Background Information:

What are the other Names for the Procedure?

• Dental Extraction
• Extraction of Tooth

What is the Tooth Extraction surgical procedure?

Tooth Extraction is a dental procedure that involves the complete removal of a tooth.

What part of the Body does the Procedure involve?

A Tooth Extraction procedure involves the teeth, gums, and jaw bone.

Why is the Tooth Extraction surgical procedure Performed?

A Tooth Extraction procedure is performed for the following reasons:

Routine removals:

• Weakening of supporting tissue surrounding the bone or gums
• Infection of the nerve within the tooth
• Fracture of a tooth that cannot be repaired
• Insufficient space for normal tooth growth

Impacted-tooth removals:

• Infection and severe pain surrounding the lower wisdom teeth
• Damaged or degeneration of surrounding teeth and bone due to abnormal growth of surrounding tissue

What are some Alternative Choices for the Procedure?

This depends on the reason behind the extraction. However, usually no alternatives exist when a Tooth Extraction is indicated.

What are the Recent Advances in the Procedure?

There are no recent advances in the field of Dental Extraction.

What is the Cost of performing the Tooth Extraction surgical procedure?

The cost of Tooth Extraction procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Tooth Extraction procedure and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

Prior to Tooth Extraction surgical procedure:

How is the Tooth Extraction surgical procedure Performed?

• The extraction of an exposed tooth may be performed after numbing the area with a local anesthetic
• The dentist then uses an instrument to grip the tooth and loosen it from its underlying bony socket. Once the tooth has been freed up, it is removed with a forceps
• Pressure is applied using sterile cotton to control any bleeding from the empty bony socket
• The extraction of impacted teeth requires the use of sedating medication/laughing gas/ general anesthetic
• The surgeon then cuts the overlying gum to expose the tooth. Some bone may also have to be removed to facilitate the Dental Extraction. The resulting soft tissue defect after extraction may require suturing

Where is the Procedure Performed?

Tooth Extraction procedure is usually performed in an out-patient surgery center facility, a dentist or an oral surgeon’s clinic or office, or a hospital.

Who Performs the Procedure?

A dentist or an oral surgeon performs the Tooth Extraction procedure.

How long will the Procedure take?

A simple Dental Extraction takes less than 20 to 30 minutes, while extraction of an impacted tooth may take longer.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Tooth Extraction procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Tooth Extraction procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Tooth Extraction surgical procedure?

Before a Tooth Extraction procedure, the patient has to undergo certain tests such as:

• Routine blood and urine analysis
• X-ray of the mouth

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Tooth Extraction procedure?
• Why is this procedure necessary?  How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests or periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Tooth Extraction surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Local anesthesia by injection and occasionally general anesthesia by injection and inhalation are administered for the procedure.

How much Blood will you lose, during the Procedure?

The blood loss during a Tooth Extraction procedure is minimal.

What are the possible Risks and Complications during the Tooth Extraction surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
• Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders and chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Tooth Extraction surgery are:

• Excessive bleeding
• Infection within the surgical wound
• Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Tooth Extraction surgical procedure?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise.

After the Tooth Extraction surgical procedure:

What are the possible Risks and Complications after the Tooth Extraction surgical procedure?

The possible risks and complications that may arise after the Tooth Extraction procedure are:

• Excessive bleeding
• Infection surrounding the surgical wound
• Abnormally dry sockets

What is the Prognosis after the Surgery?

The prognosis after a Tooth Extraction is usually good.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Pain that worsens and swelling around the gums and teeth
• Bleeding or fluid drainage from the surgical wound
• The occurrence of any symptom that causes uneasiness such as nausea or vomiting
• Stitches that fall out a few days after surgery
• Prolonged excessive bleeding
• Signs of an infection
• Headache, muscle aches
• Fever, feeling sick
• Dizziness
• Complications associated with prescription medications used in treatment
• Failure of prescription medications used in treatment to relieve pain

What Post-Operative Care is needed at Home after the Tooth Extraction surgical procedure?

At home, the following post-operative care is recommended after a Tooth Extraction procedure:

• Avoid smoking or drinking straws for the first day after the procedure
• Keep the mouth tightly closed on gauze dressing. Replace gauze dressing every half-hour if required, in case of excessive bleeding
• Apply ice packs to relieve pain after the procedure
• One day after the procedure, gently rinse the mouth with warm salt-water
• Complete the course of prescribed medication under advice of the physician
• Take antibiotic medication to help combat or prevent infection, per your physician’s advice
• Avoid taking nonprescription medications such as aspirin. However, individuals may take acetaminophen to relieve pain (per the physician’s advice)
• Individuals are advised to have to a clear liquid and soft food diet immediately after surgery. Avoid drinking alcoholic beverages until the wound completely heals

How long does it normally take to fully recover, from the Procedure?

Complete recovery depends on the complexity of the extraction process and may take anywhere between 1-2 weeks.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

Generally, the procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Usually, no tissue is sent for a pathological analysis. However, if a tissue sample is sent, then:

• The tissue removed is processed in the laboratory under a pathologist's supervision
• Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Tooth Extraction surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• An out-patient surgery center facility, the dentist or oral surgeon’s clinic/office, or a hospital
• An anesthesiologist (if anesthesia was administered)
• A pathologist (if the tissue is sent for analysis)
• A dentist or oral surgeon

The patient is advised to inquire and confirm the type of billing, before the Tooth Extraction procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA