthetic extractions are necessary
Impacted teeth should be considered for removal. If it is clear that a partially impacted tooth is unable to erupt into a functional occlusion because of –Inadequate space –Interference from adjacent teeth, or some other reason
It should be scheduled for surgical removal.
Removing the impacted tooth is contraindicated in cases of medical compromise, and Full bony impaction in a patient who is over the age of 35 Or in a patient with advanced age. In these casesthe tooth may be retained.
Supernumerary teeth are usually impacted and should be removed
A supernumerary tooth may interfere with eruption of succedaneous teeth and has the potential for causing their resorption and displacement. When there are more teeth than the regular number , hyperdontia or supernumerary teeth is the name given to this condition.
–Teeth associated with pathologic lesions
Teeth that are involved in pathologic lesions may require removal.
In some situations the teeth can be retained and endodontic therapy performed.If maintaining the tooth compromises the complete surgical removal of the lesion, then the tooth should be removed.
Patients who are to receive radiation therapy for a variety of oral tumors should have serious consideration given to removing teeth in the line of radiation therapy.
–Teeth involved in jaw fractures
Patients who sustain fractures of the mandible or the alveolar process occasionally must have teeth removed. In a majority of situations the tooth involved in the line of fracture can be maintained. If the tooth is injured or severely luxated from the surrounding bony tissue, its removal may be necessary to prevent infection.
Occasionally, a patient requires removal of teeth for esthetic reasons. In these situations teeth may be –Severely stained, as with tetracycline staining or fluorosis –Or they may be severely malopposed and usually protruding.
Other techniques, such as bonding, can be employed to relieve the staining problem. While orthodontic or osteotomy procedures can be used to correct severe protrusion. But the patient may choose to have extraction and prosthetic reconstruction
A final indication for removal of teeth is economic. All previous indications for extraction already mentioned may become stronger.
If the patient is unwilling or unable financially to support the decision to maintain the tooth.
The inability of the patient either to pay for the procedure or to take enough time from work to allow it to beperformed,may require that the tooth be removed.
–Systemic contraindications. Severe uncontrolled metabolic diseases.
- Brittle diabetes and end-stage renal disease with severe uremia are part of this group.
- Patients who have uncontrolled leukemias and lymphomas should not have teeth removed Until the leukemias can be brought under control.
The potential complications are : –Infection as a result of nonfunctioning white cells. –And excessive bleeding as a result of an inadequate number of platelets.
- Patients with any of a variety of severe uncontrolled cardiac diseases should also have their extractions deferred until the disease can be brought under control.
- Patients with severe myocardial ischemia, such as Unstable angina pectoris and patients who have had a recent myocardial infarction (Ml) should not have a tooth extracted
- Patients who have severe uncontrolled hypertension should also have extractions deferred.
- Patients who have severe, uncontrolled cardiac dysrhythmias should have their extraction procedures deferred as well.
- Pregnancy is a relative contra indication –Patients who are in the first or last trimester should have their extractions deferred if possible.The latter part of the first trimester and the first month of the last trimester may be as safe as the middle trimester for a routine uncomplicated extraction.But more extensive surgical procedures should be deferred until after the child has been delivered.
- Patients who have a severe bleeding predisposition, such as hemophilia, or severe platelet disorders should not have teeth extracted until the coagulopathy has been corrected by the administration of coagulation factors or platelet transfusions.Close coordination with the patient’s hematologist can result in an uncomplicated recovery from the extraction procedure in most situations
- The most important and most critical is a history of therapeutic radiation for cancer.
Extractions performed in an area of radiation may result in osteoradionecrosis and therefore must be done with extreme caution.
- Teeth that are located within an area of tumor, especially a malignant tumor, should not be extracted.
- Patients who have severe pericoronitis around an impacted mandibular third molar should not have the tooth extracted until the pericoronitis has been treated.
Nonsurgical treatment should include :
–Irrigations–Antibiotics–And removal of the maxillary third molar to relieve impingement on the edematous soft tissue overlying the mandibular impaction.
After all the evaluation ( medical history, social history and history of present complaint) is done, your dentist will undergo a clinical evaluation of teeth for removal. This includes :–Access to tooth, –Mobility of tooth, –Condition of crown.
Sometimes radiographic evaluation of teeth for removal is required to know the relationship of associated vital structures, configuration of roots, condition of surrounding bone.
What to expect if you have to have a tooth removed?
You will be administered a certain dose of anesthetic agent in the surrounding tooth area, to numb the region so that you do not feel the pain. One should make the difference between pain and pressure.
If the tooth is impacted, the dentist will cut away gum and bone tissue that cover the tooth and then, using forceps, grasp the tooth and gently rock it back and forth to loosen it from the jaw bone and ligaments that hold it in place. Sometimes, a hard-to-pull tooth must be removed in pieces.
Once the tooth has been pulled, a blood clot usually forms in the socket. The dentist will pack a gauze pad into the socket and have you bite down on it to help stop the bleeding. Sometimes the dentist will place a few stitches — usually self-dissolving — to close the gum edges over the extraction site.