TREATMENTS

Tooth Extractions

You and Dr. Van Stralen may determine that you need a tooth extraction for any number of reasons. Some teeth are extracted because they are severely decayed; others may have advanced periodontal disease, or have broken in a way that cannot be repaired. Other teeth may need removal because they are poorly positioned in the mouth (such as impacted teeth), or in preparation for orthodontic treatment.

The removal of a single tooth can lead to problems related to your chewing ability, problems with your jaw joint, and shifting teeth, which can have a major impact on your dental health.

To avoid these complications, in most cases, Dr. Van Stralen will discuss alternatives to extractions as well replacement of the extracted tooth.

The Extraction Process

The goal of the extraction process is to remove the problem tooth with as little disruption to neighboring structures as possible.  We have many techniques and specialized instruments to make this process as comfortable and safe for adjacent anatomy as possible.  Usually the process will begin with the Dr. Van Stralen anesthetizing your tooth and surrounding gums with a short-acting local anesthetic.

During the extraction process you may feel of pressure as the tooth is carefully removed.  You feel pressure without pain as anesthetic interferes with the ability of nerve cells to transmit pain stimuli, yet the nerves that transmit pressure stimuli are not profoundly affected.

Rarely, the pain stimuli can overwhelm the local anethestic and you may begin to feel something.  If you  should begin to feel pain at any time during the extraction please let us know right away and we will take immediate steps to eliminate any pain you may be experiencing.

Sectioning a tooth

Some teeth have multiple roots which diverge.  These teeth require each root to be removed separately so that the surrounding boney architecture remains undamaged.  Dividing teeth into more that one piece is called sectioning.  If necessary Dr. Van Stralen will divide the tooth into sections then removes each section individually.  We perform all tooth sections with a sterilized surgical handpiece (drill) that irrigates the surgical site with sterile saline and does not exhaust air into wound.

After Extraction Home Care

Bleeding

Some bleeding may occur. Placing a piece of moist gauze over the empty tooth socket and biting down firmly for 45 minutes can control this.

Blood clots that form in the empty socket.

In most cases, Dr. Van Stralen will place a fibrin clot and a fibrin membrane in the extraction socket and join the overlaying tissue with sutures to hold the fibrin in place.  (Please see the PRGF section under treatments for more information on this technique.)  This will accelerate healing and care must be taken in order to not to dislodge the clot.

  • Avoid rinsing or spitting for 24 hours after the extraction.
  • Avoid use of a straw, smoking or hot liquids.

Swelling

With this technique, swelling is rare as white blood cells are fractioned from the fibrin.  If some swelling does occur, place ice on the effected area for 10 minutes and off for 20 minutes. Repeat this cycle as you feel necessary for up to 24 hours.

Pain and Medications

If you experience pain you may use non-prescription pain relief medications such as acetaminophen or ibuprofen.  Pain medications work better if taken before the pain begins.  Always try and take some pain medication before the anesthetic wears off then evaluate the need for future pain medications as healing progresses.  A good way to use acetominophen and ibuprofen is to take small amounts of each at the same time.  For example, for moderate pain, 650 mg of acetominophen and 400 mg of ibuprofen works well; for severe pain, 975 mg of acetominophen and 600 mg of ibuprofen works well.

Eating

Following most extractions, chew "away" from the extraction site as much as possible. Stay away from hot liquids and alcoholic beverages for 24 hours. A liquid diet may be advisable for 24 hours.

Brushing and Cleaning

Immediately after tooth extraction, avoid brushing teeth near the extraction site for one day. Resume gentle cleaning on the second day. Avoid commercial mouth rinses, as they tend to irritate the site. Beginning 24 hours after the extraction, rinse with salt water (1/2 teaspoon in a cup of water) after meals and before bed.

Dry Socket

Dry sockets manifest themselves as a dull-throbbing pain  that appears three or four days after tooth extraction. The pain can be moderate to severe and radiate from the extraction area. Dry socket may cause a bad taste in your mouth or bad breath.  Also, the extraction site may appear dry. 

A dry socket occurs when a blood clot fails to form in the extracted tooth socket or when the blood clot has been dislodged.  In such case, healing is significantly delayed.   When a fibrin clot is placed, formation of a dry socket is extremely rare.  However, it is always beneficial to follow classic post-extraction instructions mentioned above.  These guidelines have been shown to reduce the chances of developing a dry socket significantly.

If you feel that you may be experiencing a dry socket after tooth extraction, call our office immediately and Dr. Van Stralen will apply a medicated dressing to the dry socket to relieve the pain.

Healing

In addition to accelerating healing, a fibrin clot will stimulate your body to grow bone in the extraction socket.  Without a fibrin clot, the extraction socket (hole in your jawbone where the tooth was) will smoothen and fill in with bone but 35-40% of the width and height of the bone in that area will be lost within 6 months to a year.   It is always much easier to preserve bone rather than to reconstruct bone.