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All the below content has been written by Dr. Sandip Sachar. 

Tooth Extractions

What is a tooth extraction?

A tooth extraction is simply the medical term for removing a tooth from the mouth.  The root of the tooth is attached to the jaw bone with the periodontal ligament.  In a tooth extraction, the entire tooth is removed.

Why would I need a tooth extraction?

At Sachar Dental NYC, our philosophy is always to perform the least invasive procedures and most conservative treatments possible.  We will try to save the tooth before we do an extraction.  With that said, extractions are unfortunately, a common procedure.  There are many reasons why one might need a tooth extraction, when the tooth cannot be saved.

  • Extensive decay.
  • Advanced infection.
  • Bone loss from gum disease.
  • Advanced periodontal disease.
  • Tooth fracture from trauma.
  • Tooth fracture from clenching or grinding.
  • Teeth that are too crowded.
  • Extra teeth.
  • Making room for orthodontic appliances.
  • Baby teeth that failed to fall out on their own.
  • Problematic wisdom teeth.

Tooth extraction due to extensive decay.

Extensive tooth decay is the most common reason for having a tooth extracted.  Tooth decay can affect any part of the tooth including any one of the surfaces, and the root.  Left untreated, decay can become deep and extensive, and lead to the need for a tooth extraction. When presented with tooth decay, there are many methods that we can perform to save the tooth.  These methods include fillings, inlays, onlays, crowns and root canal.  All of these methods involve removing the decay and sealing the tooth.  When the tooth decay becomes more extensive, we may determine that these methods will fail, or after one of these methods has already failed, a tooth extraction becomes necessary.  Left untreated, a cavity may lead to tooth infection, and this bacteria can spread to the bone, and into the blood.  Once the infection spreads into the blood, it can reach other organs and become a medical emergency.

Tooth extraction due to advanced periodontal disease.

Periodontal disease is another name for gum disease.  Its early stages, periodontal disease can be treated and reversed with regular professional dental cleanings, when necessary, with deep professional cleanings, and with periodontal therapy. Untreated gum disease becomes advanced periodontal disease, and can lead to loss of the underlying bone under the tooth.  When this occurs, periodontal disease is no longer reversible.  Eventually, the bone gets severely eroded such that it can no longer hold the tooth in placed securely.  This is a process that happens over a prolonged period of time.  Unfortunately, when gum disease reached this point, tooth extraction becomes necessary. 

Tooth extraction due to trauma.

Most fractured teeth can be saved.  Many times, a fractured tooth can be saved by either bonding or holding the fracture fragments together with a crown.  When the fracture extends deep to the root of the tooth, such as a vertical fracture, the tooth may not be able to save be saved.  Unlike a fracture of your bones, a fractured tooth does not heal, and restore its original strength.  More extensive fractures lead to tooth extraction, when the tooth cannot be saved. Left untreated, an extensively fractured tooth will cause continued pain with any pressure, or biting.

Tooth extraction due to baby teeth that failed to come out on her own.

On rare occasions, as a child gets older, a baby tooth may not fall out on its own.  When this happens, it may impede the eruption of the permanent tooth underneath.  In order to allow the permanent tooth to erupt in a timely manner, we will take steps to extract the baby tooth.  Failure to remove a baby tooth that impedes the eruption of an adult tooth can lead to future complications.  Left untreated, the adult tooth may remain in the bone and can become ankylosed.  The permanent tooth that has become ankylosed is unable to erupt from the bone, and may lead to problems in the future.  It is very difficult to remove an ankylosed tooth when necessary.

Tooth extraction in preparation for orthodontics / braces.

The removal of a tooth in order to make room for orthodontics/braces has become much more rare in recent years.  In the past, it was done much more frequently.  More recent technology has allowed us to use Invisalign or palatal expanders to make more room in the mouth.  When this rare procedure is done, an extraction may allow for more space to move the teeth using braces or other orthodontic appliances.  

Tooth extraction for problematic wisdom teeth.

Wisdom teeth that are not problematic do not need to be extracted.  Wisdom teeth do need extraction when they become symptomatic or painful, do not have room in the mouth to erupt, have formed a cyst within the bone, or are too far back in the mouth to keep clean.  An impacted wisdom tooth is one that has not erupted from the bone, or gum.  Asymptomatic impacted wisdom tooth do not need to come out, unless there is a cyst or pathology within the bone.

Tooth extraction for congenitally supernumerary teeth.

A supernumerary tooth is the medical term for the congenital occurrence of having an extra tooth, or an extra piece of a tooth.  While this is very rare, sometimes we will extract the extra tooth if it becomes necessary.

Signs and symptoms of teeth that may need to be extracted.

The decision to extract a tooth is complex, is performed by our dentists on an individual basis, and is different for every patient. The most common symptoms that lead to tooth extractions are pain and loose teeth, however, these do not always lead to extractions.  When you come in for an evaluation, we will determine what is causing the problem and make the determination if an extraction is necessary or not.  Extraction is always a last resort, as we always try to save a tooth.

How to prevent the need for tooth extractions.

In order to prevent the need for a tooth extraction, we recommend proper oral hygiene at home including brushing and flossing.  We also recommend coming in twice per year for dental checkups and professional cleanings. Catching dental problems early is the best way to avoid the need for an extraction.  For example, treating a fracture before it becomes too extensive can prevent the need for extraction in the future.  Diagnosing and treating tooth decay early will also help to prevent decay from becoming too extensive.  Likewise, catching and treating gum disease will also prevent it from spreading to the bone and leading to the necessity for a tooth extraction.

What are the goals of extracting a tooth?

The most obvious short-term goal of a tooth extraction is to treat pain.  Another common goal of a tooth extraction is to remove an infection.  Left untreated, infections can spread into the blood and other organs.

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

The difference between a simple tooth extraction and a surgical tooth extraction, is that, in a surgical tooth extraction we need to remove parts of the bone.  In a simple tooth extraction, we are able to remove the tooth without the need to remove or file the bone.  An example of a surgical tooth extraction is removing a tooth that has not erupted out of the bone.  In this case, we need to incise the gum and remove some of the bone in order to access the tooth.  Sometimes, the tooth needs to be split into several pieces to completely remove it.

When do we refer more complex tooth extractions to an oral surgeon?

For some patients, after your clinical examination and x-rays, we may decide to refer a tooth extraction procedure to an oral surgeon.  We do this when we feel that the patient would be more comfortable having sedation or general anesthesia.  Also, when we see on x-ray that the jaw nerve is too close to the tip of the root, we will refer these patients to an oral surgeon.

Clinical examination prior to a tooth extraction

Prior to deciding to extract a tooth, we will take x-rays.  We will use our experience and judgment to determine if a tooth can be saved or not.  If we decide that the tooth cannot be saved, we will then recommend a tooth extraction.  As always at Sachar Dental NYC, we try to use the most conservative approaches and least invasive procedures.  We will always try to save the tooth prior to performing an extraction when we decide that there is a good chance that the tooth can be saved.  As always, we spend time in order to educate our patients about their condition so they can make informed decisions.

How is a simple tooth extraction performed?

The technique used to remove a tooth depends on where the tooth is located, the reason it is being removed, the overall health of the patient, and the health of the tooth.  In a simple extraction, the first step is to obtain local anesthesia to the gums.  This will allow you to have a pain-free procedure with minimal discomfort.  A dental instrument is utilized to elevate the tooth and free the periodontal ligament.  With another dental instrument, the tooth is grasped, and forces are applied to free the attachments to the ligament and bone. Pressure will be applied to the socket in order to stop the bleeding.  Sometimes, sutures may be placed into the gums. 

How is a surgical tooth extraction performed?

The technique used to remove a tooth depends on where the tooth is located, the reason it is being removed, the overall health of the patient, and the health of the tooth.  In a surgical extraction, the first step is to obtain local anesthesia to the gums.  If the tooth has not erupted from the bone, an area of bone will be removed to expose the tooth.  Using dental instruments, the tooth will be elevated and the periodontal ligament will be identified and freed.  In a surgical extraction, there is need to remove some of the bone in order to make room for the tooth to come out. On occasion, the tooth may be need to be broken into smaller pieces to be removed.  Pressure will be applied to the socket after the tooth is removed in order to stop the bleeding.  Stitches will then be placed into the gums in order to close the socket.

Why do we sometimes place a bone graft after a tooth extraction?

Sometimes, after we perform a tooth extraction, we make a decision that a dental implant will be necessary in the future.  In this case, we assessed the health of the bone after the tooth is extracted.  If we decide that the bone is not strong enough to receive an implant, will recommend enhancing the strength of the bone with a bone graft.

What is a dry socket?

A dry socket is a complication that rarely occurs after a tooth extraction.  Normally, after a tooth extraction, a blood clots forms over the bone where the tooth came out.  This blood clot remains on the bone during healing.  A dry socket occurs when this blood clot is dislodged or dissolves too soon.  This leaves the bone exposed.  Treatment for dry socket involves an additional procedure to clean the site and introduce a dry socket dressing into the area.  Sometimes, oral antibiotics will be prescribed.  Follow-up visits are necessary to change the dressings and monitor healing progress, until it is fully healed.

Do I have to have my wisdom teeth extracted?

Only problematic wisdom teeth need to be extracted.  Problems that necessitate extraction of wisdom teeth include pain, cysts within the bone, recurrent gum infections, not having enough room for the wisdom teeth to erupt, and when wisdom teeth are too far back that they cannot be kept clean.

What are the post-procedure instructions after a tooth extraction?

After a tooth extraction, you will be instructed not to eat until the anesthesia wears off.  You will be instructed to continue to bite on a piece of gauze in order to stop the bleeding for up to 40 minutes.  You will be instructed to refrain from spitting, rinsing, drinking from a straw, smoking, and consuming alcohol beverages for 24 hours.  After the first 24 hours, you will be advised that you may brush gently in the area.  We will recommend gentle warm saltwater rinses 2-3 times per day to be started after the first 24 hours.  You will be instructed to call us if he notices extensive swelling or bleeding present. Your follow-up visit will be at 1-2 weeks.  If stitches were placed, they will be removed on that visit.

What should I expect after a tooth extraction?

After a tooth extraction, the local anesthesia will wear off in 1-2 hours.  You will be given pain killers to take as necessary.  If necessary, you will be given antibiotics as well.  Some discomfort is normal and to be expected after this procedure.  Some swelling is also normal after a tooth extraction.

What are my options to replace the tooth after a tooth extraction?

The most ideal replacement for an extracted tooth is a dental implant.  The next best option to replace a tooth after extraction is a fixed permanent bridge.  Another option for a single tooth extraction is a removable clip on tooth called a “flipper”.  If multiple teeth have been extracted, we often make a removable partial denture.

What can happen if I do not replace a missing tooth after extraction?

Normally, the load of chewing is equal distributed across all of the teeth.  After an extraction, this balance of load is disturbed.  Having one tooth removed, puts increased load on the remaining teeth. This puts them at greater risk of fracture and wear.  Additionally, the surrounding teeth may drift into the space where the tooth was removed and alter your bite.  This may lead to future pain and problems with TMJ.  Additionally, it is common for patients to favor the opposite side of the mouth from where the tooth was removed for chewing.  This sometimes leads to problems with TMJ and increased wear of these teeth.

What is the cost of a tooth extraction in Midtown Manhattan, NYC?

At Sachar Dental NYC, our one-time charge for a simple tooth extraction is $400.  The cost for a surgical extraction is $600.  Most PPO dental insurances cover the cost of a tooth extraction at 80% to 90%.  As always, before coming in for your visit, we will check your insurance benefits.  We will be able to let you know what your out-of-pocket expenses will be prior to performing the procedure.  After the procedure, we will submit a claim to your dental insurance company and collect the insurance payment directly from them.  On the day of your visit, you will only be responsible for your percentage.

Does my dental insurance cover a tooth extraction?

Most dental PPO insurance plans cover the cost of a tooth extraction at 80% to 90%.  Prior to having any procedure done, at Sachar Dental NYC, we always check with your insurance to see if it is a covered service and determine what your out-of-pocket expenses will be.  We always will let you know prior to performing any procedure what charges you will be responsible for.  On the day of your procedure, you will only be responsible for your percentage.  We will then submit a claim to your dental insurance and collect the insurance payment directly from them. 

Can I use flexible spending dollars or a medical savings account for these charges?

Yes, you may be able to use your medical savings accounts or flexible
spending dollars to cover charges related to your treatment.  At the
time of your service, we will provide you with all the necessary
documentation and receipts.

Do you offer payment plans for treatment?

At Sachar Dental NYC, we offer interest free financing through Lending
Club and Care Credit.  In 15 minutes, we will let you know if you are
approved for interest-free financing.  These options will enable you to
make payments over the next 12-18 months without any interest charged.

Why are we the best dentists in New York City for a tooth extraction?

As always, at Sachar Dental NYC, we always perform the most conservative approach and the least invasive procedures possible.  We are never in a rush to perform a tooth extraction.  If possible, we always attempt to save the tooth prior to performing an extraction.  When extraction is determined to be necessary, we have the extensive experience of performing many extractions on our patients in order to perform this procedure correctly.  We are well versed in ways to make this procedure less painful for our patients.  We always allot the proper amount of time for our procedures such that our patients never feel rushed.  Additionally, we have a team of high skilled specialists that includes an implantologist, a periodontist, and a prosthodontist, all within the same office. This allows us to plan your extraction procedure completely, including performing the actual extraction, placing a bone graft when necessary, and performing future dental implants.  We are experts in tooth extraction from start to finish.

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