A dental extraction (also referred to as exodontia) is the removal of a tooth from the mouth. Extractions are performed for a wide variety of reasons, including tooth decay that has destroyed enough tooth structure to prevent restoration. Extractions of impacted or problematic wisdom teeth are routinely performed, as are extractions of some permanent teeth to make space for orthodontic treatment.
Historically, dental extractions have been used to treat a variety of illnesses, as well as a method of torture to obtain forced confessions. Before the discovery of antibiotics, chronic tooth infections were often linked to a variety of health problems, and therefore removal of a diseased tooth was a common treatment for various medical conditions. Instruments used for dental extractions date back several centuries. In the 14th century, Guy de Chauliac invented the dental pelican, which was used through the late 18th century. The pelican was replaced by the dental key which, in turn, was replaced by modern forceps in the 20th century. As dental extractions can vary tremendously in difficulty, depending on the patient and the tooth, a wide variety of instruments exist to address specific situations.
Reasons for tooth extraction
The most common reason for extraction is tooth damage due to breakage or decay. There are additional reasons for tooth extraction:
Severe tooth decay or infection. Despite the reduction in world-wide prevalence of dental caries, still it is the most common reason for extraction of (non-third molar) teeth with up to two thirds of extractions.
Extra teeth which are blocking other teeth from coming in.
Severe gum disease which may affect the supporting tissues and bone structures of teeth.
In preparation for orthodontic treatment (braces)
Teeth in the fracture line
Insufficient space for wisdom teeth (impacted third molars). Although many dentists remove asymptomatic impacted third molars, American as well as British Health Authorities recommended against this routine procedure, unless there are evidences for disease in the impacted tooth or the near environment.
Receiving radiation to the head and neck may require extraction of teeth in the field of radiation.
Types of extraction
Extractions are often categorized as "simple" or "surgical".
Simple extractions are performed on teeth that are visible in the mouth, usually under local anaesthetic, and require only the use of instruments to elevate and/or grasp the visible portion of the tooth. Typically the tooth is lifted using an elevator, and using dental forceps, rocked back and forth until the Periodontal ligament has been sufficiently broken and the supporting alveolar bone has been adequately widened to make the tooth loose enough to remove. Typically, when teeth are removed with forceps, slow, steady pressure is applied with controlled force.
Surgical extractions involve the removal of teeth that cannot be easily accessed, either because they have broken under the gum line or because they have not erupted fully. Surgical extractions almost always require an incision. In a surgical extraction the doctor may elevate the soft tissues covering the tooth and bone and may also remove some of the overlying and/or surrounding bone tissue with a drill or osteotome. Frequently, the tooth may be split into multiple pieces to facilitate its removal.
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