Minimally invasive tooth extraction technique. Indications for tooth extraction and methods of operation Forceps for extraction of teeth of the upper jaw

(tooth extraction) is the most common operation in humans. It can be typical (simple), complex, atypical. The main goal of a typical (simple) tooth extraction operation is the need to create conditions for the tooth to emerge from the jaw, that is, it is necessary to destroy the connection of the tooth with the surrounding tissues and slightly expand the alveolus. During surgery, the doctor usually stands (or sits) on the right side of the patient. However, the position of the doctor, the patient in the chair and the tilt of the patient’s head should be such that it is comfortable for the doctor to work and for the assistant to help. The dentist and assistant must have a clear view of the surgical field and be able to control the condition of the oral cavity and fix the jaw and alveolar process near the tooth that is being removed with their left hand.

The following mandatory stages of a simple tooth extraction operation are distinguished, which are carried out after anesthesia:

syndesmotomy - detachment of the mucous membrane from the tooth and destruction of the upper parts of the dental-gingival junction;
applying forceps to a tooth
advancement of forceps
fixation of forceps
loosening of the tooth (luxation or rotation, depending on the shape of the tooth root)
traction - removing a tooth from the alveolus
hole revision
treatment of the tooth alveolus (reposition or suturing of its edges)

Apply forceps so that their axis coincides with the axis of the tooth, advance the forceps until they come into contact with the neck of the tooth and the edge of the alveolus.

Applying the cheeks of the forceps to the tooth (a – correct; b – incorrect) and to the upper edges (c) of the walls of the tooth socket (this is undesirable, since bone is lost)

You need to squeeze the forceps so as not to split the tooth, especially if it is fragile or has a carious cavity. After applying the forceps, the first luxation movement is usually made in the direction of the thinnest wall of the tooth alveolus (usually outward in the buccal direction), so that it breaks and enlarges the opening for the tooth. In the lower jaw, when removing molars, the first movement is made in the lingual direction, because on the outside there is an external oblique line (buttress of the lower jaw), which counteracts the force that is applied.

After the operation, the edges of the alveoli are brought together with fingers, and if necessary, the mucous membrane over the alveoli can be sutured with catgut, silk, or a pressure bandage (a tampon that the patient presses with his teeth to stop bleeding from the alveoli) can be applied to it. It should be noted that the extracted tooth is not immediately thrown away, but is examined and shown to the patient to avoid questions about the need to remove the tooth and the presence of all its roots.

Classical tooth extraction surgery technique has some features when removing various teeth, which is determined by the number and structure of their roots, the alveolar process and the jaw itself, the nature of the pathological process in the area of the alveolar process, the degree of destruction of the tooth, its position in the jaw, characteristics of soft tissues and other factors. Teeth with rounded roots (canines, central incisors) are removed with a predominant use of rotational movements, and teeth with flat roots or multi-rooted teeth are removed with a predominance of luxation movements. The force of tooth dislocation must correspond to the resistance of the bone of the walls of the tooth socket.

The use of a particular elevator, as well as the direction of the first luxation movement (inward or outward) also depends on the above factors. Thus, a direct elevator is usually placed on the medial surface of the tooth and rotational movements are carried out with the elevator based on the alveolar bone or medially located teeth, which will make it possible to remove teeth or their roots. An angular elevator is inserted into the alveolus of an already removed tooth root and also carries out a rotational movement in the direction of the root and interradicular septum, which are subject to simultaneous removal.

Scheme of removing the root of the upper tooth with a straight elevator (a – d – stages of the operation) and removing the roots of the lower molars with an angular elevator (according to A. E. Verlotsky) (e)

Features of root anatomy and tooth extraction in the upper jaw

Anterior incisors- their roots are round in shape. Use straight forceps; rotational movements, dislocation - in the direction of the vestibule of the oral cavity.
Lateral incisors- slightly flattened, the top is bent towards the sky. Rotational and luxation movements are used.
Fangs- the roots are massive, long, flattened, like a aligned triangle. The forceps are straight, the movements are luxation, then rotation.
Premolars- the roots are flattened, the first premolar has 50% buccal and palatal roots. The forceps are S-shaped, the movements are luxation, the first movement is made in the buccal direction.
Molars- the first two (6 and 7) have three roots: two buccal and one palatal. In the area of the 6th tooth, the outer wall of the alveolus is thickened due to the zygomatic-alveolar ridge, and in the area of the 7th tooth, the outer wall is thinner than the inner. An S-shaped forceps with a spike on the outer cheek is used to bifurcate between the buccal roots. The first luxation movements are towards the palate (6th tooth) or outwards (7th tooth).
Upper 8 teeth removed with special bayonet pliers with long cheeks, the first movement is outward. Often they can only be removed using a direct elevator.
Roots of upper teeth- removed with bayonet forceps or straight and S-shaped forceps with cheeks that converge. The roots of the upper molars are removed either all together (while maintaining the connection between them), or one by one (when the connection is already destroyed, the roots are single).

Features of the anatomy of roots and tooth extraction in the lower jaw

The patient's position is as low as possible, the head is almost vertical, the chin is tilted towards the chest. When removing left teeth, the doctor stands to the right and in front near the patient, the first finger covers the chin, 2 and 3 fingers cover the alveolar process, and when removing right teeth, the doctor stands immediately behind the patient, 1-2 fingers of the left hand cover the alveolar process, and 3-4 5 fingers - chin, holding the lower jaw. The line of strength (thick cortical plate) comes from the lingual surface in the area of 1-2-3 teeth, gradually passes at the level of 4-5 to the outer surface and at the level of 6-7-8 teeth passes into the external oblique line (buttress of the lower jaw). Taking this into account, the first luxation movement is carried out, gradually increasing the amplitude of movements, and rotational movements are also used. Traction of the tooth is carried out upwards and outwards so as not to injure the upper teeth.

Incisors- roots are flattened laterally, narrow beak-shaped forceps are used, movements are mainly luxation.
Fangs- long roots, strong, use wide beak-shaped forceps, movements - luxation and rotation.
Premolars have one round root, slightly flattened. Movements - luxation and rotation.
Molars(6, 7) have two flattened roots (anterior and posterior). Beak-shaped forceps with spikes, the first luxation movement of the 6th tooth is towards the buccal side and the 7th tooth is towards the lingual side. 8th tooth - the structure of the roots (there are 1-4 of them) can be multivariate, so removing a tooth is very difficult, even after an X-ray examination. They use special forceps with spikes, elevators, and often perform complex or atypical removal.

If a typical operation does not allow tooth extraction, then they proceed to a complex tooth extraction operation. Complex tooth extraction involves the use of additional surgical techniques and instruments to remove a root or tooth from the alveolus without opening and detaching the mucoperiosteal flap and without partially or completely removing one or two bone walls of the alveolus. To do this, additional tools and means are used - bone burs and a drill, narrow chisels, a dental mirror and additional illumination of the fossa, various probes, narrow elevators, and other tools. First of all, you need to accurately determine the presence, position and size of a broken tooth root, and the proximity of important adjacent anatomical structures. To do this, after drying and illuminating the hole with a mirror, it is carefully examined, radiographs are taken, or the position of the root is determined during surgery. All methods of complex tooth extraction are conventionally divided depending on the degree of destruction of the walls of the fossa in order to expose the root of the tooth, or according to the impact on the tooth - removing the remains of the tooth completely or fragmenting the remains of the tooth and removing its fragments one by one. The following surgical techniques are used that are indicated in the presence of a single-rooted tooth or an isolated root of a two- or three-rooted tooth (mainly in the upper jaw), an unfilled root canal, and the absence of hypercementosis of the tooth root:

submucosal subperiosteal application of the cheeks of forceps to the upper edge of the alveolus of the tooth, squeezing and simultaneously removing the root of the tooth and the upper edge of the alveolus, but this is not optimal, since part of the bone of the fossa is lost
removing the bone from the top of the hole around the root with a bur so that you can dislocate the root outward with a long elevator-stroker or use narrow long forceps (bayonet) to fix and remove it
use a bur to expose the entire length of the tooth root on one side, then remove it using a scaling hook or an excavator
push the apex of the tooth root out of the hole with any straight instrument, for example a straight elevator, which is inserted through an incision in the mucous membrane and the outer wall of the tooth alveolus perforated with a bur in the area of the root apex
After visualizing the root canal, a cone-shaped screw with a strong thread and a handle is tightly inserted into it, the screw is securely fixed in the canal, the screw is gradually turned by hand several times in the direction of tightening the thread and the screw is pulled out. After such combined movements, the root is freed from the hole and removed (if the intraradicular screw does not enter the root canal, it is carefully expanded)
after inserting a screw into the root canal, a special device is used to create mechanical traction to remove the tooth root
expansion of the tooth fossa without exposing it - use a hand-held cylindrical cutter of the required diameter with a ratchet, round with the diameter of the root, to remove bone around the root along its length, followed by removal of the tooth root
separation of the tooth with a bur (or chisel) in the zone of root connection into separate parts of the tooth and root, followed by alternate removal of roots and tooth fragments alone

Scheme of the operation of complex tooth extraction - separation of the roots of the teeth with a bur and their alternate removal with an elevator: a - d - stages of the operation

They also use other surgical techniques and their combinations, instruments for complex removal of teeth and their roots, taking into account specific clinical conditions. After the operation, the tooth socket is treated in a typical manner. Only after the failure of a complex tooth extraction operation do they proceed to an atypical tooth extraction operation.

The operation of atypical tooth extraction consists of opening the bone of the alveolar process of the jaw in the area of the tooth, removing 1-2 sides of the root of the tooth or the bone of the tooth socket, exposing the tooth and removing it. This operation is quite complex and traumatic.

Indications

Fracture of the tooth root and the inability to remove it typically with forceps due to the small size of the root that remains, fragility of the root after endodontic treatment or hypercementosis, significant curvature and atypical structure of the roots of the tooth, dystonia and inclusion of teeth when their typical removal is impossible, insufficient mouth opening due to various reasons. Sometimes the need to perform an atypical extraction is due to a lack of tools, equipment, or an insufficient level of qualifications of the doctor, who does not sufficiently master the technique of typical and complex tooth extraction.

Contraindications to atypical tooth extraction surgery

There are generally accepted contraindications, to which we can add the doctor’s uncertainty regarding his ability to carry out such an operation, the patient’s insurmountable reluctance to continue the removal, who is already tired of the operation, insufficient organizational capabilities of the surgical room (shortage of tools, equipment, etc.), a difficult clinical situation, and inability to perform the operation on an outpatient basis. It should be emphasized that in the case of a difficult clinical situation, the doctor should not continuously continue the operation fruitlessly, trying to typically remove a tooth and only further injuring nearby tissues. It is necessary to move in a timely manner to other surgical instruments and surgical techniques that are more effective and appropriate in new specific clinical conditions.

Incisional options for atypical tooth root removal

For atypical tooth extraction, the following instruments are used: scalpel, raspatory, hemostatic clamps, needle holders, dental mirrors, bone burs and cutters of various types and sizes, straight and angled dental handpieces, needles, suture material (), Farabeuf hooks, chisel and hammer, bone nippers, hemostatic sponges (), syringes for washing the wound and other instruments. However, a hammer and chisel can only be used as a last resort, since this negatively affects the state of the brain, the general somatic and psychological state of the patient, and leaves him with unpleasant memories of the operation if it is carried out while the patient remains conscious. An atypical tooth extraction operation usually involves the following steps:

dissection of the mucous membrane and periosteum
detachment of the mucoperiosteal flap
removal of the necessary (usually the outer) walls of the alveoli and exposure of the tooth root
dislocation (root) of a tooth from its socket
tooth root removal
revision and treatment of the alveoli
mobilization of the mucoperiosteal flap
closing the surgical wound by placing a mucoperiosteal flap in place and suturing the surgical wound. If necessary, additional fragmentation of the tooth or its roots is carried out during the operation.

Stages of atypical tooth extraction surgery. 1, 2 – dissection and detachment of the flap; 3, 4 – removal of the outer wall of the fossa; 5, 6, 7, 8 – separation and removal of tooth roots; 9 – sewn wound (according to V. A. Evdokimov)

This operation is complex and must be performed by highly qualified doctors with the help of an assistant in appropriate clinical conditions. The patient's position is lying or half-sitting in a chair, in good lighting. The operation requires high-quality pain relief, the availability of all necessary instruments, and often premedication, medication and postmedication.

If a tooth (root) penetrates into the maxillary sinus (upper molars and premolars) or into the soft jaw tissue (the lower wisdom tooth and lower molars are most often displaced into the pterygomandibular space), they must be removed as quickly as possible (to prevent the development of neck phlegmon , pterygomandibular space, acute or aggravated sinusitis) in a hospital setting. These operations are complex, can take a long time and lead to serious complications. Preparing a patient for a planned operation of atypical tooth extraction should be consistent and, first of all, include complete therapeutic sanitation of the oral cavity: removal of dental plaque, filling of carious cavities, treatment of acute periodontal diseases and mucous membranes. Immediately before the operation, rinse the mouth with antiseptic solutions.

From the point of view of general and local preparation, it is usually typical, with the exception of cases of removal of impacted and semi-impacted teeth, when it is necessary to foresee in advance all possible features of the operation, warn and psychologically prepare the patient, premedicate him, and also prepare all the necessary tools and equipment, prepare in advance the necessary orthopedic devices (mouth guards, bite plates, etc.). In the postoperative period, the patient is prescribed anti-inflammatory, painkillers and restorative medications to prevent inflammatory complications (especially if a tooth is removed in a functionally active place - a wisdom tooth), and the patient is monitored until the wound is completely healed.

The wound can heal by primary intention, and then the alveolus of the tooth and the bone defect around it become a closed space. Sometimes suppuration of the wound and separation of its edges are noted, and then healing occurs by secondary intention. Complications of the operation: inflammatory (myositis, suppuration of the surgical wound, lymphadenitis, etc.), neurological (neuritis of the mandibular nerve, dental plexus, nerve sensitivity disorders), anatomical disorders (formation of defects in the alveolar process of the jaws, penetration of the maxillary sinus or nasal cavity, prolonged pain, etc).

Dental forceps have been and remain tools for removing teeth. For certain groups of teeth, a different type of forceps is used, since our teeth have different structures and are located differently in the dentition. For example, to remove the upper anterior tooth and the maxillary canine, there are straight forceps, and the remaining upper teeth are removed using S-shaped ones. The incisors of the lower jaw are pulled out using forceps curved at 90º with narrow cheeks (the part of the forceps that grasps the crown or root of the tooth being removed). The fangs and the two teeth following them are pulled with forceps, on the contrary, with wide cheeks. To remove large molars of the lower jaw, forceps with spikes that go between the roots are used.

What is the typical tooth extraction process like?

When teeth are removed, local anesthesia is first administered. The doctor then removes about half a centimeter of gum tissue from the tooth. Then forceps are applied to the crown of the tooth being removed. When removing teeth in the upper jaw, the doctor presses on the forceps with his entire right hand. When removing teeth on the lower jaw, pressure is applied with the thumb of the right hand. The tooth is then dislocated to destroy the tissue that holds it in place. To remove single-rooted teeth, such as front teeth, rotational or pendulum-like movements are performed. When removing molars, pendulum-like movements are performed. The culmination of this action is the tooth extracted from the hole.

How is a complex tooth extraction performed?

Complex wisdom tooth extraction is considered to be a case when the tooth cannot be removed with the simple application of forceps. As a rule, in such situations, access to the root of the tooth being removed is first created by cutting the mucous membrane and periosteum. Complex tooth extraction with an oblique or horizontal position is carried out in parts, for which a laser or a special saw is often used. You should not be afraid of this, since cutting a hard-to-reach tooth only shortens the time of its removal. After the procedure, the doctor smoothes the sharp edges of the bone wound, washes it with hydrogen peroxide or furatsilin, the mucoperiosteal flap is placed in place and fixed with sutures.

In complex cases, tooth extraction surgery does not have a uniform technique. How the doctor will act depends on the specific case.

When is complex tooth extraction indicated?

Tooth extraction is considered difficult due to tumor or edema, periodontitis, periodontitis, abscess and gumboil. The presence of a cyst and a fistulous tract in the tooth also complicates the removal procedure. Impacted (unerupted) teeth are also indications for surgical tooth extraction. Difficult cases include removal of a dystopic wisdom tooth standing outside the dentition; removal of 4 teeth to correct malocclusion; removal of baby teeth in children at an early age. Severe curvature of the roots and fracture of the apical part of the root are also indications for surgery. Please note that complex tooth extraction is not performed during pregnancy.

The method in which your tooth will be removed depends on the individual case. Only a specialist can determine the removal strategy. In any case, you should not be afraid of this procedure. A competent doctor will perform the removal correctly, and all you have to do is say “thank you”

How can you undergo a tooth extraction procedure with minimal losses to your health, nerves and wallet;
Why do teeth sometimes have to be removed and what indications does a dental surgeon use when making an appropriate verdict?
In what situations is it better to wait a little while removing a tooth or not even remove it at all?
What are the stages of the procedure and what awaits you in the dentist’s office;
Is it possible today to remove teeth without scary forceps, without pain and with minimal trauma;
How difficult and time-consuming can be the removal of problematic teeth - impacted, semi-impacted, resorcinol-formalin and even ordinary molars, but with specific roots;
How can a patient help the attending physician so that tooth extraction goes without problems;
What to do if you need to urgently remove a tooth at night, on weekends or holidays;
Is it possible to remove teeth for free in hospitals today and what is often hidden behind the cheapness of the service...

Tooth extraction (extraction) is considered a dental operation and involves surgery. In other words, when you go to remove a tooth, you are going for a surgical operation, and therefore you should treat this procedure with full responsibility.

Next, we will look at many nuances that will help an ordinary unprepared person go through this test with minimal losses to their nerves, wallet and their health (the patient’s mistakes and negligence can lead to very serious consequences).

On a note

Situations are different: sometimes a tooth has to be removed urgently, sometimes it is planned, but in both cases the question immediately arises: which dentist is more advisable to contact? Which doctor can remove a tooth as competently and painlessly as possible?

Someone may immediately say without hesitation that they need to see a dental surgeon. This, on the one hand, is the correct answer, but in practice everything may not be so simple. The fact is that in clinics, hospitals and even in private dentistry there is often a situation where one dentist works on a mixed appointment. That is, he treats (preserves) teeth that can still be saved, and also removes “bad” teeth, carries out professional teeth cleaning, and in addition, the same doctor also deals with prosthetics for missing teeth. In total, we get 2-3 or more specialties “in one bottle”. Is it worth contacting such a specialist?

Of course, everything depends on the doctor’s professionalism and experience, but in practice, most dentists focus on one area of work, having significantly less experience in other areas. For example, there are dentists on mixed appointments who spend a lot of time treating teeth, but the removal is not very high quality. A lot here depends on the complexity of the work ahead. But after an hour and a half of torment, during which the doctor cuts, drills and even chisels with instruments, it is unlikely that any of the patients would like to hear that, they say, the tooth is too complex and cannot be removed (this also happens).

That is why it is best to remove a tooth from a dental surgeon who specializes only in this manipulation in its various forms.

In addition, there are also maxillofacial surgeons - relatively speaking, they are even higher in level than dental surgeons. These specialists are not limited in their work only to “pulling out” teeth (even the most complex ones), but can also help with injuries to the maxillofacial area, dangerous complications of periodontitis (periostitis, osteomyelitis, abscess, phlegmon, lymphadenitis), congenital and acquired deformities, diseases TMJ, tumor processes, etc.

For example, if there are significant problems with opening the mouth, when it is necessary to remove a wisdom tooth due to widespread swelling of the face and neck, a dislocation of the jaw or a fracture, it is worth turning to maxillofacial surgery.

Why do teeth sometimes have to be removed?

Before removing a tooth, the dentist determines the indications for this in advance, that is, weighs the pros and cons. There are clinical situations when a tooth can be considered controversial - this means that the dentist, even taking into account the available indications, cannot unambiguously say whether it is worth the risk of preserving it, or whether to remove it out of harm’s way.

It is also not uncommon for one clinic to offer to immediately pull out a diseased tooth, while another one undertakes to save it.

On a note

Sometimes, in order to recognize a tooth as subject to removal, a council of dentists of different profiles gathers: a therapist, a surgeon, an orthopedist, an orthodontist, and a periodontist.

How can we explain such uncertainty in dental practice?

In life, as you know, everything is not as simple as it may look in books and textbooks. The indications and contraindications for tooth extraction that exist today were developed back in Soviet times by reputable scientists, and most of them have been adopted into modern protocols that guide dental surgeons in their practice. However, they may not always be suitable for a specific clinical situation, and there are a number of reasons for this:

Improvements in equipment, instruments and dental treatment methods increase the chances of saving teeth, sometimes contrary to existing protocols;
At the same time, thanks to the latest diagnostic methods and modern approaches in dentistry, a dentist alone or collectively can decide to remove a tooth, even if there are indications for its preservation.

Below are examples of the main indications for tooth extraction:

Failure of endodontic treatment in the area of the periapical inflammatory focus (in other words, when a cavity with pus has formed on the root of the tooth, and treatment procedures do not have an effect);
Emergency cases - diseased teeth, which are the source of an active microbial process, cannot be treated and provoke diseases such as periostitis, osteomyelitis, abscess, phlegmon, lymphadenitis, sepsis, etc.;
Technical difficulties associated with curved or difficult-to-pass canals, leading to the impossibility of conservative treatment, as well as perforation of the tooth cavity or root wall;
An arrangement of teeth that results in permanent injury to the mucous membrane of the mouth or tongue;
Tooth mobility of the third degree and its protrusion due to bone resorption during periodontitis or periodontitis;
Location in the fracture line (teeth that interfere with the reposition of fragments and are not subject to conservative treatment);
Complete destruction of the tooth crown when it is impossible to use the root for orthopedic purposes;
Supernumerary teeth that interfere with prosthetics or cause injury to soft tissues, disrupting aesthetics and chewing;
Protruded teeth due to the loss of an antagonist, as well as those that interfere with the creation of a functional prosthesis;
In case of malocclusion, even teeth not affected by caries can be removed for orthodontic indications;
Some types of root fractures resulting from mechanical trauma.

Wisdom teeth are a separate category, which a number of dentists recommend removing urgently, while other doctors suggest trying to preserve them, even at some risk of developing complications.

On a note

There are situations when orthodontic treatment (for example, with braces) cannot be started without removing wisdom teeth, even if they have fully erupted and do not interfere with the bite.

The same ambiguous situations often arise in relation to the preservation of teeth, for example, when it is impossible to pass through root canals, perforation of the wall or breakage of an instrument in the canal. One clinic may recommend the removal of such a tooth, and formally this falls within the indications, while another dentistry may offer to save the tooth using the latest technologies (for example, a microscope plus removal of instrument fragments from the canal using ultrasound).

In other words, when removing teeth, an individual approach, common sense and medical logic, combined with the experience and professionalism of the doctor, are very important. And not the simple old-fashioned method of cutting from the shoulder, which took place in Soviet times not because of a good life: the tooth is badly damaged - under the forceps, the third channel is not located - under the forceps, a slight swelling has appeared in the area of the transitional fold in the projection of the tooth root - also urgent “rip it out” without waiting for periostitis.

Such antediluvian tactics (which, unfortunately, are still sometimes found in some clinics by those tired of the flow of patients and low salaries of doctors) are currently unacceptable and are fraught with negative consequences for patients.

Situations when you can wait a little to remove a tooth or not remove it at all

Despite the variety of options noted above that involve tooth extraction, there are also many situations when it is better not to remove a problematic tooth or to postpone it.

The most common situation is related to pediatric dentistry, when parents of children with carious lesions on a baby (temporary) tooth urgently demand that the tooth be pulled out, accompanied by something like this phrase: “It will fall out anyway - why treat?”

This logic is too straightforward and does not take into account the fact that the change of teeth should normally occur at the appropriate age: symmetrical groups of teeth gradually become mobile and in many cases fall out on their own. If a tooth is removed prematurely (even a year earlier), then there is a high risk of malocclusion and the development of anomalies in the eruption of permanent teeth.

In other words, with early removal of baby teeth (especially multiple ones), future permanent teeth can literally “move apart” in different directions, or even not erupt in a single or group form. No sane parent needs such a prospect, so it is better now to save the child from surgical intervention by curing caries or its complications, rather than later investing energy and money in correcting the bite and the child’s psyche.

On a note

Meanwhile, there are clinical situations where acute conditions that threaten the health and life of the baby require immediate removal of a temporary tooth. Or when the tooth can no longer be saved even with modern treatment methods.

Regarding the impossibility of a child’s cooperation with a doctor at the stage of dental procedures: there is not only treatment and removal of teeth under anesthesia, but also various forms of superficial sedation and premedication, which allow the procedure to be carried out as comfortably as possible and minimize the possibility of the child developing a fear of a white coat in the future.

Cases when a person wants to pull out an innocent tooth occur quite often in adult dentistry, especially among men and women over 45-50 years of age. This is largely due to old memories of the remnants of Soviet dentistry, when a tooth, at any opportunity (even with caries), was sent under forceps. Until now, such categories of citizens often receive appointments, especially in budget (free) dentistry with requests or even demands to remove a tooth due to caries or pulpitis.

For example, a tooth began to ache from cold, hot, sweet food, or night pain of aching nature has just begun, and the patient is already negative about dental treatment. The motives can be different: from “love for pulling teeth” (quickly, inexpensively and there is no scary drill with its sound) to 100% confidence that after treatment the tooth will still have to be removed (the negative experience of past decades, when teeth were treated for a long time, but in the end I still had to apply for removal).

So, what is important to keep in mind: modern dentistry has long crossed out these prejudices. Now, not only with caries (even deep) and pulpitis, but also with most periodontitis, teeth are treated wonderfully, and there is no need to rush to remove them. And even if the tooth seems to have broken at the root, it is not a fact that the root will need to be removed, since it is quite possible to restore the functionality and aesthetics of the tooth with the help of a root tab and crown.

Stages of tooth extraction: how it all happens in most cases

After the decision is made to remove the tooth in accordance with the indications, the stage of preparation for the procedure begins.

The photo below shows an example of a broken front tooth that needs to be removed:

The nature of the preparation depends on the characteristics of the future manipulation (with or without anesthesia, with or without premedication), but the most basic stages include:

Taking anamnesis (especially allergic status);
Psychological preparation of the patient (many are afraid, so it is important for the doctor to reassure the patient and set him in a positive mood);
Medicinal preparation of the surgical field (rinsing the mouth with antiseptics, treating the injection site).

On a note

It is recommended to make an appointment for tooth extraction in the morning, when you and the doctor are still full of energy. If anesthesia or sedation is not planned, then it is better to eat well before the procedure - this will give you more strength and the blood will clot better.

If it is possible to remove a tooth using forceps, then the removal is called simple, and it is carried out in several stages:

In some cases, stitches may be required.

To make tooth extraction pain-free, both domestic anesthetics (for example, Lidocaine) and imported ones (articaine-type drugs) can be used. “Articaines” are recognized as the most effective today, but the correct anesthesia technique is also very important - a lot depends on the level of professionalism and experience of the doctor.

Today in dentistry there are different options for pain relief when removing a diseased tooth. During conduction anesthesia, a group of teeth is “frozen”. A good example is the torus or mandibular technique: when implemented, the patient does not feel the lip, tip of the tongue and cheek on the corresponding side.

Infiltration anesthesia is done in the projection of the tooth root onto the gum: in this case, freezing occurs only in the extraction zone: almost always this is sufficient for all upper teeth, as well as lower ones - from the first to the fifth. For the 6th, 7th and 8th lower teeth, infiltration anesthesia will not be enough, so torusal anesthesia is done. If this guide technique is not done or done poorly, then it can be very painful during the removal of the lower large molars.

Among modern methods, intraligamentary anesthesia (intraligamentous) can also be noted. It is done with a special syringe and has a lot of advantages (it does not cause facial numbness, it comes on quickly, it lasts for 20 minutes, which is enough for most outpatient removals).

For complex removals, anesthesia is sometimes used. A characteristic difference between a complex tooth extraction and a simple one, in addition to the time it takes, is the use of a drill (for sawing the tooth into pieces, sawing out the bone), screws, ligatures and some other specific tools (sometimes the tooth is literally split into pieces using a chisel and hammer).

The photograph below shows an example of a tooth cut into three parts using a drill before removal:

On a note

A dental surgeon cannot always accurately determine in advance whether tooth extraction will be difficult or simple. In many cases, the doctor can only roughly guess which tooth can cause problems, and which one will almost “jump” out of the socket during extraction.

Sometimes a specialist immediately sees a potentially complex tooth (resorcinol-formalin, semi-retained, impacted, with specific roots) and warns the patient in advance that the procedure will not be easy and quick.

“The day before yesterday I had my lower wisdom tooth removed. It was a real nightmare... They spent more than an hour sawing the tooth, hammering it with a hammer, breaking out the roots, and almost broke the jaw. They cut the bone and turned everything completely around. The worst feeling was when the doctor tried to break out a tooth several times, I thought that he would dislocate or break my jaw. All four roots of the tooth stuck out in different directions, so it was difficult to remove. Now half my face is swollen, the pain is terrible, I can’t swallow or open my mouth normally. The doctor said he hasn’t seen anything like this for a long time...”

Natalya, Moscow

Option for tooth extraction without “scary” forceps: ultrasonic technology

In order to minimize tissue trauma during tooth extraction, and therefore speed up and make the subsequent healing process more favorable, there is a so-called atraumatic method of tooth extraction. Such removal could be classified as complex, but the use of additional means (drill, periotome, etc.) in this context, on the contrary, simplifies the procedure, reduces its time and makes it minimally traumatic.

Suppose a patient has a severely damaged upper sixth tooth (at the level of the gum or even under the gum), but the roots do not exist independently, but are connected into one whole. Using a drill, the crown part of the tooth in the middle is carefully cut out: in this case, each root becomes independent. Periotome allows you to quickly and accurately remove them without damaging the septa, walls of the alveoli, and the gingival margin.

The photos below demonstrate the individual stages of the atraumatic method of removing three teeth at once with preliminary cutting:

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If only forceps were used in this case, then the cheeks of the forceps would have to be moved deep under the gum in order to “loose” and “dislocate” the fused roots. In 50% of cases this will work, but with varying degrees of breakage of the outer and inner walls holding the root. After such root removal, uneven or sharp bone tissue remains, creating new problems for both the doctor and the patient.

Often, with the help of forceps, it is not possible to remove complex teeth at all, and the result is only a waste of time and useless “biting” of both the alveoli and the roots with forceps.

Atraumatic tooth extraction can also be accompanied by the use of ultrasound. It is this technique that modern clinics are currently actively using as “know-how”. The piezosurgical device allows, using an ultrasonic scalpel, to bloodlessly separate the periodontal ligaments that hold the tooth and remove it from the socket.

The main advantages achieved by tooth extraction using ultrasound:

Bloodlessness;
Speeding up work;
Antiseptic effect;
No overheating;
Help in removing complex teeth (impacted, semi-impacted, dystopic, resorcinol-formalin).

This type of atraumatic tooth extraction is ideal for subsequent immediate implantation, when the implant is installed immediately in a fresh hole.

Features of the removal of potentially problematic teeth (impacted, semi-impacted and resorcinol-formalin) – should you be afraid?

To remove impacted and semi-impacted teeth (that is, unerupted or only partially erupted and largely hidden in the jaw bone), as well as resorcinol-formalin teeth (that is, previously treated with resorcinol-formalin paste and which have become fragile as a result), the doctor can use both anesthesia, if there are indications for it, and local anesthesia.

Most often, these teeth are removed under local anesthesia.

The picture below shows an impacted wisdom tooth:

From the practice of a dentist

Some budget dentists (especially in small towns and villages) who work on mixed appointments (therapy plus surgery) are afraid to remove teeth from this category. Seeing a semi-impacted or, even more so, impacted tooth (from an image), they can immediately refuse removal and send the patient to maxillofacial surgery at the nearest regional clinic or dental center. The motivation for this may be either a reluctance to tinker with these teeth (the procedure may require 1-2 hours of painstaking work), or the fear that the lack of experience and tools will not allow removing all the roots - which means that the exhausted patient will still have to be referred to another to a more qualified dentist in this matter.

Stages of complex tooth extraction:

Preliminary preparation (premedication, treatment of the surgical field, etc.)
Conducting anesthesia (general or local);
Creating access to the tooth to be removed;
Instrumental technology to improve conditions for “dislocation” of tooth roots;
Root extraction;
Hemostasis;
Preservation of the socket for preparation for implantation (according to indications);
Suturing (as appropriate);
Purpose of recommendations.

Creating or improving access to a tooth involves the use of elevators, a periotome, smoothers, a drill with a set of burs and cutters, and also (rarely) a chisel and a hammer. After access to the tooth to be removed is partially created (gum retraction, flap detachment), the tooth is removed using an elevator, and if this is impossible (as with impacted ones, for example), then the alveolar bone is cut out with cutters in the projection of the tooth location. At the same time, cooling is applied to the prepared area, since the bone tissue should not overheat, otherwise necrosis will develop.

When the tooth to be removed becomes visible, the surgeon can immediately begin to use elevators to “pick up” it. Often, to make the work easier, the tooth can be sawed (or split) into pieces.

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How long can such a complex removal take? Depending on the complexity of the procedure, the availability of necessary instruments and the experience of the doctor, the procedure can take from 10 minutes to 2 hours.

After extracting the diseased tooth and removing the granuloma or cyst (if any) from the socket, sutures are applied and recommendations are given. In some situations, the socket is preserved before subsequent implantation to avoid atrophy of the bone walls. For this, natural bone substitutes or synthetic ones (inorganic bone matrix) are used.

After a complex tooth extraction, the doctor must prescribe home treatment to ensure the most comfortable postoperative period and prevent alveolitis, which may include medications of various types:

Painkillers (Ketorol, Ketanov, Nise, etc.) to relieve pain in the first days after surgery;
Antibiotics and sulfa drugs (to eliminate bacterial infections in the maxillofacial area);
Antihistamines (to reduce swelling and other manifestations of the inflammatory reaction);
Preparations for rinsing and treating the removal area (gels, ointments) with anti-inflammatory, wound healing, analgesic, antiseptic and antibacterial effects.

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Generally speaking, the list of recommendations that exists in the arsenal of Russian dentists is huge, and each dentist adheres to his own list of necessary postoperative treatment. Some people prescribe the same thing to each patient, while others have an individual approach (which is the most correct).

But it should be borne in mind that some dentists may not say anything to the patient at all, even as parting words or advice. If you had a tooth removed and were not given recommendations, be sure to ask for them, or find out from another doctor, as this helps to avoid unnecessary anxiety and very unpleasant complications.

How to help your doctor so that tooth extraction goes without problems

Despite the fact that in dentistry anesthesia is used before tooth extraction, there is always a risk that the procedure may not go as smoothly and painlessly as we would like. This is often due to the fact that the patient is not ready for the procedure and does not behave quite correctly.

Let's see how to prepare for tooth extraction, so that at least on our part we can help a good doctor carry out the manipulation without any problems.

Firstly, surgical intervention on a “neglected” tooth, when the stage of the acute process has reached its apogee (you can’t even touch the root because of the pain, “flux” has appeared) is tolerated in many cases much worse than the planned removal of a “calm” tooth. Moreover, in this context, it does not matter which tooth will have to be removed: a molar (six, seven, eight) or some front tooth will need to be removed.

It is not difficult to imagine what unforgettable emotions a patient (as well as a doctor) can experience when they have to remove a diseased tooth or its remains against the background of periostitis and other purulent complications, when anesthesia has almost no effect, and any touch to the tooth causes hellish pain. But the tooth needs to be loosened! At the same time, there is still a risk that the rotted crown part may break off, and you will have to “pick out” the roots separately...

This is interesting

Often anesthesia is given in the projection of the tooth root, when there is pus everywhere under the gum in this area. At the same time, the “sufferer” demands from the dental surgeon that everything be absolutely painless: “Give a strong injection, doctor, as long as it doesn’t hurt!” However, it is immediately clear that where the pus is located, a priori they are “not happy” with the new solution: there is nowhere to put the existing exudate.

A bad doctor, as a punishment for such a patient who took too long to get to the doctor’s office, will simply inject the entire portion of the anesthetic at one time, and in terms of the severity of sensations, the procedure will be similar to tooth extraction without anesthesia, when there are “sparks from the eyes” from pain. A normal surgeon will gradually inject the gum with an anesthetic in 2-4 stages, release milliliters of purulent fluid to eliminate pain during drug administration and try to achieve stable anesthesia for painless tooth extraction.

So the patient’s excessive patience before going to the doctor can create a lot of problems. Therefore, if it is known for sure that a badly damaged tooth needs to be removed, then it is better to get rid of it as planned: make an appointment and, in the absence of contraindications, end the problem once and for all before the tooth gets sick.

For tooth extraction, the ideal option would be to make an appointment in the morning:

There are several more practical tips that help the patient safely undergo the tooth extraction procedure:

Before tooth extraction, you should eat well (unless anesthesia or sedation is planned). A well-fed person copes better with stress, faints much less often, and the blood clots better, which is important after the procedure;
You should not take alcohol for courage. The risk of swelling and prolonged bleeding in drunk people is increased, not to mention inappropriate behavior;
In case of great fear of the procedure or fear, you can resort to sedatives (Tenoten, tincture of valerian, motherwort, Corvalol, etc.) 20-60 minutes before surgery, depending on the activity of the drug. In this case, the choice of drug must be coordinated with the attending physician or local therapist and have an idea of the measure (especially regarding alcohol tinctures, since their use can smoothly lead to alcohol intoxication);
It helps to have a positive attitude. If you are initially committed to a successful outcome of the procedure, then the removal almost always goes well, and the healing time is as short as possible. The more a person tells himself that nothing will work out and the more he stresses himself out, the more anxiety he causes himself and the doctor, sometimes simply out of anxiety, taking the wrong actions (using unnecessary ointments, rinses, dangerous folk remedies, etc.) ;
When planning complex operations (removal of a difficult impacted tooth, all wisdom teeth at once, etc.), it is recommended to consult with your doctor about starting to take anti-inflammatory, painkillers and even antibiotics before the intervention.

If a tooth is declared unusable, then in emergency cases it is removed urgently. But there are situations when the patient is going to have a tooth removed as planned - in these cases it sometimes makes sense to postpone the procedure.

ARVI and acute respiratory infections in the active period;
Painful and heavy periods;
Cardiovascular diseases, when their treatment is accompanied by the use of certain drugs (for example, anticoagulants - Warfarin, Xarelto, etc.);
Pregnancy (at some stages - an exclusively individual approach);
Acute diseases (acute appendicitis, acute pancreatitis, etc.).

It is not difficult to guess that after many of the listed conditions disappear, you can safely consult a doctor about a planned tooth extraction.

What to do if you need to urgently remove a tooth at night, on weekends or holidays?

You can often observe panic among residents of large cities and megalopolises when a badly damaged tooth suddenly begins to hurt on holidays or holidays. That is, emergency surgical care is required, but the person is squeezed within four walls and does not know where to go for tooth extraction and what, in general, to do.

Meanwhile, it doesn’t matter what day it is (Sunday, March 8, New Year or another holiday), since in cities there is round-the-clock emergency dental care with a duty schedule for dental surgeons. It is enough to contact a regional dental clinic or a regional hospital with a department of maxillofacial surgery.

But not only in large cities there is an “emergency room” in dentistry. Even in the regional center at night, on weekends and holidays, you can, as patients say, “pull” your teeth after calling the post in advance. Usually it looks like this: you call an ambulance or a paramedic station and find out the possibility of urgent tooth extraction. The specialist contacts the dentist on duty, and he arrives at the office within an hour to help you (if on holidays the dentist holds appointments as scheduled until a certain time, then most often he has to be called at night).

As for the private sector, things are much simpler here. There are dentists that provide appointments 24 hours a day. Doctors in such clinics work 3-4 shifts and are ready to remove a tooth at any time when needed.

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The night shift is popular not only among people who are caught off guard by pain, but also among parents of children with toothache who work late at work. In addition, many people involved in business have free time only after 22:00, and some even after 00:00.

Is it possible to remove teeth for free in hospitals today?

But what about those people who do not have the money to have their teeth removed in a private clinic? Moreover, the price for such services today varies, depending on the region and complexity of the procedure, from 500 rubles. up to 20,000 rub.

Someone might even be surprised by such a high price - pulling teeth for 20 thousand rubles for one pulled out tooth? Isn't it too expensive?!

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The fact is that 20 thousand rubles is also not the maximum for tooth extraction, since there are complex clinical cases that require increased costs of time and materials.

Typically, an additional markup is made for the following types of removal (formulations from clinic price lists are given below):

“Atypical tooth extraction” (that is, complex);

“Laser” (using a laser scalpel);

“Using ultrasound”;

"Without forceps";

“In a dream” (anesthesia or superficial sedation).

The list goes on and on. Moreover, for example, by atypical removal in clinics they often mean not only complex tooth extractions, but also the removal of any wisdom tooth in general, even if the removal is simple. This is most often done for commercial purposes, since a kind of instilling fear in patients about wisdom teeth makes it possible to set an increased price in the price list for getting rid of them.

So is it still possible to remove a tooth cheaply?

Firstly, given the great competition, private dentistry sets different prices for the same service, and the price can be very affordable, regardless of what kind of tooth it is: a canine (or, as patients often call it, an “eye tooth”) , wisdom tooth or any other chewing tooth. It happens that in one clinic you can remove a wisdom tooth for 1000 rubles, and in another they will offer a price of 5000 rubles.

In both cases, removal is paid, and the main question that the patient faces is whether he can trust a more budget-friendly option?

Based on the recommendations and reviews of relatives, friends and colleagues, you can almost always find a professional doctor who removes teeth well. Whose office wall may not be hung with dozens of certificates and diplomas, but who knows his business well and is attentive to the patient. There are small private offices where they can remove a tooth for 500 rubles painlessly and efficiently without being charged for coffee, magazines, leather chairs and other surroundings.

Another thing is that you need to go to such a specialist on the recommendation of trusted people, and not just go to remove a tooth at the first clinic you come across, where they will offer the lowest cost of the service.

Is it possible to remove a tooth efficiently, but for free?

Free cheese (especially in dentistry) can only be in a mousetrap - perhaps this is the first thing that comes to mind in such a matter. However, every year hundreds of thousands of citizens receive free surgical care under a regular compulsory medical insurance policy.

The principle is as follows: a person who is attached to this institution goes to a hospital or clinic at his place of residence to have a tooth removed. They give him a coupon to see the dentist, and using this coupon he removes one or more decayed teeth for free. If there is no attachment, and the coupon does not go through the computer, then, of course, you can also remove the tooth, but for a fee.

If a dentist cannot perform an extraction (for example, we are talking about an impacted or resorcinol-formaldehyde tooth, or there is generalized edema that is life-threatening, pediatric specialization is required, etc.), then the patient has the right to receive a referral for free help, where the medical institution, the referral diagnosis according to ICD-10 and the need for one or another manipulation will be indicated.

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There is also a list of free drugs that a dentist under the compulsory medical insurance policy can provide to the patient at the stage of providing care. This is especially true for anesthesia.

Not all hospitals (especially in villages, settlements, and small towns) are regularly and fully allocated the necessary materials. Most often, they are supplied with domestic drugs for anesthesia (Lidocaine, for example), although today, according to compulsory medical insurance, there are even articaine anesthetics on the list, which, however, practically do not reach the recipient. In order to work as comfortably as possible and be able to provide high-quality anesthesia to the patient without risking his health, dentists are forced to extract a tooth for a fee, where a person pays money for a “good injection.” Of course, this is cheap compared to a private clinic, and costs about 100-400 rubles, depending on the region.

But this does not mean at all that free tooth extraction “under lidocaine” will necessarily be painful. Free removal in many budget institutions can mean increased risks, ranging from the fact that the anesthetic injection will be done in a hurry and will not work as expected, and ending with a long queue of the same sufferers in the corridor with the likelihood of being punished by a tired surgeon for any an inaccurately spoken word with a three-story obscenity to the ears.

So here everyone chooses where to go for tooth extraction and how much he is willing to pay for this service. In conclusion, we can only note that having decided on a budget, you should look not for a clinic, but first of all for a good doctor - this will be the guarantee that tooth extraction will most likely be virtually painless and without unnecessary problems.

Be healthy!

An interesting video with an example of atraumatic tooth extraction using ultrasound

What to do after tooth extraction to avoid complications

The reasons for tooth extraction can be different, depending on the circumstances in the form of the patient’s condition and the characteristics of the ongoing pathological processes in the crown or roots. The procedure is a last resort measure used in the absence of the possibility of prosthetics with an artificial crown or inlay.

Tooth extraction can be carried out for two reasons: urgently due to an inflammatory process in the acute phase occurring inside the cavity or in neighboring tissues, or planned, according to. These factors include significant destruction of the crown, excluding the possibility of prosthetics on the remaining roots, as well as long-term therapeutic treatment of chronic inflammation, which did not bring results.

An additional reason is the complication of the inflammatory process in the form of infection of the maxillary sinuses and other anatomically adjacent areas.

Important! A separate category includes the removal of supernumerary or unerupted teeth, such as a wisdom tooth or an incorrectly growing canine, which injures the periodontium or tongue.

The complexity, duration and cost of tooth extraction depends on its type:

lactic;
permanent (simple or complex multi-root);
retinated;
dystopic;
fragmented;
cranky.

Before instrumentally removing a tooth from the socket, it is necessary to collect an anamnesis and a series of studies.

Before instrumentally removing a tooth from the socket, it is necessary to collect an anamnesis and a series of studies aimed at analyzing the general condition of the entire dental system, blood clotting and reaction to standard anesthetics. In order for gum healing after tooth extraction to be successful, you must also resort to radiography and orthopantomography, which will provide information about the condition and structure of the tooth being removed, including the location and shape of its roots.

The entire procedure should be as painless and comfortable as possible for the patient with, which will be facilitated by the use of infiltration or conduction type anesthesia. In the first case, the anesthetic is injected into the gingival tissue near the tooth socket or in the area of the periosteum, and in the second, the entire branch of the trigeminal nerve, which is responsible for the sensitivity of this half of the jaw, is anesthetized.

Indications for the procedure

A general indication for removing a crown with roots from the alveolus is the lack of possibility or practical sense in carrying out conservative treatment to preserve it. The operation may be emergency if purulent inflammation has affected adjacent parts of the jaws, causing periostitis, or if significant destruction of the crown has occurred as a result of mechanical trauma.

Indications for planned removal are extensive loss of coronal tissue as a result of deep caries, as well as root canals that cannot be passed (if it is impossible to use necrotizing pastes). The situation can be complicated by the following pathologies:

perihilar periodontitis;
sinusitis;
neuralgia;
jaw oncology.

The indication for elective removal is extensive loss of coronal tissue as a result of deep caries.
Note! In severe surgical cases, a general fracture of the alveolar process or the entire jaw may provoke the need for removal if the crowns in this area complicate bone grafting or may cause a secondary infection.

How the gum heals after tooth extraction depends on its location: an extracted wisdom tooth (third molar), growing atypically from the alveolus, requires a longer recovery period. Also difficult for the dentist are supernumerary or any other teeth that cannot erupt due to adjacent crowns or gum tissue. In this case, the decision is dictated by the fact that such molars prevent the patient from eating and articulating normally, disrupting the bite and causing discomfort.

Other pathologies and indications for which tooth extraction is an effective solution are third or fourth degree looseness, as well as interference that can be created by crowns in relation to installed prostheses or orthopedic structures. In this case, modern tactics of preserving living teeth by any available methods give way to the need to ensure the normal functioning of the entire row or jaw.

The list of pathological conditions that are contraindications that complicate wound healing after tooth extraction includes:

Additional Information. Relative contraindications include pregnancy and menstruation in female patients: planned dental treatment should be postponed to another time.

Process steps

The entire removal process is divided into three stages: anesthesia, extraction and coagulation hemostasis, to which pre-procedural antibiotic therapy may be added. The anesthetic is used of infiltration or conduction type - Articaine, Ultracaine, Ubistizin, Septanest, Mepivacaine or Scandonest, which are injected into the soft tissues using a syringe.

Additionally, before the injection, the dentist can numb the gums using the application method. In a number of clinics that have a full-time anesthesiologist, the patient will be offered a treatment, practiced in case of increased sensitivity of a person to pain or allergies to local anesthetics. This method is more expensive and not very beneficial for the body.

Normal coagulation hemostasis of the body copes with the resulting bleeding within 40-50 minutes.

When a tooth is removed, it takes a long time to heal, as a rule, due to the individual characteristics of the patient and the difficulties that arose during the operation. Amputation using the classical method involves careful expansion of the alveolar socket and destruction of the periodontal ligaments, for which the crown is instrumentally loosened along several axes. With proper anesthesia, there should be no pain, although the sensations of rocking and pressure cause discomfort to the patient. After a short period of time, the tooth can be extracted with forceps.

The wound after tooth extraction can be more serious if the root system is so complex and curved that it is too difficult to simply get it out, and the dentist decided to resort to sequential fragmentation of the crown. The remaining roots must be removed with special tools without damaging the soft tissue, after which the free hole must be cleaned and treated with an antiseptic.

Normal coagulation hemostasis of the body copes with the resulting bleeding within 40-50 minutes, so it is enough to apply a sterile tampon for this period. Otherwise, socket tamponade using triiodomethane should be used. Complex surgical tooth extraction may require stitches to be placed in the gums at the end of the operation.

Postoperative complications

The stages of healing a hole after tooth extraction consist of observing a number of measures to ensure the safety of the prepared area:

If swelling has formed after extraction, it is permissible to apply ice or cold objects to the skin on the outside of the face - cooling the gums directly is prohibited due to the risk of infection. When the hole heals after tooth extraction, short-term antibiotic therapy may be required to prevent the development of inflammatory complications.

Every fourth case of surgical intervention ends in the development of postoperative alveolitis, due to which the wound after tooth extraction takes longer to heal than usual. This inflammation of the hole is a consequence of unprofessional treatment by the dentist, failure to comply with hygiene measures after surgery, or poor blood clotting. The clinical picture of alveolitis is the formation of dry plaque on the walls of the socket, pain, swelling and an unpleasant odor.

The healing time of the gums depends on the reaction of neighboring teeth to the patient’s extraction: in rare cases, they may become dislocated or loosened after surgery. Congenital or acquired osteoporosis, as well as the presence of cysts in the alveolar process, affects how long it takes the jaw to heal, since the traumatic nature of the operation during which the tooth was pulled out can lead to its fracture.

During the entire period of time during which the gums heal, you should plan the installation of a prosthesis: a bridge or an implant, since the toothless area of the alveolus provokes the movement of healthy teeth in its direction. Many options for the development of events in this case include malocclusion, decreased attractiveness of the smile, atrophy of the alveolar process and impaired articulation.

When a gingival fistula has already appeared, it threatens with serious complications. If such a tooth is not removed in time, the infection will spread further and further. Severe damage to a tooth by caries, when it cannot be restored, is also an undoubted indication for removal. The doctor also has to resort to radical measures in case of complicated periodontal diseases, for example, when no methods of treating periodontitis can eliminate severe tooth mobility and keep them in the socket. It should be noted that tooth extraction for pregnant women, as a rule, is not carried out and it is better to take care of this problem before conceiving a child.

Teeth removal technique

Today, prosthetics on bridges have already been replaced by the installation of implants, but the methods of removing teeth actually remain the same. The following main methods of tooth extraction are distinguished: simple and surgical. The first is used in cases where the crown of the tooth is well preserved and there is something to grab onto with forceps. As a rule, this happens with periodontitis. Here, destruction occurs rather around the periodontal tissues, so the crowns are generally well preserved.

Surgical tooth extraction is required in cases where access to it is difficult. For example, if the crown of a tooth is broken off, or it has not erupted completely - these are typical problems that a wisdom tooth can cause. In these cases, the dentist needs to do research and plan the procedure well. Surgical intervention helps provide the necessary access to the tooth. This type of tooth extraction is also called complex or atypical. In such cases, it is important to reduce the risk of developing inflammation after tooth extraction. Therefore, before tooth extraction, dental plaque is removed with ultrasound, and when a tooth is removed, antibiotics are prescribed.

Tooth extraction without pain

There is no need to be afraid that it will hurt you when a tooth is removed. Unlike the Middle Ages, in the 21st century this procedure has ceased to be barbaric. Thanks to anesthesia, tooth extraction is completely painless and comfortable for the patient. A slight prick is the only thing you will feel. You may experience pain after a complex wisdom teeth removal, but this can also be eliminated with the help of painkillers.

Typically, a local anesthetic is used during tooth extraction, but sometimes tooth extraction is performed under general anesthesia, for example, to remove several units in one session. Only the doctor decides what type of anesthesia to use when removing a tooth. The main thing for the patient is to inform him before the procedure whether he is allergic to pain medications or has serious chronic diseases. This will help avoid serious complications, such as anaphylactic shock due to anesthesia during tooth extraction.

To ensure successful healing at the removal site, you must adhere to a few simple rules:

Avoid eating for 2-3 hours after the procedure.
Do not touch the socket with your tongue or foreign objects.
Do not eat hot foods; chew on the side opposite to where the tooth was removed.
You can brush your teeth only the next day after surgery.
You should not use rinses without a doctor’s prescription.
And the next day you need to visit the dentist again for a follow-up examination.

In modern dentistry, tooth extraction has ceased to be a scary and painful undertaking. You shouldn’t draw terrible pictures from the last century, when teeth were torn with huge forceps and without anesthesia. Simultaneously with tooth extraction, today it is already possible to place an implant by resorting to one-stage dental implantation. But this radical measure should not be considered as treatment.