Tooth extraction

What we do at our office

Dr. Baruch Tetri, DDS, is a periodontist, a specialist in the gums and the jawbone. He makes the diagnosis and the call on whether a tooth is worth keeping; a difficult tooth is not automatically hopeless, and a root canal, gum treatment or a crown is sometimes the better answer. Routine and surgical extractions are done at our office by Dr. Tetri. Because he also places implants and grafts bone, the socket is managed with the replacement in mind, on the same day when that is the plan. Wisdom teeth have their own guide.

What happens at the visit

1. Diagnosis. We examine the tooth, the bite and the gum around it, review your medical history and medicines, and give you the prognosis (how long the tooth is likely to last) and the alternatives.
2. Imaging. An X-ray of the tooth and its roots; a limited CBCT (a three-dimensional dental X-ray) when a root sits near the nerve of the lower jaw or the sinus, or when an implant is planned.
3. We settle the plan with you: simple or surgical removal; local anesthetic alone or with sedation after a medical review, where our permits and team allow; what goes into the socket; and what replaces the tooth, and when.
4. Medicines. Do not stop a blood thinner or aspirin on your own; we coordinate with the doctor who prescribes it. Most extractions in healthy patients do not need an antibiotic.
5. The extraction. A visible tooth is loosened and lifted out through its socket; a broken-down tooth or retained root may need a small opening in the gum or the tooth divided into pieces. The socket is cleaned, and a bone graft (ridge preservation) is placed when an implant is planned.
6. Healing. Written instructions, gauze, and a follow-up call or visit. Soft, cool food the first day; most people work the next day after a simple extraction. Surgical sites take longer and swell more.

Risks and limits

• Dry socket: the blood clot is lost and the bone is exposed, usually on day two to four, with pain that spreads toward the ear. No smoking, no straws and no vigorous rinsing for the first 48 to 72 hours lowers the risk; if it happens, we dress the socket and it usually settles within a few days.
• Bruising, swelling and a stiff jaw for a few days are expected after a surgical removal.
• Lower back teeth sit near a nerve; altered sensation in the lip or tongue is uncommon and usually temporary. We map the nerve on the scan when a root is close.
• Bone and gum shrink after a tooth is removed. A graft reduces that shrinkage but does not stop it, and is not needed for every socket.
• Bleeding that soaks the gauze after an hour of firm pressure, or pain that gets worse after day three, means call us.

Questions patients ask

Does it hurt?

With the tooth numb you should feel pressure rather than pain; tell us if you feel more. Afterward, for most extractions, ibuprofen plus acetaminophen controls pain better than opioids; we tell you the amounts that are safe for you.

Do I need to replace the tooth?

Not always. A back tooth with a solid partner across from it can sometimes be left; a gap that lets the neighbors drift usually should not be. We compare an implant, a bridge and a removable tooth before the extraction.

What is the difference between a simple and a surgical extraction?

The access. Simple means the tooth comes out through its own socket; surgical means the gum is opened or the tooth divided to reach it.

Sources

• AAE: Treatment options for a diseased tooth
• AAOMS: Dental and soft-tissue surgery patient guide
• EFP consensus: Extraction-socket management
• ADA: Acute pain management after tooth extraction
• ADA: Anticoagulant and antiplatelet medicines in dental care
• ADA MouthHealthy: Dry socket

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Tetri’s Smile · 16690 Collins Avenue, Suite 701, Sunny Isles Beach, FL 33160 · Serving Aventura, Bal Harbour, North Miami Beach, Hallandale Beach and greater Miami.

Related: Wisdom teeth · Dental implants · Bone grafting · Sedation dentistry