Tooth Extraction

There are many reasons for needing to have a tooth removed (dental extraction), in fact it’s one of the most common reasons to see an emergency dentist.

Normally having a tooth removed is an option that patients elect for when a tooth is beyond repair, or when previous attempts at repair have been unsuccessful.

Occasionally you may elect to have teeth extracted because of other reasons, and these may include time, personal finances or if you are unwilling to go through extensive treatments to restore the tooth. It can sometimes be a fine line between choosing to save a tooth or to remove it, but your dentist will be able to guide you about chances of treatment being successful and alternative replacements should you take the tooth out.

Why dental extraction?

  •  Decay of a tooth such that it is beyond repair
  • Persistent infection-for example impacted wisdom teeth, failed root canal treatments
  • Orthodontics-removal of teeth to allow space for orthodontic treatment
  • Gum disease
  • Trauma
emergency dentist, 24 hour dentist north london, dental extraction, tooth taken out
There are many reasons why it may be time to say goodbye to your tooth

The procedure of having your tooth removed

Your dentist will have a discussion with you about the pros and cons of a dental extraction. You may be asked to a sign a consent form.

A thorough assessment will be made, and this will normally include x-rays. If your extraction looks like it may be difficult, or if it carries certain risks, then you may be referred to an oral surgeon for the procedure.

Most dental extractions are carried out with local anaesthetic, however, you may ask to be referred for sedation if you are particularly nervous or anxious.

  • Application of topical gel to numb the injection site.
  • After a few minutes, the dentist will inject the area around the tooth in order to anesthetize the tooth and surrounding areas.
  • It normally takes 10-15 minutes to allow the effect of the anaesthesia to become effective.
  • The dentist will check if you are sufficiently numb
  • Using special tools, the dentist will initially gently loosen the tooth. You may feel pressure during this time.
  • Once the tooth has been loosened, the dentist will use special forceps to help wiggle the tooth out. Again you may feel pressure and movement of the tooth on it’s way to being delivered.
  • Occasionally you may hear some sounds-creaks and cracks. This is nothing to worry about-remember there is a reason why the tooth is being removed and it already may be very weak and fragile.
  • Sometimes the dentist may make incisions in the gum to allow better access for the procedure. Sutures may be placed and these may be resorbable.
  • The dentist will wait to see a good blood clot form prior to discharging you, and will provide you with instructions on how to take care of the wound.

What you should expect after a dental extraction?

tooth extraction, dental extraction, emergency dentist
Having a tooth removed isn’t that scary
  • Soreness and discomfort is to be expected.
  • You may develop a localized swelling-this is nothing to worry about and is entirely normal. It should resolve within 3 days, but may get worse before it improves.
  • A mild taste of blood in the mouth is normal. If you have any heavy bleeding, place a clean cotton pad over the wound and hold firm pressure by biting or with your fingers for 10-15 minutes.
  • Do not smoke for FIVE days after the procedure.
  • Gently bathe the area with warm salty water the following day. Do this 5 or so times a day for a week.
  • Avoid alcohol for 24 hours.
  • Do not use aspirin.
  • You can use anti-inflammatories and ice-packs to help reduce swelling and discomfort.
  • Avoid hard,hot and spicy foods for a few days.

Most wounds heal uneventfully. If you are unlucky, you may develop dry socket, but this is more likely if you have had a very difficult extraction, have smoked or are prone to delayed healing and infections.

KNOCKED OUT TOOTH

Dental trauma can occur at any time and when you least expect it. Trips, falls and blows to the face are all common causes of a knocked out tooth.
There are a number of other issues that can arise due to a traumatic injury to the body of a tooth, with avulsion (completely knocked out) being the most extreme. These include concussion (a knock), subluxation( a minor loosening), extrusion(the tooth has moved out of the socket and looks longer), lateral luxation(the tooth has been pushed backwards or forwards but is still in the socket), intrusion(the tooth has been pushed further into the socket and may look shorter than before).
What can you do to help a knocked out tooth?
There are a few things that you can do to help maximize the chances of your tooth being replanted, and minimizing the risk of complications.

How to fix a knocked out tooth
Teeth can be knocked out due to direct trauma through blows to the face, sports injuries and trips.

1. Assess other injuries. If the person who has sustained the injury requires further medical attention then this must be sought first. In the meantime you need to try keep the tooth clean and moist.
2. Keep the tooth moist. You can ask the patient to insert the tooth into the socket (if it is clean) or hold it in their cheek fold. Do not attempt to scrub the surface of the root-it contains very sensitive cells and fibers that are important for the healing process. Alternatively, you can keep the tooth moist in contact lens solution or milk. Allowing the tooth to dry out plays a big role in complications arising.

store knocked out tooth in milk until you get to an emergency dentist
Store your tooth in a moist medium until you can see an emergency dentist.

3. The highest chances of a successful replantation is to have the tooth professionally replanted within 1-2 hours. This minimizes the risk of complications and failure of replantation.
4. Arrange an appointment with the emergency dentist or 24 hour dentist, time is of the essence.
What will happen at the dental emergency clinic?
The emergency dentist will do a thorough examination. This may include x-rays and clinical photographs. They will also assess soft tissue injuries and injuries to adjacent teeth. You may also have an examination performed to ensure you have not broken or fractured your jaw.
An assessment will also be made of the likelihood of a successful replantation. This is dependent upon how long it has been since the injury, whether the root of the tooth has been damaged in any way, whether the tooth has been kept in a moist medium, how old the patient is and the stage of root development, and whether there are any further injuries to the supporting tissue of the root in the jaw.

Replantation of a knocked out tooth
1. You will be numbed using local anaesthetic
2. The socket will be gently flushed out with saline to ensure there is no foreign debris inside
3. The tooth may be allowed to soak in some special solution for 20 minutes to help its success at replantation
4. The tooth will be very gently replanted and an x-ray will be taken to confirm it’s correct positioning
5. The emergency dentist will place a flexible splint, it may look like a brace. This needs to be kept for 4 weeks to allow the tooth to replant with the bone and to keep it in position
6. You may be given antibiotics
7. You will be required to reassess the tooth regularly in order to make sure that no complications are arising. Complications can occur at any stage, even many years after the injury, so it is important that your regular dentist is routinely examining the tooth.

You will need to follow some basic instructions:
1. Avoid participation in contact sports.
2. Soft diet for up to 2 weeks. Thereafter normal function
as soon as possible.
3. Brush teeth with a soft toothbrush after each meal.
4. Use a chlorhexidine (0.1%) mouth rinse twice a day for
1 week.

What is a dental abscess?

 

A dental abscess is a collection of pus that forms around the tissues of the tooth and can spread into the surrounding tissues.

It is most often caused by a bacterial infection of the pulp of the tooth secondary to decay or trauma to the tooth.

They are not always immediately painful or symptomatic, such that you may not be aware of it’s presence for some time until it’s too late.

There are two main types of dental abscess, a periapical abscess (related to the main body of the tooth) and a periodontal abscess (related to the gum tissue of the tooth).

What are the signs and symptoms of a dental abscess?

  1. Severe, persistent, throbbing toothache that can radiate to the jawbone, neck or ear
  2. Sensitivity to hot and cold temperatures from the tooth
  3. Sensitivity/pain on chewing or biting
  4. Fever/raised temperature
  5. Swelling in your face or cheek or lips/chin, or the area under the eye. You may also develop a swelling in the gum besides the tooth, and this may develop a pimple like opening.
  6. Tender, painful and swollen lymph nodes under your jaw or in your neck
  7. Sudden rush of foul-smelling and foul-tasting, salty fluid in your mouth and pain relief if the abscess ruptures

    dental abscess and 24 hour dentist at emergency dentist
    A dental abscess causing a localised gum swelling.
  8. The offending tooth may feel loose and raised, such that you touch that tooth prior to any others when closing your mouth.

A dental abscess is something that you cannot ignore. Although symptoms may reduce, especially if any swelling bursts, they will not go away, may become more aggressive and may leave you open to dangerous complications.

You need to see a 24 hour dentist immediately. Left untreated the fluid may spread to other structures and cause difficulties breathing. There is also a risk of septicemia.

Signs of complications

  1. Difficulty in opening the mouth
  2. Very high fever
  3. Severe difficulty in breathing and or swallowing
  4. A raised tongue, such that your mouth feels smaller than usual
  5. In rare circumstances dental abscesses can spread to other organs including the brain
dental abscess
A swollen face can be distressing and debilitating. It is usually caused by a dental abscess

Treatment

The main principle is to manage the source of the abscess

  1. Opening the tooth to allow a portal for pus to drain (initiating root canal treatment)
  2. Removal of the offending to tooth
  3. Incisional drainage of any well-formed swelling. This is normally done inside the mouth, but in extreme cases may be required from the skin side.

    Drainage of dental abscess
    This procedure normally provides some immediate relief. Surface anaesthesia is used to numb the swelling, and a small incision is made to allow a path for drainage. a drain may be placed to help keep the incision open
  4. Prescription of antibiotics

Normally, a combination of some of these treatments is performed, the aim is to allow the abscess to resolve prior to definitive treatment.

Tips

  1. Do not ignore
  2. Do not hope that it will go away. You need to see an emergency dentist.
  3. Do not attempt to lance or drain the swelling yourself
  4. Do not attempt to remove the tooth yourself (yes, we’ve seen people try)
  5. Using your partner’s antibiotics that your girlfriend’s GP gave to her 2 years ago for a UTI will not help. You are just delaying appropriate treatment.
  6. If you are feeling very unwell, experiencing difficulties in breathing and running a very high temperature, then a trip to A/E may be in your best interest.

    emergency treatment of dental abscess
    Extra-oral drainage and drain placement