People are sometimes anxious when they have a tooth removed, and fear of the unknown is usually the cause of this anxiety. We'd like you to know about the steps we take when we extract a tooth, as well as what we do to ensure that you're comfortable -- before, during and after the procedure.

Some teeth must be extracted There are a number of situations that indicate to us that we need to extract your tooth. Perhaps the tooth is badly decayed and cannot be saved, or the gums surrounding it have advanced periodontal disease (gum disease) so there's no longer enough bone and connective tissue to hold the tooth in your jaw. Other teeth need to be removed because they aren't positioned correctly in the mouth and there is no other solution, as is the case when wisdom teeth are impacted.

First, we'll examine your mouth and teeth, and we may take X-rays of the questionable tooth so we can evaluate its root and the bone that surrounds it. Be sure to tell us about any medical conditions you may have, or problems you've had with previous extractions. You'll also need to be sure to tell us about any medicines or supplements you're taking, including aspirin, ibuprofen, herbal supplements and any other overthe-counter medicines. If you take oral contraceptives, we'll need to know about that, as well, because you could be more prone to having problems with healing.

If we find a significant amount of infection during the exam, we may prescribe an antibiotic for you to take for several days before your tooth is extracted. Be sure to take them exactly as directed.

First, a little bit about tooth anatomy and the tooth extraction process...

The roots of your teeth are encased in sockets in your jawbone, and are held in their sockets by ligaments. When we extract a tooth, we need to expand the tooth socket and disconnect the tooth from the ligament that holds it in place.

W hat are your choices for treating a problem tooth? Delaying treatment is a risky alternative because the problem will only get worse. If the tooth has a cavity, it will get deeper and get into the nerve. If there's bone loss around the tooth, you'll lose more bone, and if the damage has gone too far, and the tooth has to be removed, then delaying treatment lets the infection spread to other teeth, or, worse yet, to the rest of your body. Your life can even be threatened by infections in the jaw.

Sometimes, you may not have an alternative, and your tooth may have to be removed.

It's important to replace a tooth after it's been extracted. A missing tooth can set off a chain reaction resulting in many new problems. When a tooth is lost, the biting force changes on the teeth next to the space, and they begin to shift, and when a tooth no longer has anything to chew against, it can begin to extrude out of its socket. As your bite changes, your jaw joint may be damaged. And it's much harder to clean teeth that have shifted, so harmful plaque and tartar can accumulate, causing cavities and periodontal disease.

If a tooth is healthy enough be saved, the alternatives to having it removed may be having root canal therapy and a crown, or using surgical procedures such as bone grafting or root amputation.

An appropriate analogy for tooth removal is the removal of plant roots from soil. If a plant's root is deep and entwined in the soil, you can't simply pull it up to remove it. You rock the root back and forth and maybe twist it from side to side to gently enlarge the hole, making removal much easier. This is precisely what we do when we're removing a tooth.

Before we bigin the extraction, we'll use anesthetic to numb the tooth and surrounding area. Once you're completely numb, we'll use instruments called "elevators" or forceps to remove your tooth. Elevators are placed next to your tooth and are used to gently roll the tooth out of its socket. Forceps are used to carefully grip the tooth. As we remove your tooth, you'll feel pressure, but not pain. If you do feel any discomfort beyond just a sensation of pressure, be sure to let us know. We'll stop immediately and give you more anesthetic.

Sometimes, if the tooth's roots are curved or are tightly held in its socket, we might need to cut the tooth into sections and remove the sections one at a time. This is a very common practice that can reduce the amount of time and effort needed to remove a tightly held tooth.

To minimize problems after your tooth is removed, you'll need to follow our post-operative instructions carefully, especially for the first 24 hours following the extraction. These instructions will tell you how to control bleeding, how to prevent dry socket, how to minimize swelling, and what to eat and not eat. If you have any questions, please don't hesitate to call our office.