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The tooth pulling
The actual tooth extraction takes place with special extraction forceps, whereby the tooth is loosened with rotating and tilting movements and then removed. With a few exceptions, pulling is not an act of strength, but rather a very soulful technique. With force alone, the tooth often breaks off and then has to be completely removed by opening the jaw.
Once removed, the extraction wound quickly fills with blood. This so-called blood clot represents a natural wound closure and is the basis for the wound to heal. For simple protection against saliva, oral cavity bacteria and secondary bleeding, the dentist lets the patient bite on gauze swabs for about half an hour. Further measures such as wound inserts and special mouth rinses directly after an uncomplicated removal are not necessary, and they are often even harmful for wound healing.
Tooth extraction with complications
If the tooth crown and its roots have already been severely damaged, or if the X-ray shows a strong curvature of the roots, the tooth in the forceps can break (fracture) even with careful extraction.
The fragments must be completely removed in order to avoid impaired wound healing and subsequent chronic inflammation in this area. Sometimes this removal is possible with special levers and claws over the tooth socket (alveolus) without having to open the jawbone. If this does not succeed, the doctor or oral surgeon creates surgical access to the root remnant via the jawbone and removes it in this way.
The mucous membrane is unfolded with a scalpel and raspatory (surgical instrument for detaching the periosteum from the bone), the jawbone in the area of the fractured root is removed using bone burrs and the (tooth) root parts are exposed. This is done under the most sterile conditions possible. Sterile saline solution is used for cooling and cleaning wounds.
With a fine lever, the broken parts of the root are carefully lifted out of the jawbone (luxated). If the field of operation is unclear or difficult to see, a control X-ray may be necessary to clarify the complete removal.
Finally, the mucous membrane flap is returned to its original position and attached to the adjacent tissue by means of sutures that are removed after a week.
Reasons for pulling teeth
Every dentist will endeavor to preserve his patient's own teeth for as long as possible.
You should therefore ask why each time you pull a tooth. If the reason is not clearly explained to you, or if you have the impression that they will quickly "pick up pliers", you can also get a second opinion.
Reasons for tooth extraction are, for example:
- The tooth is destroyed deep into the root and no longer offers a hold even to a post tooth.
- A root canal treatment as a last resort for the tooth is not possible for anatomical reasons (curved or inaccessible root canals, position of the tooth far back in the jaw).
- The tooth has no opposing bite or any other useful function; it may also press on healthy neighboring teeth due to a lack of space.
- The tooth has not erupted properly (wisdom tooth) and is difficult to reach for hygienic measures due to its incorrect position.
- The tooth is so loosened that periodontological measures (treatment of the gums) do not promise any success.
- As part of an orthodontic examination, it is determined that the jaw is too small to properly accommodate all teeth and will be too later (dentition reduction).
- The teeth are so crooked in the jaw that prosthetic measures are not possible.
- There is a medically proven serious underlying disease and the involvement of pathological dental processes cannot be ruled out.
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