Saving a natural tooth is almost always the best option, but unfortunately, it is not always possible.  Teeth are usually removed due to trauma, decay and disease, or overcrowding.  Tooth extraction is relatively straightforward in the vast majority of cases, and can usually be performed quickly with a local anesthetic.

Extractions are either “simple” (a tooth is visible above the gum line and it can be removed with forceps) or “surgical” (a tooth is buried under the gum or in the bone, and then it becomes necessary to cut through the gum and remove the bone that is obstructing the tooth, with a surgical drill).  This is called an odontectomy.  General dentists and all dental specialties perform tooth extraction.  However, some teeth are more difficult to remove for reasons usually related to the tooth’s position, the shape of the tooth roots, and the integrity of the tooth.  For that reason, your personal dentist may wish to refer you to an oral and maxillofacial surgeon to evaluate your teeth and remove them with the appropriate procedure and level of skill.  After the tooth is removed, a bone graft is placed if needed with a membrane covering it, and stitches are used to close the gum.

An extraction can start out as “simple” but if a tooth breaks off during the procedure, it may become “surgical” and need to be taken out in pieces.

Surgical extraction is often needed for wisdom teeth because they’re usually impacted, meaning they have become blocked from emerging, or are not completely erupted.  The procedure involves cutting through gum tissue and bone.  When a tooth is partially or totally encased in bone, the tooth will often be extracted in small sections rather than removed in one piece in order to minimize the amount of bone that needs to be removed to get the tooth out.  Other conditions that require surgical extraction are removing severely broken teeth, root tips, or teeth with long-curved roots.  In some cases, the bone around a tooth has become dense and hard, requiring surgical treatment.

If a tooth is extracted it must (or should) be replaced with a bridge, implant, or removable partial denture in order to restore chewing function and prevent adjacent teeth from drifting into the gap.  If a tooth can be saved with a root canal, it’s usually the best option.  Not only are any of these treatments more expensive than a root canal procedure, but they require more treatment time and sometimes additional procedures to adjacent teeth (like preparation for crowns) and supporting tissues (like bone grafts).

WHAT TO EXPECT FOLLOWING AN EXTRACTION

After a tooth extraction, a blood clot should form inside the tooth socket. This clot is necessary for healing and it must be treated with care to avoid a dry socket.  This can happen if the blood clot fails or becomes dislodged, exposing bone and nerve, and that can be painful!

Immediately following the dental extraction and for the following 2-4 days, an inflammatory phase begins. The patient may experience minor pain and discomfort, and possibly have the taste of blood in the mouth because of minor bleeding, which is normal. The tissues around the empty socket may appear swollen and red.

From 4 days to 5 weeks, a proliferative phase begins, where a tissue similar to a scab forms in the socket and the wound edges pull together to reduce in size. This healing tissue may appear whitish. Some patients think the socket is infected and try to clean it with a toothbrush, only to injure it more and cause delay in the healing process. If there is evident debris in it, it is advisable to gently wash it out with water or an alcohol-free mouth wash.

Within weeks and continuing for years after the extraction the scar tissue is formed and the bone heals.

Tooth extractions are not recommended for patients with uncontrolled bleeding disorders, advanced cardiac conditions, end-stage renal disease, and recent history of head and neck cancer.

If the tooth or its surrounding tissues are infected, antibiotics are prescribed for about one week before the extraction.  It is necessary to eliminate any infection to allow the anesthesia to work. Once the infection is gone, the dental extraction may take place. Also, your dentist may prescribe high doses of antibiotics to be taken 1 hour before the procedure to lower the possibility of infection.

Common post-extraction procedures:

  1. Bite a small piece of gauze for a few minutes, take it out and discard it: The blood coagulation mechanism starts immediately, and under normal conditions, bleeding should stop after a few minutes. Shortly after, a newly formed blood clot is established inside the socket and it will not fall out, unless the patient fails to follow the dentist’s instructions.
  2. No hard spitting: After a tooth extraction, the empty socket contains a delicate clot, therefore any change of pressure in the mouth, can dissolve it. This is why it is advised to spit gently or to use a towel to collect the drool.
  3. Eat cold foods: Having ice cream or cold jello is a good idea of a snack following a dental extraction. Cold will contract blood vessels, helping to stop the bleeding. Other measures regarding food are important, such as chewing on the opposite side of the mouth, avoiding hard or crunchy food and very hot meals.
  4. Sneeze with the mouth open: Trying to sneeze with the mouth closed or covering the nose when sneezing may damage the clot as well; therefore keeping the mouth open is the best way to prevent this problem from happening.
  5. No exercise: Working out raises the body temperature, this dilates blood vessels and could cause bleeding. It is recommended to suspend exercise for one week.
  6. Avoid sunlight exposure: For the same reason working out should be avoided, sun light exposure must be kept to a minimum, in particular on the first day after the tooth extraction.
  7. No aspirin: If you are taking aspirin or any other blood thinner, your dentist should have discussed your case with your physician prior to your tooth extraction. However, if you are not under any treatment, and feel that you need aspirin for another reason, it is important to consult with your dentist before taking it.
  8. No smoking: Smoking should be avoided for several weeks because it interferes with the healing process.
  9. No touching the socket: This may seem obvious, but many patients are curious and touch the wounds with their fingers or with the tongue, causing further injury and disintegrating the clot.
  10. Take the medication your dentist prescribes: Pain killers may be prescribed by the dentist. It is important for you to take them because only the dentist knows how traumatic the extraction was and how painful the injury will be after the anesthesia wears away.

Tooth loss can be a traumatizing event.  When teeth are gone, the bone immediately begins to dissolve and shrink, both horizontally and vertically, and as bone loss increases, support for the mouth and face is compromised, and the negative effect on facial esthetics, speech, self-esteem, and even nutrition and overall health cannot be overstated.  That is why the gold standard to replace missing teeth now is dental implants, because they provide the ridge of bone that holds your teeth with continued stimulation, just like natural tooth roots, keeping the bone healthy and whole, and thus preventing facial features from sagging and shifting, causing that old-age sunken-in appearance, like a witch’s chin.

If you are interested in tooth extractions in Costa Rica, fill out the “Find a Dentist” form on this page.  One of our patient advocates will reply to your needs.