How are tooth roots removed?

One of the most dreaded medical procedures is having a tooth extracted. The thought of sitting in a dentist's chair under anesthesia scares some people more than the bloodiest horror film. But it's not nearly as horrific as it sounds. Tooth and tooth root extraction is a common surgery, one with few complications and minimal pain.

A tooth may have to be extracted due to various dental concerns. Periodontal disease, also known as advanced gingivitis, can cause a tooth to become separated from the gum and bone that holds the tooth within the socket [source: WebMD]. Once this happens, the tooth needs to be removed to prevent even more infection. Also, if you play a sport or sustain an injury to the mouth, one or more teeth can be knocked loose to the point that they need to be taken out avoid further complications.

There are also basic orthodontic reasons to have a tooth extracted. Baby teeth that crowd a mouth often mean adult teeth will also be crowded. And while some people seem to have enough room in their mouths for wisdom teeth to come through completely, dentists often extract them because they're difficult to reach with a toothbrush and floss, which increases the risk of tooth decay.

Other reasons why a person may have a tooth extracted include [source: Colgate]:

A person who has a high risk of infection due to an organ transplant, receiving cancer drugs or is under immunosuppressive therapy. People with transplants or serious illnesses are highly susceptible to infection. Even if there's only a small chance a tooth may become a problem, it must be taken care of immediately.
Children needing braces may need baby teeth removed to help their adult teeth come in straight. This is sometimes considered a cosmetic procedure, but it allows for braces to work more efficiently.

Both baby and adult teeth "erupt" (the formal name for teeth coming in the mouth) when they come all the way in through the gums. According to Dr. Jeremy Rosenberg, a dentist in Atlanta, Ga., teeth that need to be extracted fall into two categories -- fully impacted or partially impacted. Full impaction means the tooth is under the gum and completely covered by the jawbone. A partially impacted tooth means the tooth is partially covered by some bone and gum tissue. A tooth is always completely removed, roots and all. Dr. Rosenberg said that occasionally, a small fragment of root may break off and is left in the bone if it will cause trauma to the area to remove it. He explained that the body forms bone around it and heals normally. However, this doesn't happen often, and the root piece has to be very small to be left in the mouth.

Now you know why teeth are extracted. On the next page, learn how they're removed and by whom.

Tooth Extraction

A general dentist or specialized surgeon of the mouth, called an oral or maxillofacial surgeon, will perform tooth and tooth root extractions [source: WebMD]. Some general dentists don't like to extract teeth, so they'll refer all extractions to an oral surgeon. Periodontists (dentists who specialize in treating periodontal disease) and cosmetic dentists may also perform tooth extractions [source: AAP].

Your dentist or oral surgeon will first determine the difficulty of the tooth extraction, based on the condition and position of the tooth (such as if it's fully or partially impacted). A tooth with advanced periodontal disease, for example, is easier to extract than a healthy tooth with long roots because the tooth and gums surrounding it have deteriorated so much. Wisdom teeth generally have their own issues for removal, including teeth that have already come through the gums; soft-tissue impaction, where the tooth is lying under the gum; partial-bony impacted, where the tooth is partially erupted and partially stuck in the jaw; and full-bony impacted, where the tooth is completely stuck in the jaw [source: WebMD].

There are two types of tooth and tooth root removal procedures. The first one is called a simple extraction, which is performed on a tooth that has already erupted. A dentist uses forceps or a "dental elevator" placed between the gum and tooth, to loosen it and remove it completely [source: Colgate]. There is usually no cutting into the gum during this procedure. The second type of tooth removal is called a "surgical extraction," where an oral surgeon needs to cut into the gum line to expose the tooth and roots for extraction.

Most tooth extractions are done with the same local anesthetic used when filling a cavity. According to Dr. Rosenberg, it's usually up to the patient to decide if he prefers sedation in addition to local anesthesia. Sedation methods include nitrous oxide (commonly known as laughing gas), an IV sedative that goes directly into the patient's bloodstream or an oral sedative [source: WebMD]. A dentist may recommend general anesthesia instead of local if several teeth will be removed in the same surgery or if the patient has significant anxiety over the procedure. If general anesthesia is used, another person is needed to accompany the patient home after the procedure.

Next up, learn how to care for your mouth after a tooth has been removed.

Extraction Site Care

Overall, there isn't much risk associated with tooth extractions, but as with any medical procedure, there is always the chance of complications. With tooth extraction, complications may include delayed healing, infection, numbness of the mouth and dry sockets. With a dry socket, the protective blood clot that forms over the extraction site either dissolves or moves, which leaves the tooth socket (or bone) exposed to everything you put in your mouth, and can be extremely painful [source: WebMD]. Dry sockets are treated with pain relievers, rinses or other treatments from your dentist.

There is a standard after-care regimen for patients who have teeth extracted. Dr. Rosenberg recommends that patients gently bite down on gauze to stop any bleeding post-surgery and then begin saltwater rinses the day after extraction. He also advises patients to continuing rinsing after each meal for a week or two after surgery, which will kill bacteria and flush any food debris that may get stuck in the extraction site. Antibiotics and pain medicine may also be given if the person needs it; otherwise, it's just a matter of time for the body to heal itself.

Other things you can to do make sure your mouth heals properly include [source: ADA]:

Eat soft foods and liquids such as soup, gelatin, oatmeal and pudding for a couple of days. This will allow the site to heal without traumatizing the extraction site through biting or chewing.
Avoid smoking and using straws (sucking in air can be painful to the wound and lead to dry sockets).
Gently brush your teeth, and avoid directly brushing the healing socket until you feel the area is strong enough for full pressure.

Lots More Information

Sources

American Academy of Periodontology (AAP). "What is a Periodontist?" (Sept. 29, 2011) http://www.perio.org/consumer/periodontist2.htm
American Dental Association (ADA). "Tooth Extraction." (Sept. 8, 2011) http://www.ada.org/2926.aspx
Colgate. "Tooth Extraction." (Sept. 20, 2011) http://www.colgate.com/app/CP/US/EN/OC/Information/Articles/Oral-and-Dental-Health-Basics/Checkups-and-Dental-Procedures/Tooth-Removal-Extraction/article/Tooth-Extraction.cvsp
Edmonds, Molly. "Are people without wisdom teeth more highly evolved?" (Sept. 29, 2011) https://health.howstuffworks.com/human-body/parts/no-wisdom-teeth2.htm
Rosenberg, Jeremy, D.D.S. Dentist in Atlanta, Ga. Personal correspondence. Sept. 18, 2011.
WebMD. "An Overview of Dry Socket." (Sept. 29, 2011) http://www.webmd.com/oral-health/dry-socket-symptoms-and-treatment
WebMD. "Dental Health and Wisdom Teeth." (Sept. 29, 2011) http://www.webmd.com/oral-health/guide/wisdom-teeth
WebMD. "Gingivitis and Periodontal Disease (Gum Disease)" (Sept. 29, 2011) http://www.webmd.com/oral-health/guide/gingivitis-periodontal-disease
WebMD. "Tooth Extraction." (Sept. 29, 2011) http://www.webmd.com/oral-health/tooth-extraction