Most tooth extractions heal uneventfully, however, recovery can be greatly complicated by the dreaded dry socket. A dry socket occurs when the blood clot that fills the socket becomes dislodged or never fully forms in the first place. It is important after a tooth extraction to leave the surgical site undisturbed so that the blood clot has a chance to mature. If one vigorously rinses their mouth out or puts negative pressure in their mouth by doing things like sucking through a straw or drawing in cigarette smoke, the blood clot can easily come out. The result is a hole in the gums – hence the term “dry socket”. Another big factor is smoking. The nicotine will constrict blood vessels making it difficult for a proper blood clot to form, Making one more susceptible to a dry socket.
When a dry socket does occur, you will know it. After three to four days following the extraction, an intense pain will occur. There will be no redness or swelling, like with an infection. You can try to control the pain with an anti-inflammatory, such as ibuprofen, but it is best to call your dentist. Although a dry socket is not life threatening, it still is extremely painful and your dentist can help relieve the pain. Plus, it would be good that the dentist can rule out more serious problems. If it is a dry socket, then the dentist will flush out the debris from the socket, then place a medicated packing in the area for one week to ten days. The dry socket should be healed by that time and the packing can be removed.
Removing a tooth is not the brute force that is the common perception. Extracting teeth actually requires a lot of finesse. There is a small space between the tooth and the bone. This is where the periodontal ligament resides. This ligament is what holds teeth in. Teeth are not set rigidly in concrete. If you’ve ever looked in the mirror and tried to wiggle your teeth with your fingernails, then you’ve probably noticed that the tooth will move slightly. This allows the force of the bite to be buffered before it gets transmitted to the bone. The trick to extracting a tooth is to break the periodontal ligament. Pressure is applied slowly until the microscopic fibrils of the ligament begin to snap. If the pressure is applied too fast, then the tooth will usually break apart in a very inopportune place.
The pressure to extract a tooth can be applied by a variety of instruments; the most common being the forceps. Forceps look like common household pliers only with very specialized beaks. Other instruments called elevators are commonly used. Elevators resemble a screwdriver, except that is is curved to match the contours of a tooth. An elevator is placed between the teeth and gently rotated until the tooth raises from it’s socket. This way, teeth can be removed in a very comfortable manner.
A goal of every dentist is to save teeth, however, there are times that the best thing for a tooth is to remove it. If there is not enough room for wisdom teeth – out they come. If the teeth are too crowded, then the orthodontist may recommend extracting some strategic teeth to make room. We can rebuild teeth that are broken down by decay or fracture from the “ground up” but if the damage slips too far below the gums or bone, then the best alternative may be extraction. Fractured teeth many times can be saved by placing a crown or cap over them, however, if the fracture goes too deep into the root, then the only solution is removal. Teeth that have had root canal treatment tend to be very brittle since there is no nerve inside to bathe the tooth with fluid. If these teeth are not restored with a crown, then there is a high likelihood that the tooth will split and need to be taken out. The most common reason for the need for tooth extraction is gum disease. Severe periodontitis (gum disease) can affect many or all teeth in the mouth causing the teeth to loosen and thus will need to eventually be removed.