A tooth is extracted due to several reasons, may that be either the decay or the mobility of the tooth, or the incorrect eruption of the wisdom tooth. A few common reasons for the extraction of the tooth include Pulpal Necrosis, Periodontal Disease, Cracked Teeth which cannot be managed by Endodontic procedures, Supernumerary tooth, Teeth that are involved in jaw fractures, Radiation Therapy and even financial situations where the patient isn’t able to afford the treatment procedures to save the tooth. [Read this for the Post Extractions Instructions for the Patient]
The dentists job does not end with the extraction of the tooth. There are several precautions that are to be followed by a Dentist, may that be a normal extraction or a surgical one. Either way, there is an extraction socket that has to be healed in a certain amount of time, and it should not have any debris or calculus of the extracted tooth, and even a small part of the tooth. When the socket is entirely clean and has only the blood clot, only then the socket would heal well.
Following are a few precautions to be taken by the dentist after they have extracted the tooth:
Keep in mind not to debride the extraction socket if there is no necessity. If there is no debris or calculus then it isn’t necessary always to debride the socket.
If there was a periapical cyst or granuloma in the radiograph prior to the extraction, and it hasn’t come out as a whole or part, then curettage is to be done after the tooth is extracted. To do so, a periapical curette should be used.
If any debris, calculus, amalgam or a root tip is visible in the socket, gentle removal should be done using a curette or suction tip.
* Reason for not performing curettage and debridement when not necessary, is that the current periodontal ligament tissue and the bleeding walls of the bone are in the best condition to help in the rapid healing of the socket. If curettage is done in a vigorous way, it would just injure the tissues and can delay the healing.
Reduction of the socket to the normal size should be done when the molars are extracted, especially when the buccolingual cortical plates are expanded to help in the proper extraction of the tooth. A gentle finger pressure is enough to reduce the plates to their normal position, and this would prevent the delayed healing which could be caused due to the bony undercuts.
If at all an implant placement is being planned for the future after the healing of the socket, then utmost care has to be taken while reducing the buccolingual plates because overreduction of the cortical plates may intervene with the proper placement of the implants.
Constant bleeding after the removal of the tooth would be seen sometimes when the patient is getting it extracted due to a periodontal disease, as there could be a presence of granulation tissue around the gingival cuff, which, if not removed, would show no constriction or retraction of the arterioles and thus the bleeding would continue during or after the extraction. If the cause for extraction was periodontal, the granulation tissue should be removed either a curette, a tissue scissor or a hemostat.
Reduction of sharp bony edges – This is one of the final and important part to check. Palpate the bone with your finger and try to check if there are any sharp bony edges or projections. If there are any, then the mucosa should be reflected and the bone should be either filed and smoothed using a Bone File, or else trimmed using a Bone Rongeur.
Adequte amount of Gauge or Cotton – Hemostasis is achieved by placing a 2 x 2 inch gauze piece or a ball of cotton, in the place where the crown of the extracted tooth used to be. Proper control of bleeding is achieved when the gauze is placed in the exact place and the person bites, so that the pressure due to the bite goes into the socket. Placing a bigger piece of gauze or cotton would not enhance the hemostasis, but would increase the pressure on the teeth during the bite.
Suturing is indicated when the 3rd molar is extracted, or multiple adjacent teeth are extracted at the same time and there is a wide socket formed after extraction. Placing sutures not only helps in controlling the bleeding, but also approximates the tissues around the socket to aid in proper tissue position during healing.
Antibiotics should be prescribed along with mild analgesics, so that the socket which was open after extraction, should not get infected by any micro-organisms that made their entry into the socket. Any cross infection due to instrumentation can also be prevented, if a 3-day or 5-day antibiotic therapy is followed after the extraction.
If at all the tooth extraction socket doesn’t heal well, the inflammatory reaction on the bone can cause a condition called Dry Socket.