Tooth Extraction

Primary vs. Permanent Tooth Removal

Smiling Patient in Business AttireGenerally the primary or “baby” teeth become loose on their own and the child can wiggle them out. Occasionally, a primary tooth may not become loose on its own and may block the eruption of its permanent replacement tooth. Roots on a primary tooth are generally smaller than their permanent tooth counterparts. Most children and adults who have a primary tooth removed have a very quick recovery time.

In the absence of periodontal disease or trauma, permanent teeth do not usually become loose on their own. Removal of a permanent tooth will require some modifications of your daily routine. In some situations, it may be best if you do not return to work after having a permanent tooth removed. We will give you written post-operative instructions to take home if you have a tooth removed in our office.

At your orthodontist’s request or Dr. Steckelberg’s diagnosis, primary and/or permanent teeth may be removed in our office to allow for an improved orthodontic result. This is done with careful consideration of the individual variables present.

Surgical Removal of Tooth

Sometimes a tooth is not able to be removed without creating a small surgical opening around that tooth. That extra opening can allow for better visualization, as well as removal of any bone that might be trapping your tooth in place. If your tooth requires surgical removal, you may need sutures, or “stitches.” Dependent on the suture material used, you will usually need to return for a quick visit to have your sutures removed one week after your surgery.

We try to let you know before your appointment if surgical removal of your tooth is anticipated. However, some situations do arise that may necessitate a surgical opening. It is just important to keep in mind that removal of any tooth may require an additional follow-up visit in our office.

Wisdom Tooth Removal

If appropriate, Dr. Steckelberg does remove some wisdom teeth in our office. A current panoramic X-ray must be utilized in determining if you will need to have an oral surgeon remove your wisdom teeth.

Patients on Anti-Coagulant Treatment

If you are taking Coumadin, Warfarin, daily aspirin, or any other type of “blood thinner,” modification may be needed prior to removing a tooth.  Make sure to tell us if you are taking one of the newer anti-coagulant medications such as Pradaxa, Eliquis, or Xarelto, which are referred to as "blood slickers". Please make sure to let us know if you are on these medications, so that we can treat you properly. A consultation with your physician, as well as pre-operative blood tests, may be needed to determine the appropriate time for surgery.

Patients on Bisphosphonates

If you are taking medications from the bisphosphonate drug family, surgical dental treatment may be modified. Examples of these medications are: Actonel (risedronate), Aredia (pamidronate), Boniva (ibandronate), Didronel (etidronate), Fosamax (alendronate), Fosamax Plus D (alendronate), Skelid (tiludronate), and Zometa (zolendronic acid). Medications generally have two names: a brand name and generic name; we have listed the generic name in parentheses. Emerging research suggests increased caution be used before any dental surgical procedure is performed. Research is still in the early stages, but our office is striving to stay on top of this recent discovery.

The concern about bisphosphonate emerged due to osteonecrosis of the jaw developing in patients who had invasive dental surgeries performed. The risk of developing osteonecrosis appears to be low, but we need to inform you of the risks and benefits, as well as any alternatives for any surgical procedures before the procedure is started.

You can learn more about osteonecrosis and other dental health topics at the American Dental Association website.

Wisdom Tooth Extraction

Impacted wisdom tooth.In most people, the third set of molars, generally called “wisdom teeth,” start coming in around age 17-25. However, the arrival of these teeth is often far from trouble-free. The extraction (removal) of one or more third molars is a relatively common procedure, performed on some 5 million patients every year. After a thorough examination and diagnostic tests such as x-rays or a CT scan, we may recommend that you have your wisdom teeth extracted. Here are some typical reasons why:

  • Your jaw may be too small to accommodate all your teeth, leading to excessive crowding and the chance of your wisdom teeth becoming impacted — that is, unable to emerge from the gums, and potentially harmful to adjacent bone or teeth
  • Your wisdom teeth may be erupting (coming in) in a crooked orientation, which can damage other teeth or anatomical structures in the jaw, and/or cause bite problems
  • If your wisdom tooth does not fully erupt (emerge from the gums), it can increase the chance for bacterial infection
  • A cyst (a closed, fluid-filled sac) may develop around the unerupted wisdom tooth, which can cause infection and injury to the adjacent bone or nerve tissue

Whether it is aimed at preventing future problems or needed to alleviate a condition you already have, the extraction of wisdom teeth can be an effective treatment. But, as with all medical procedures, its benefits must be weighed against the small risk of complications. We will be happy to discuss in detail all the risks, benefits and alternatives in your individual case.

The Extraction Procedure

X-ray of an impacted wisdom tooth.Wisdom tooth extraction is usually an in-office procedure which may be performed by a dentist or an oral surgeon. It's quite possible to have the treatment done with only a local anesthetic (numbing shot) to keep you from experiencing any pain; however, if multiple teeth are being extracted at one time (as is often the case), a general anesthetic or conscious sedation may be administered. We will talk to you beforehand about the type of anesthesia that's best for you.

Once you have been appropriately anesthetized, the gum tissue at the extraction site may need to be opened if the tooth is impacted. The tooth itself will then be gently removed. When the extraction is complete, you may need to have the site sutured (stitched) to aid healing. After the procedure is over, you will rest for a short time before going home. Depending on what type of anesthesia you have had, you may need another person to drive.

After the Procedure

The recovery period after wisdom tooth extraction generally lasts only a few days. During this time, you should rest when possible to encourage healing, and take any pain medication as prescribed. It's normal to experience some bleeding at the extraction site; this can be controlled by gently biting on gauze pads, changing them as needed, and resting with the head elevated on pillows rather than flat.

Holding an ice pack on the outside of your cheek for a few minutes at a time (for example, 5 minutes on / 5 minutes off) may help reduce swelling on the first day after the procedure. Starting on day 2, the warm moist heat of a washcloth placed on the cheek may make you more comfortable. Rinsing the mouth with warm salt water a few times a day can also help relieve discomfort.

You may want to eat soft foods for a few days after the extraction; likewise, be careful when brushing or putting anything in your mouth until your healing is complete. Be sure to follow the post operative instructions we will give you, as each situation is a little different, and we want you be as comfortable as possible.