Simple extractions are the most common surgical procedures performed in oral surgery for the removal of dentition which is no longer salvageable due to severe caries and related periodontal pathology. Prior to performing the extraction procedure, the clinician must first review the patient’s medical and dental history to be certain that he or she may undergo this procedure safely in an outpatient setting. The clinician must then carefully assess the tooth in question, both clinically and radiographically, to confirm that it cannot be saved with either periodontal or endodontic therapy.
The simple extraction procedure is most often performed using local anesthetics. In some instances, due to a high level of anxiety, the patient may elect to undergo the procedure with a combination of local anesthetic and a form of sedation. There are several sedation modalities available and the risks, complications and benefits of each should be explained to the patient in order to make an informed selection.
In general, simple extractions involve the removal of a non-salvageable tooth using local anesthetic only and without the need for invasive surgery. There is often no need to elevate, or raise, gingival “gum” tissue to extract the tooth in question, thereby minimizing post-extraction pain and swelling. In some instances, however, the transition from a simple to a surgical extraction may occur, which may not have been anticipated initially.
Prior to initiating the simple extraction, the clinician must review the potential risks and complications of the procedure.
- Damage to adjacent teeth
- Damage to soft and hard tissues
- Displacement of tooth or root into adjacent structures or regions
- Oral-antral, or sinus, communication
- Nerve injury
- Dry Socket
Although the actual risks are extremely low for simple extraction procedures, they must be discussed in order for the patient to make an informed consent.
Once local anesthesia has been obtained in the region of the non-salvageable tooth, the clinician will gently loosen the tooth within the boney socket. Once the tooth is sufficiently loosened, the clinician will often use a dental forcep for removal of the tooth from the socket. Following removal, the clinician must also gently remove any soft tissues within or at the margin of the socket that may impede proper bone healing. Next, gentle irrigation of the extraction site using sterile saline solution to remove any residual debris is performed. Finally, a piece of sterile gauze is placed at the extraction site and the patient is advised to hold firm pressure by closing his or her teeth together.
The purpose of the gauze is to help prevent swallowing of blood by the patient, as a clot is forming within the socket. In general, a healthy patient with no bleeding disorders or not taking medications which interfere with clot formation or coagulation, will form a blood clot within 30 minutes of the procedure. Slight oozing of blood from the extraction socket is normal and may continue for the first 24 hours after the extraction of the tooth. As a result, the patient should be provided with a packet of gauze to change out every 20 to 30 minutes over the course of the day. The gauze must not be kept in the mouth overnight.
Following the extraction procedure, the patient should also be provided with written and verbal post-operative instructions.
The instructions should review all of the following:
- Use and changing schedule for the gauze.
- No rinsing or spitting following the extraction during the first 24 hours.
- No forceful blowing of the nose or sneezing, particularly for upper posterior extractions, which involve communication with the sinus.
- Resuming a regular diet with the avoidance of chewing on the side of extraction.
- Application of ice to the face on the extraction side (generally 10 minutes on and off) over the first 24 hours.
- Taking of prescription medications, including dose, frequency and duration.
- Follow-up instructions and emergency contact information.
Simple extractions are a common surgical technique performed in oral surgery. They involve minimal soft and hard tissue trauma and are most often performed under local anesthesia with minimal post-operative discomfort to most patients.