Tooth extraction is often the only remaining option for teeth which are too damaged to repair due to trauma or decay. Alternatively, a tooth may be extracted when the mouth is too crowded in order to prepare for orthodontic procedures. Infection can occur if the pulp of the tooth is compromised, and if antibiotics are ineffective at curing the infection, extraction of the tooth may be the best available option. Furthermore, if the risk of infection poses a serious threat to patient’s health (in particular when the immune system has been compromised by a medical condition such as patients receiving chemotherapy or individuals with AIDS) a damaged tooth may be pulled before it has time to grow a bacterial infection. Periodontal disease sometimes leaves so little support for a tooth that it must be extracted in a dentist’s office lest it falls out on its own in less controlled circumstances. Furthermore, many people choose to have their wisdom teeth extracted due to the potential pain and complications which can arise during the eruption process.
During an extraction a local anesthetic is usually applied, unless several teeth are being removed or the tooth is so severely impacted that extensive surgery is needed - in which case the patient is put to sleep with a general anesthetic. In case of an impacted tooth, the dentist or oral surgeon must first remove gum and bone tissue covering the tooth and then extract the tooth using forceps. Particularly large or damaged teeth are often broken into chunks for easier removal. Once the tooth has been removed, a blood clot forms in the socket which is protected by a gauze pad placed in the mouth of the patient. Stitches are sometimes used to help the gums heal over the extraction site. Occasionally a condition called dry socket develops, in which a blood clot cannot successfully form in the empty socket and the dentist must apply a sedative dressing for several days while a new clot forms.
Pain killers are usually prescribed to help manage the discomfort caused by an extraction for several days following the procedure, and it is recommended to use ice for ten minutes at a time to keep swelling to a minimum. Smoking, drinking from a straw, rinsing, spiting forcefully, and eating hard foods are strongly discouraged, especially during the first 24 hours after the procedure. Patients are encouraged to continue regular brushing and flossing but are advised to avoid the extraction site. Rinsing with a saline solution can help healing, but should only be done after 24 hours have passed. Professional help should be sought if signs of infection manifest - especially fever and chills, if nausea or vomiting occur, if there is excessive redness, swelling, or discharge at the site, or if the patient experiences cough, shortness of breath, or chest pains. It is advisable to eventually fill the gap left by a missing tooth with a bridge, implant, or partial denture lest the remaining teeth shift or chewing becomes uncomfortable.
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