Sometimes it’s just necessary to have a tooth extracted.

By C ORI U RBAN Special To The Republican

Whether the tooth is causing pain or decaying or has been injured, a dentist can offer a variety of options for replacing a problem tooth.

“The reasons that teeth need to be extracted include fractured teeth or severe decay that they cannot be restored with a filling or crown,” explained Dr. Alison S. Leecock, a general dentist at Kasperowski Family Dentistry. Or teeth can have bone loss from gum disease resulting in the need for removal.

Other reasons include impacted teeth, overcrowding of space or a dental injury in which the tooth cannot be saved.

The process of an extraction can vary.

“Generally when you come to the office, your medical history is reviewed, your blood pressure is taken, and then we start the procedure by numbing the area” with local anesthetics, she explained.

Once the patient is feeling comfortable, the dentist can loosen the tooth by using instruments called elevators. Occasionally, it may be necessary to make an incision in the patient’s gums and use a drill to help access the tooth or separate it into two roots. “When we feel the tooth is ready, we are able to carefully remove it by using forceps,” she said. “Once removed, we make sure the socket is cleaned out, disinfected, and occasionally the extraction site may require grafting or sutures.”

The time it takes varies depending on the reason for the extraction, which tooth it is and the gum health of the patient. “Sometimes it is a quick in-and-out procedure, other times it can be more complex,” Leecock said.

There is a risk for pain in the procedure, but dentists do their best to minimize that for the patient. “There is a lot of pressure involved which can be uncomfortable, but anesthesia can really quiet the pain,” she noted.

Sedation is an option, and there are many types of sedation so it is important to check with the dental office to see which types are offered.

Based on the patient and the patient’s health, the decision on what type of sedation is made. Sedation can be achieved with oral sedation, medication taken prior to the appointment; nitrous oxide, which is delivered in office; or IV sedation.

Once the tooth is out, there are options to replace it depending on what end result the patient wants.

“The first option is always to do nothing and leave the space,” Leecock said. “Sometimes of your mouth.

The dentist explained that there are fixed options that can include an implant or a bridge. Implants consist of three parts: the actual implant, or “screw,” that goes underneath the gum, similar to the root of the tooth. Then, to give it that “tooth-like” appearance, you will need an abutment followed by a crown, or “cap.” The abutment allows the connection between the implant body and the crown that sits on top.

A bridge requires at least two crowns on either side of the space with the third crown in the middle to fill in where the space is.

The number of tooth extractions a year at a practice depends on what the patient population needs, but roughly 175 are completed in Kasperowski Family Dentistry office. Generally, the risks of tooth extraction include swelling, bruising, pain, damage to adjacent teeth and bleeding. There is a risk of post-operative infection, fracture or dislocation of the jaw, damage to the sinuses or damage to the nerves.

But ignoring a tooth that needs to be extracted can result in infection, swelling, pain and systemic disease. “Infection in your teeth relates to your whole body and can become very serious,” she said.

According to the dentist, after a tooth extraction, it is important for the patient to keep biting on the gauze given. Additionally, ice wrapped in a cloth on the cheek near the area of surgery can help keep swelling to a minimum. It is important for the patient to avoid spitting or sucking motions (like using a straw), and smoking for the first 3-4 hours so that the clot that has formed does not become dislodged. The day after the procedure, it is also helpful to use hot compresses on the cheek to reduce swelling and to do salt water rinses.

Any follow-up needed is usually booked about a week out to check the healing process.

The staff of Kasperowski Family Dentistry outside their Westfield Office. (PHOTO COURTESY OF STEVEN E. NANTON) this is viable if you still have a lot of chewing surfaces and if you are comfortable with how it looks depending on where it is in your mouth.”

One concern with leaving the space is that the teeth around it may shift after extraction, and this can lead to mal-occlusion, which is damage to the way the teeth fit together.

If the patient would like to replace the space, options include fixed or removable. Fixed options mean it is something that does not come in and out of your mouth. Removable means something that comes in and out

“Both of these options should be discussed with your dentist as they have certain pros and cons depending on the situation,” she said.

Removable options can include partial dentures or full dentures depending on the amount of teeth that need replacing. “Removable options are usually less expensive, and they can cover a lot more spaces at the same time which can be a nice option,” Leecock said, adding that the negative side is that it does come in and out of your mouth, and adjusting to it may be difficult.

Partials/dentures have follow-ups as needed for adjustments after they are delivered. Bridges are usually followed-up at every cleaning and exam appointment, and implants are generally followed-up at around four months to ensure that they are osseointegrated prior to restoration placement (i.e abutment and crown). After that, implants and restorations will be evaluated at every cleaning and exam appointment. The healing process itself can take a couple of weeks.

For more information go to drkasperowski.com or mouthhealthy.org/en/ all-topics-a-z/extractions.