Kitcha Dental Clinic Chiang Mai

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Patient Instruction Tooth Extraction

1. General information

Tooth extraction is a procedure to remove a tooth from its socket in the bone due to the following reasons 

  • Severe tooth decay reaching the pulp, making restoration impossible.
  • Teeth affected by advanced periodontal disease that cannot be treated.
  • Milk tooth  that do not fall out in time, preventing the permanent teeth underneath from emerging properly or causing them to come in misaligned.
  • Teeth that need to be extracted for dental treatments, such as orthodontics or dentures.
  • Teeth that have been damaged due to accidents, resulting in fractures or breaks that cannot be repaired, or teeth with broken roots that cannot be filled or treated with root canal therapy.
  • Teeth located along a jaw fracture line, in cases where the alveolar bone or jawbone is broken, require careful consideration on a case-by-case basis to decide whether to extract or preserve them.
  • Teeth with pathological conditions affecting the bone around the roots, such as cysts, tumors, osteomyelitis, or jawbone necrosis.
  • Teeth in areas that require radiation therapy and are at risk of needing extraction in the future.
  • Problems with the position and eruption of teeth, which the dentist deems necessary to extract, such as impacted teeth, embedded teeth, supernumerary teeth, or teeth that are not functional.
  • In patients who cannot maintain good oral health, frequent infections from the teeth and gums may occur, and they may no longer use their teeth for chewing food. Extraction may be considered to reduce the risk of infection in the oral cavity.

2. Purpose of the procedure/treatment

  • To alleviate pain from various causes.
  • Eliminate bacteria in the oral cavity and prevent infection in the facial area.
  • Help promote the normal growth of natural teeth.
  • Reduce the risk of tooth decay in overlapping teeth.
  • Prevent teeth from dislodging into the airway during sleep in cases of loose teeth when patients are unaware.

3. Advantages of Procedure/Treatment

  • To remove teeth with various conditions or teeth that are not beneficial, the treatment will be performed under local anesthesia or general anesthesia.

4. Risks and Side Effects

  • After tooth extraction, patients may experience pain and discomfort. Generally, the pain after tooth extraction is not severe. Pain typically appears around 12 hours after tooth extraction and gradually decreases within 2 days.
  • Swelling may occur, especially in cases of surgical tooth extraction. Swelling peaks within 48 to 72 hours after surgery. If swelling occurs after the third day of surgery, infection should be considered more than surgical swelling.
  • Infection may occur after tooth extraction, especially in patients with underlying conditions or elderly individuals. In some cases, dentists may prescribe antibiotics to prevent infection.
  • Excessive bleeding or recurrent bleeding several days after tooth extraction.
  • Delayed healing of the extraction site or exposed bone fragments are often observed in patients with underlying health conditions affecting wound healing or in the elderly. Additionally, in the case of upper premolar or molar extractions, there may be a perforation into the sinus cavity, or a tooth could be displaced into the sinus.
  • Numbness of the lips, particularly the lower lip, may occur due to the proximity of the tooth roots to the nerve.

5. Alternatives

  • If you are not ready for treatment, you may choose to monitor your symptoms. If you experience pain or swelling in your face, it indicates that you should consider tooth extraction.

6. Potential consequences of not undergoing the procedure/treatment

  • Infections can spread from the tooth to the root and the tooth socket, potentially leading to facial infections.
  • Difficulty in chewing food.
  • Can potentially develop into a tumour or cyst in the jaw.
  • Infections from the oral cavity can spread to other organs, such as in individuals with artificial heart valves or knee joints, leading to malfunction of these organs.

7. Pre/Post care

Preparation

  • Consuming sufficient food and getting adequate rest and sleep. In cases where patients have underlying conditions, they should take their medications and meals as prescribed.
  • In some cases, children may need to refrain from eating for at least 2 hours before receiving treatment to prevent vomiting.
  • Individuals with underlying medical conditions that may affect treatment should obtain approval from a physician before undergoing tooth extraction and prepare themselves accordingly. These conditions include hematologic disorders, individuals taking blood thinners, those undergoing chemotherapy or radiation therapy, and those in critical condition, among others.
  • Individuals with severe heart disease, those with prosthetic devices such as pacemakers or artificial joints like knee replacements, and individuals with occluded arteries should take antibiotic medication one hour before treatment.
  • Individuals taking anticoagulant medications such as Warfarin will undergo a blood clotting test before treatment, allowing the dentist to determine whether tooth extraction is appropriate. A blood clotting value of less than or equal to 3.5 permits tooth extraction.
  • Blood pressure should be controlled within the range of 90/60 millimeters of mercury (mmHg) to 140/90 mmHg. However, in elderly individuals or in cases of severe toothache, blood pressure may be allowed to rise up to 160/90 mmHg.

 Treatment process

  • The dentist will conduct an examination, diagnosis, and treatment planning. They will confirm the treatment plan with the patient, specifying clearly which teeth will be extracted during this session, with the patient or their relatives.
  • Inject local anesthetic precisely at the tooth to be extracted. Wait for approximately 10-15 minutes to test the effectiveness of the anesthesia.
  • Extract the tooth according to the treatment plan. In cases where extraction is difficult, a surgical tooth extraction tool may be required. After removing the tooth, bite down on gauze to stop the bleeding.
  • In cases of excessive bleeding, loose gums, or abnormal blood clotting, blood will be controlled by applying hemostatic agents along with wound closure. Patients will be instructed to bite down firmly on gauze to stop bleeding, or additional tools may be used to assist in blood clotting.
  • In some cases after tooth extraction, the dentist may consider contouring the jawbone to be compatible with the placement of prosthetic teeth, thus avoiding the need for future bone contouring surgeries.
  • After tooth extraction, patients will receive pain medication, or they may also receive antibiotics to take orally.
  • Dentists will provide guidance and instructions on post-extraction care after every tooth extraction procedure.

Post-Extraction Care Instructions

  • Bite on gauze for 1-2 hours. Swallow saliva normally.
  • Apply an ice pack externally to the cheek area where the surgery or tooth extraction was performed for 24-48 hours.
  • Consume soft foods and liquids during the first 3 days after the procedure, and then gradually resume a normal diet.
  • Brush your teeth as usual to keep them clean.
  • Take painkiller  after tooth extraction 1-2 hours before the local anesthetic wears off. Pain typically subsides within 6-12 hours after the extraction.
  • In the case of a sinus perforation, avoid vigorous rinsing. If you need to cough or sneeze, keep your mouth open wide to reduce pressure. Refrain from blowing your nose and only dab it gently. Avoid swimming for 2 months.
  • If any issues or complications arise, please call to schedule a follow-up appointment for further diagnosis.

Precautions to Prevent Continuous Bleeding

  • Do not suck on the wound or touch it with fingers or any objects.
  • Do not rinse your mouth or spit for 1-2 hours after surgery or tooth extraction.
  • Do not exercise within 24 hours. For those at risk, it’s advisable to avoid exercising for 5 – 7 days after tooth extraction.
  • Do not use mouthwash containing alcohol or rinse vigorously for 3 days after tooth extraction.

8. Methods for assessing blood clotting.

  • Once you have bitten down on the gauze for 1 hour, reassess. Remove the gauze and wait for 10 minutes to see if there is any more bleeding in the mouth. If bleeding continues, bite down on fresh gauze for another hour and reassess. The gauze should not be soaked with blood or have any white areas remaining. If there is no further bleeding after the reassessment within 10 minutes, it indicates that the bleeding has stopped effectively.
  • If after biting down on the gauze for 15 minutes, you still feel there is oozing blood between 09:00 a.m. – 08:00 p.m. lease contact the clinic at +6653-200201. For inquiries outside of clinic hours please call +66990094649 to reach the clinic coordinator for assistance in receiving further care.