A tooth extraction (also referred to as tooth extraction , exodontia , exodontic , or informally, interesting ) is the removal of the tooth from the alveolus of the tooth (socket) in the alveolar bone. Extractions are performed for a variety of reasons, but most often to remove teeth that have become unbearable through tooth decay, periodontal disease or tooth trauma, especially when they are associated with toothache. Sometimes the wisdom teeth are affected (caught and can not grow normally into the mouth) and can cause recurrent infections of the gums (pericoronitis). In orthodontics if the teeth are full, the sound teeth can be extracted (often bicuspid) to create space so that the rest of the tooth can be straightened.
Tooth extraction is usually relatively easy, and most can usually be done quickly when the individual is awake by using a local anesthetic injection to relieve pain sensation. Pain of local anesthetic block, but mechanical strength still felt. Some teeth are more difficult to remove due to several reasons, especially related to the position of teeth, tooth root form, and tooth integrity. Dental phobia is a problem for some individuals, and tooth extraction tends to be more feared than other dental treatments such as patching. If the tooth is buried in the bone, a surgical or trans alveolar approach may be required, involving cutting gums and removing bones that hold the tooth with a surgical drill. After the tooth is removed, the sutures are used to replace the gum to normal position.
As soon as the teeth are removed, the bite pack is used to press the tooth socket and stop the bleeding. After tooth extraction, the dentist usually gives a rotating suggestion not to disturb the blood clot in the socket by not touching the area with the finger or tongue, by avoiding strong mouth rinses and avoiding heavy activity. Sucking, such as through a straw, should be avoided. If the blood clot breaks off, the bleeding can be restarted, or alveolar osteitis ("dry socket") may develop, which can be very painful and lead to delayed healing in the socket. Smoking is avoided for at least 24 hours as it can damage wound healing and make dry sockets significantly more likely. Most suggest a warm mouth salt water that starts 24 hours after extraction.
The dental branches that primarily handle extraction are oral ("exodontic") surgery, although general dentists and periodontists often perform routine dental extractions because these are the core skills taught in dental schools. Periodontists perform more and more extractions, as they often follow up and place dental implants.
Video Dental extraction
Reason
The most common reason for extraction is tooth decay due to damage or decay. There is an additional reason for tooth extraction:
- Reduce costs compared to other treatments
- Severe tooth decay or infection (acute or chronic alveolar abscess). Despite the decrease in dental caries prevalence worldwide, this is still the most common reason for tooth extraction (non-third molar tooth) with up to two-thirds of extraction.
- Supernumerary teeth that block other teeth from entering.
- Severe gum disease that can affect the supporting tissues and bone structure of teeth.
- In preparation for orthodontic treatment (braces)
- Teeth in the fracture line
- Teeth that can not be returned endodontically
- Cracked teeth
- Supernumerary teeth, additions or shape defects
- Prosthetic; teeth damage the suitability or appearance of dentures
- Wisdom teeth treatment symptom, whose behavior leads to a pathosis that will lead to more (infection, inflammation, bone resorption)
- Preventative/prophylactic removal of asymptomatic asymptomatic affected wisdom teeth. Although many dentists are removing third untrained molar teeth, both the American and British Health Authorities recommend this routine procedure, unless there is evidence for an affected dental disease or close environment. The American Public Health Association, for example, adopted a policy, Opposition to Prophylactic Appointment on Third Molars (Wisdom Teeth), due to the large number of injuries resulting from unnecessary extraction.
- Cosmetics - to remove bad tooth look, not suitable for recovery
- Head and neck radiation therapy, to treat and/or manage tumors, may require tooth extraction, either before or after radiation treatment
- Deliberate, medically unnecessary experiments, as a form of physical torture.
- It was once common practice to remove the teeth of an institutionalized psychiatric patient who had a history of biting.
Maps Dental extraction
Type
Extraction is often categorized as "simple" or "surgical".
Simple extraction is performed on the teeth seen in the mouth, usually under local anesthesia, and requires only the use of instruments to lift and/or understand visible tooth parts. Usually the tooth is lifted using a lift, and using forceps, swaying forward and back until the periodontal ligament has been sufficiently broken and the supporting alveolar bone has dilated sufficiently to make the teeth loose enough to lift. Usually, when the tooth is lifted with forceps, slow, stable pressure is applied with controlled strength.
Surgical extraction involves removal of teeth that can not be easily accessed, either because they have broken below the gum line or because they have not been fully erupted. Surgical extraction almost always requires an incision. In surgical extraction, the doctor can remove the soft tissues that cover the teeth and bones and can also lift some of the surrounding jaw bone tissue and/or surrounding it with a drill or osteotome. Often, teeth can be broken down into sections for easy shifting. Surgical extraction is usually performed under general anesthesia.
Use of Anticoagulant
Studies have shown that there is a correlation between the consumption of anticoagulant drugs after tooth extraction and the amount of bleeding. In one such review, oral anticoagulants are prescribed for some subjects, all undergoing dental surgery. 89 of 990 subjects (9%) experienced postoperative bleeding delays, and 3.5% of these cases were not controlled by local measures ('serious cases'). Other studies have reported more patients with minor postoperative hemorrhage. However, it is difficult to standardize bleeding because the definitions used to categorize bleeding rates tend to differ from study to study. However, most studies agree that there is a risk of major bleeding if patients regularly take oral anticoagulants at the time of simple tooth extractions.
For simple extraction, anticoagulant therapy may be continued, because the risk of bleeding is not high and the risk of thromboembolism caused by the temporary withdrawal of anticoagulants is much higher than for serious bleeding after extraction. However, for complex extraction (3 or more teeth or multiple adjacent teeth), the risk of bleeding is higher, and the dentist should consult with the patient's physician. Patients who undergo anticoagulant treatment should tell their dentist when setting up the procedure. Individual care plans should be made for patients, and patient clinicians should be contacted to confirm the anticoagulant used, and the type of dosage. INR patients should also be taken into account. When patients have INR 4.0 or more, they should be referred to a specialist. Risk of bleeding increases in older people (especially after postoperative tooth extraction) as they are more susceptible to dental caries and periodontal disease. This should also be taken into account by the dentist.
To improve the effectiveness of oral anticoagulant drugs, the risk of bleeding can be further minimized by the use of sponges and collagen stitches and rinsing 5% tranexamic acid mouthwash four times a day.
Overall, patients taking long-term anticoagulant therapy such as warfarin or salicylic acid should not stop using it before having extracted teeth. Extraction should be performed using the least traumatic extraction procedure and patients should make sure to tell their dentist or oral surgeon about any medication they may take before the procedure.
Use of antibiotics
Antibiotics can be prescribed by the dentist to reduce the risk of certain post-extraction complications. There is evidence that antibiotic use before and/or after impacting wisdom tooth extraction reduces the risk of infection by 70% and decreases the incidence of a dry socket by one-third. For every 12 people treated with antibiotics after the wisdom tooth extraction, one infection was prevented. The use of antibiotics does not seem to have a direct effect on the manifestations of fever, swelling or seven-day post-extraction trismus. In a review of Cochrane 2013, 18 randomized double-blinded control trials were reviewed and after considering the biased risks associated with the study, it was concluded that there is overall evidence supporting the routine use of antibiotics in practice to reduce the risk of infection. following the third molar extraction. There are still reasonable concerns remaining regarding the possible adverse effects of the indiscriminate use of antibiotics in patients. There are also concerns about the development of antibiotic resistance that advocates against the use of prophylactic antibiotics in practice.
Post-extraction healing
Immediately after tooth extraction, bleeding or just oozing is very common. Pressure is applied by biting on the gauze, and the form of thrombus (blood clot) in the socket (hemostatic response). Common hemostatic measures include local application of pressure with gauze and use of oxidized cellulose (gelfoam) and fibrin sealant. Dental practitioners usually have absorbent gauze, hemostatic packing materials (oxidized cellulose, collagen sponges) and stitching kits are available. Sometimes a 30-minute continuous pressure is required to fully withstand bleeding. Speaking, which removes the mandible and thereby removes the pressure applied to the socket, rather than maintaining a constant pressure, is a very common reason that the bleeding may not stop. This is likened to someone with a bloody wound in their arm, when instructed to apply pressure, otherwise holding the wound intermittently every few moments. Coagulopathy (clotting disorders, eg hemophilia) is sometimes found for the first time if a person has no other surgical procedure in his life, but this is rare. Sometimes blood clots can dislodge, trigger more bleeding and formation of new blood clots, or lead to dry sockets (see complications). Some oral surgeons routinely scrape the socket wall to encourage bleeding in the belief that this will reduce the chance of dry sockets, but there is no evidence that this practice works.
The possibility of further bleeding decreases as the healing progresses, and is unlikely after 24 hours. If bleeding occurs beyond 8-12 hours, this situation is then referred to as post extraction bleeding. Blood clots are covered by epithelial cells proliferating from the gingival mucosa at the socket boundary, taking about 10 days to cover the entire defect. In clot, neutrophils and macrophages are involved as an inflammatory response occurs. The next proliferative and synthesis phase occurs, characterized by osteogenic cell proliferation of adjacent bone marrow in the alveolar bone. Bone formation begins after about 10 days since the tooth is extracted. After 10-12 weeks, the socket outline is no longer visible on the X-ray image. Bone remodeling when the alveolus adapt to edentulous state occurs in the long run as the alveolar process slowly absorbs. In the maxillary posterior tooth, maxillary sinus pneumatization rate may also increase as antral floor remodal.
Post Extraction Bleeding
Post extraction bleeding is bleeding that occurs 8-12 hours after tooth extraction. There are various factors that contribute to post-extraction bleeding.
Local factors
- Laseration of blood vessels
- Osseous bleeding from the central nutrient/blood vessel
- Inflammation
- Infection
- Trauma Extraction
- The patient's failure follows the post-extraction instruction
Systemic factors
- Platelet problem
- Excessive coagulation/fibrinolysis disorder
- Inherited/drug-induced problem
Type of Bleed
1. Primary prolonged bleeding
This type of bleeding occurs during/immediately after extraction because the actual hemostasis has not been reached. It is usually controlled by conventional techniques such as applying pressure packets or hemostatic agents to the wound.
2. Reactionary bleeding
This type of bleeding begins 2 to 3 hours after tooth extraction as a result of the cessation of vasoconstriction. Systemic interference may be required.
3. Secondary bleeding
This type of bleeding usually begins 7 to 10 days post-retraction and is most likely due to an infection that destroys a blood clot or localized vessel ulceration.
Interventions
When the dentist decides how to control post-extraction bleeding, many factors must be taken into account:
- Surgical area
- Location of bleeding
- Wound size
- Extend bleeding
- Accessibility of bleeding sites
- Bleeding time
If on patient examination, blood pressure below 100/60 and heart rate greater than 100bpm, hypovolemic shock should be suspected and patient should be sent to the hospital for IV blood transfusion.
Interventions of post-extraction bleeding can be categorized into two main groups:
Local intervention
(i) Surgical intervention
- Involve the suture of the bleeding site. The sutures will help close the socket and help unite the gingival tissue. Interrupted or horizontal mattresses are equally recommended.
- If the bleeding is secondary to trauma to the blood vessels, the patient may need to be sent to the hospital because large blood vessels may require ligation and smaller blood vessels burned
(ii) Non-surgical hemostatic measures
- Involve the use of drugs, sealants, adhesives, absorbent agents, biology, and product combinations
(iii) Combination of both
- A resorbable hemostatic package, such as oxidized cellulose or sponge collagen, in addition to tailoring is recommended if the source of bleeding comes from the bone inside the socket.
2. Systemic intervention
There are specific factors that need to be taken into account when considering a nerve injury after removal of the lower third molar (lower wisdom teeth). The position of molars is an important risk factor associated with inferior alveolar nerve injury. The horizontal impacted molar has a higher risk of nerve injury, as the impacted molar depth increases. Furthermore, the most important factor for the prediction of inferior alveolar nerve injury is proximity of the root tip to the mandibular canal.
Pain management
Many drug therapies are available for pain management after third molar extraction including NSAIDS (non-steroidal anti-inflammatory), APAP (acetaminophen) and opioid formulations. Although each has its own efficacy of relieving the pain, they also have an adverse effect. According to Dr. Paul A Moore and Dr. Elliot V. Hersh, the combination of Ibuprofen-APAP has the greatest efficacy in relieving pain and reducing inflammation along with the fewest side effects. Taking either of these agents alone or in combination can be contraindicated in those who have certain medical conditions. For example, taking ibuprofen or any NSAID along with warfarin (blood thinners) may not be appropriate. Also, prolonged use of ibuprofen or APAP has GI and cardiovascular risk. There is high-quality evidence that ibuprofen is superior to paracetamol in managing postoperative pain.
Preservation socket
Preservation of sockets or alveolar ridge preservation (ARP) is a procedure to reduce bone loss after tooth extraction to maintain tooth alveolus (tooth socket) in the alveolar bone. At the time of extraction, a platelet-rich fibrin membrane (PRF) containing a bone growth-enhancing element is placed inside the wound or grafted material or scaffold placed in the extracted tooth socket. The socket is then immediately sealed with seams or covered with a non-resorbable or resorbable membrane and stitched.
Replacement options for missing tooth
After extraction of the tooth, the gap is left. The choice to fill this gap is generally noted as Bind, and the right choice is agreed between the dentist and the patient based on several factors.
History
Historically, tooth extraction has been used to treat various diseases. Prior to the discovery of antibiotics, chronic tooth infection is often associated with a variety of health problems, and therefore sick tooth removal is a common treatment for a variety of medical conditions. The instruments used for tooth extraction came from centuries ago. In the 14th century, Guy de Chauliac discovered pelicans, which were used until the end of the 18th century. The pelicans were replaced by a tooth key which, in turn, was replaced by modern day counterparts in the 19th century. As tooth extraction can vary greatly in difficulties, depending on the patient and the tooth, various instruments exist to cope with certain situations. Rarely, tooth extraction is used as a method of torture, for example to obtain forced confession.
Until the early 20th century in Europe, tooth extraction was often done by dentists who traveled at the city fair. They sometimes have musicians with them playing hard enough to cover up the crying pains of those whose teeth they were taken. In 1880 in the PyrÃÆ' © nÃÆ' Â © es-Orientales (France), one traveling dentist claimed to have extracted 475 gears in an hour.
See also
- Teeth regeneration
References
Source of the article : Wikipedia
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