Sunday, July 21, 2013

What is a Surgical Extraction and Why Do We Need to Know About It ?

A panoramic x-ray. These use much less radiation than many forms of x-ray.  Many dentists believe these should be done every three years.  They cost, depending upon where you are in the nation, about $105.00  US

     Most of the time when human beings require tooth extractions, they can be done by a conventional dentist, and the process is fairly easy for them. The crown of the tooth (the portion which is visible in the mouth) can be grasped with an instrument and removed easily with a twisting action. Most extractions resolve and heal fairly quickly thereafter.   As we grow and age, even if we have taken very good care of our teeth, the chances increase that we will need some extractions from time to time.  There are a number of reasons that a conventional extraction as I described above would not be possible. The extraction of wisdom teeth which have no erupted above the gums are an example of surgical extractions.
                       Some ethnic groups, particularly American Indians may have teeth where the crown is obvious in the mouth but the roots of the teeth themselves might be much much longer than the tooth  I have tooth roots, for example which are four to five times the length of my teeth which are seen below the gums.  This can be a good thing, and a bad one.  Long tooth roots can mean that a significant amount of decay in a tooth can exist before the patient experiences pain there.  It can also mean that teeth with such root length may not be able to be extracted conventionally because the root extends to, or into the sinuses in the patient's face, or down into the region in which there are nerves in the patient's jaw.  Long roots such as these, certain types of broken teeth and some other special circumstances would therefore necessitate a surgical extraction of a tooth.    Sometimes the roots are so damaged, they cannot be removed conventionally without being broken.   A surgical extraction of a tooth can involve the cutting of the gum, the drilling of a tooth into halves or thirds, or the removal of some bone to permit access.  The patient can be pleasantly and easily sedated and unaware but cooperative. The patient can be simply well numbed, or the patient can be more deeply sedated.   Often surgical extractions, particularly complex ones, are done by oral surgeons, and not  always general dentists. (Prosthodontists and maxillofacial surgeons also do surgical extractions.) Some families also simply have "roots that just don't quit".
                     In the past when such surgical extractions took place,  they were sutured closed.  Nowadays, there is the tendency to leave many areas open following such surgeries, to allow healing through second intention, from the bottom up.  This also allows drainage from the wound itself or from the sinus which was impacted by the procedure itself.  Sometimes patients are given special directions and a special syringe to accommodate extraction region hygiene post-operatively.

This is a panoramic x-ray which is most frequently done before wisdom tooth extraction, tooth extraction and certainly before surgical extraction of a single tooth due to decay or breakage.
                  Of course, it's a little daunting to be told that you have a hole where your molar used to be which leads all the way to an open maxillary sinus and that it "will fill in by itself if you keep in clean".  However, this is most often truly the case.
                  Tomorrow morning I will have my third surgical extraction of a very long rooted molar which enters my sinuses.  Fortunately, my wisdom teeth were gone in my teens. Unfortunately, this is not covered under health insurance, even though a broken molar predisposes to a potential abscess, sepsis and an infection in the lining of the heart.   Wish me luck !


Gorges Smythe said...

I'll pray for you.

Sandy said...


Oh you poor thing, I'm wishing you luck and praying for you. This is no fun, I've been in your shoes not to long ago. The bill is hefty even if you have insurance. I had 3 surgical extractions at once (it doesn't matter how good you are with cleaning and keeping up with your teeth). Make sure you have an adult with you to drive you and watch you the first several hours after the surgical extraction.

JaneofVirginia said...

Thanks Sandy, The oral surgeon won't even do the procedure if you don't have "a responsible adult" driving and with you afterward. This oral surgeon has worked on me before and is very good. I hate spending all this money too ! Thanks for the prayers and kind words.

JaneofVirginia said...

Thanks Gorges, Prayers are always appreciated !

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