Dr. med. Philipp Nicol is a freelance author of the NetDoktor medical editorial office.
This text complies with the requirements of medical literature, medical guidelines and current studies and has been reviewed by medical professionals.
Tooth extraction is the removal of a tooth (tooth extraction, exodontics) without further surgical measures. Tooth damage after inflammation or accidents is often the cause. Here you can read everything about pulling a tooth, when to do it and what risks there are.
What’s the tooth pull?
Tooth extraction is an old treatment method. There are already records of tooth extraction from the first century. A distinction is made between simple tooth extraction and operative tooth removal. The latter is only used in complicated cases – for example when removing wisdom teeth. The cost of tooth extraction is covered by the health insurance.
When do you pull the tooth through?
In principle, the so-called conservation principle applies to tooth pulling. A tooth should only be extracted if it can no longer be preserved with all other conservative methods or if its preservation would not be meaningful or harmful. For this purpose, the treating dentist considers alternative, tooth-conserving treatment methods. These include, for example, root canal treatment or root tip resection.
There are several reasons (indications) for tooth extraction:
Loose or damaged tooth
If a tooth is so damaged in an accident that it can no longer be preserved, or if it is severely damaged by caries or periodontitis, for example, it must be pulled out.
lack of space
Congenital malocclusions of the jaw can cause crowding of the teeth. By extracting healthy teeth, space can be created for the remaining teeth. The so-called “Hotz extraction therapy” is usually used.
Under certain circumstances teeth can already be extracted preventively. This prevents these teeth from becoming infected and aggravating an existing disease or making treatment more difficult. This applies, for example, to the following cases:
- Organ transplants: Dental germs can cause graft rejection here.
- Chemo- or radiotherapy: protection against radiation-induced tooth damage (osteoradionecrosis)
- Heart valve replacement: tooth extraction prevents inflammation of the inner lining of the heart (endocarditis), which often originates from tooth germs.
In patients who are not allowed to undergo surgery due to a disease, tooth extraction is usually not possible. This includes, for example, the following clinical pictures:
- severe cardiovascular diseases
- suppressed immune system (immunosuppression)
- bleeding propensity
- Acute inflammations or tumours in the operating area
- Allergy or intolerance to the anaesthetic used (local anaesthetic)
What do you do when you pull a tooth?
Your dentist will first inform you about the procedure. This consultation includes possible alternatives, the procedure of tooth extraction, possible complications and the subsequent treatment. In addition, the dentist will ask you about your age, underlying diseases, medication or possible allergies.
He then thoroughly examines the affected tooth and the condition of the remaining teeth. An x-ray of your teeth will also be taken. The dentist can prescribe a sedative for anxious patients.
Anaesthesia in tooth pulling
Pain can be relieved well with a local anaesthetic. For this purpose, the dentist injects an anaesthetic into the tissue near the tooth (usually lidocaine or articaine). The anesthetic effect is further improved by the addition of a vasoconstrictor. A rare complication is the accidental injection of the anaesthetic into a blood vessel, which can cause serious side effects (systemic side effects).
Procedure of tooth extraction
Depending on whether the tooth is pulled in the upper or lower jaw, the dentist sits or stands in front of you. The dentist first disinfects the mucous membrane in the oral cavity, followed by local anaesthesia. Various levers and forceps are used to pull the tooth, depending on whether the tooth is already loose or still firmly anchored. If the dentist uses a scalpel, a detailed disinfection of the oral cavity should follow and the surroundings should be covered with sterile cloths.
Once the tooth is removed, the wound is closed. In most cases, it is sufficient to press the tooth gap tightly with a swab. It is usually only necessary to suture the wound by pulling an operative tooth.
What are the risks of tooth extraction?
In the vast majority of cases, tooth extraction is uncomplicated – 90 percent of procedures are successfully completed within five minutes. Nevertheless, complications can occur. These include
- fracture of the crown or root of the tooth
- swelling or bruising
- Injury of adjacent structures, such as neighboring teeth or nerves
- Opening of the maxillary sinus
- inhalation or ingestion of tooth parts
- infection or bleeding
Endocarditis (inflammation of the inner lining of the heart)
Interventions in the oral cavity can cause inflammation of the inner lining of the heart. This is especially true for people with congenital heart defects or patients with heart valve replacement. These “high-risk patients” are given so-called endocarditis prophylaxis as a preventive measure – an antibiotic administration before the dental procedure that reduces the risk of infection.