Complicated Tooth Extractions

Most general dentists perform tooth extractions, but when a tooth extraction looks like it will be complicated, a dentist may refer the patient to an oral surgeon. Simple dental extractions use leverage and force to pry the tooth loose and remove it from the mouth, but these methods won’t work in certain situations. If you need a tooth or teeth extracted, your dentist can talk to you about what procedures will be recommended for you and provide you with specific information and expectations, but following is a review of some of the more general reasons that some tooth extraction procedures might be more complex than others.

The crown of a tooth is the part that is visible above the gum line. If the crown of a tooth has broken fully apart or decayed beyond repair, your dentist may recommend extracting the damaged tooth. Depending on how much of the tooth remains in the jaw, it may be difficult to grip or manipulate using traditional dental tools. This is especially challenging when there is very little tooth to maneuver. Sometimes, the tooth that remains is very delicate, and, while there may appear to be a sufficient amount of tooth for traditional extraction tools, that remaining tooth is highly likely to fracture if a dentist attempts to extract it. This means that an oral surgeon may be called upon to perform what may look like an otherwise uncomplicated extraction, to prevent any complications that appear likely to the trained eye of a dental professional.

In addition to problems with the crown of the tooth, there may be issues with the roots of the target tooth that would result in a referral to an oral surgeon. This is also why dentists usually recommend extracting the wisdom teeth early on, before the roots become too entangled in the jaw. It is more complicated overall to remove a tooth with many roots, like a molar, and this complication increases when the roots are crooked or otherwise complexly shaped. The amount of force required to extract complicated roots could result in damage to the gums or jaw, or even in breakage of the tooth, and specialized surgical techniques are required for successful extraction of these teeth. Roots can pose problems for extraction with other teeth beyond the molars, too. Any tooth with a particularly long root, and especially long roots that are also thin, may need to be extracted by a specialist to avoid injuring adjacent tissue or breaking the tooth while the root is still in place.

An impacted tooth is a tooth that isn’t able to properly erupt through the gum tissue. If the tooth is situated at an angle in the jaw, or if there is insufficient space in the jaw for all the teeth, it may remain snugly beneath the gum tissue, or even beneath the jawbone. The teeth that are impacted most commonly are the wisdom teeth, which are the third molars, farthest back in the mouth. Impacted teeth can be removed by an oral surgeon. In some cases, the bone that surrounds the root of a tooth is compromised in some way, making an extraction in that area more complicated. These issues include excess bone density, which can be caused by excessive clenching or grinding of the teeth, as well as bone inelasticity or deposits of excess bone tissue, called exostoses, that may appear in the jaw following trauma or injury to the area, or due to heredity.

How many teeth can you extract at once?