A dental extraction is the removal of a tooth from the mouth. Extractions are performed for a wide variety of reasons. Tooth decay (properly known as dental caries) that has destroyed enough tooth structure to prevent restoration is the most frequent indication for extraction of teeth. Extractions of impacted or problematic wisdom teeth are routinely performed, as are extractions of some permanent teeth to make space for orthodontic treatment (straightening of teeth). There are other reasons a tooth is extracted. It may be badly damaged or decayed, could be causing overcrowding or preventing a tooth from erupting.
Types of Extraction
Extractions are often categorized as "simple" or "surgical". Simple extractions are performed on teeth that are visible in the mouth, usually under local anaesthetic, and require only the use of instruments to elevate and/or grasp the visible portion of the tooth. Typically the tooth is lifted using an elevator, and subsequently using forceps, rocked back and forth until it is loosened from the alveolar bone. Surgical extractions involve the removal of teeth that cannot be easily accessed, either because it has broken under the gum line or because it has not come in yet. In a surgical extraction the dentist makes an incision in the gum to reach the tooth and may also require the removal of overlying bone tissue with a drill or osteotome. After the tooth is removed, a clot will usually form in the socket. Occasionally this clot can become dislodged, resulting in a condition called dry socket, also known as alveolar osteitis. This is not uncommon and occurs almost exclusively after extraction of lower molars, due to their lesser blood supply than their maxillary counterparts. Certain factors contribute to its development, such as age, smoking, birth-control, extent of surgery peformed to extract the tooth, duration of time the extraction site was surgically exposed, and various others. Dry-socket lengthens the healing process and usually causes severe pain and discomfort that is often not manageable with pain medications. It is appropriately treated with a medicated gauze or resorbable gel-foam or surgical packing that is changed (or replaced) every two to three days until granulation tissue can cover the bone at the extraction site. Often, these dressings contain a material called "eugenol", an obtundant which alleviates dry-socket pain.
Historically, dental extractions have been used to treat a variety of illnesses. Before the discovery of antibiotics chronic tooth infections were often linked to a variety of health problems, and therefore removal of a diseased tooth was a common treatment for various medical conditions. Instruments used for dental extractions date back several centuries. In the 14th century, Guy de Chauliac invented the dental pelican (resembling a pelican's beak) which was used through the late 18th century. The pelican was replaced by the dental key which, in turn, was replaced by modern forceps in the 20th century. As dental extractions can vary tremendously in difficulty, depending on the patient and the tooth, a wide variety of instruments exist to address specific situations.