Dr. Al Danenberg ● Nutritional Periodontist
June 24, 2019
I have been providing Skype consultations for several years. People have reached out to me with their dental and nutritional questions as far away as Australia. Questions have ranged from eating the perfect diet for dental health to complex questions about surgical procedures. One of the most frequent questions I have been asked recently is, “How can I be sure that my dentist extracts my tooth correctly?” These people have fears of tooth extractions because they have heard of some serious complications from improper surgical techniques.
So, let me give you my opinions. I’ll explain in detail what I think a dentist should or should not be doing when removing a tooth from your jaw.
Removing a Tooth
Basically, when a tooth is removed correctly, the bone will heal without complications. Obviously, the area is thoroughly numbed so that the patient will feel no discomfort. After the area is numb, here is how most conscientious dentists will remove a typical tooth:
An instrument called a “periotome” is wiggled around the tooth where it is attached to the bone. This dental tool loosens the fibers that attach the tooth root to the bone. Then a “forceps” and an “elevator” may be used to slowly put pressure on the tooth, which eventually loosens it further. The tooth should come out with minimal trauma to the bone.
The dentist then will completely clean out the socket with “curettes” to make sure no root fragments or unhealthy soft tissues are sticking to the bone surface lining the tooth socket. A normal “blood clot” will form in the socket naturally, and the area will heal with little to no discomfort. Sometimes, the dentist will place a “plug” of collagen into the socket to help the clot form.
If an implant will be used later to replace the missing tooth, a “bone graft” might be placed into the socket at the time of the extraction to strengthen the bone The dentist may want to protect the socket area while healing by inserting over the socket a “membrane”, which is sutured in place. Usually, these membranes and sutures will melt away slowly over time.
But if the extraction is done improperly, several bad outcomes could occur. Here are a couple of problems and how the dentist might avoid them:
“Cutting” the tooth out and producing excess heat
Sometimes the tooth is anchored so tightly in the jawbone that it must be “cut into sections” with a drill to remove it. If the “cutting” procedure generates too much heat, bone surrounding the tooth socket could burn and die. The result could be a “dry socket”, which is extremely painful.
A dry socket is when a normal blood clot does not form naturally in the socket immediately after the tooth is extracted. The reason could be infection in the healing socket or dead bone lining the socket’s inner surface. Living bone then becomes exposed with no blood clot. This causes pain, which could be excruciating.
The solution to prevent heating the tooth and the adjacent bone is for the dentist to bathe the area with copious amounts of saline during the “cutting” procedure to keep the area cool.
If a dry socket occurs, research has reported that raw honey placed into the socket area will improve healing and reduce pain. Also, the dentist could re-enter the area, clean it out appropriately, place Platelet Rich Fibrin (PRF), and allow the socket to heal. Platelet Rich Fibrin is obtained from the patient’s blood. Medical research has shown that PRF will hasten the healing process.
Removing the tooth but leaving unhealthy tissue inside the socket area
After the tooth is extracted, the dentist must “curette” or scrape the surface of the socket completely. If soft tissues or tooth fragments are allowed to remain in the socket, there is a significant risk that this dead tissue will cause various problems.
One problem would be infection developing in the socket area. This isolated area of infection might be retained within the bone well after the area “heals” creating a bone lesion.
Another problem would be chronic inflammation developing as the immune system reacts continuously to the retained dead tissue.
None of these problems might cause immediate pain. Unfortunately, it may take months or years after the tooth was extracted for symptoms to manifest locally or in other areas of the body. If these lesions in the bone occur, they will need to be removed ASAP.
If the lesion is not removed, the isolated infection could break out of its restricted space in the bone. It could travel through the bone, the lymph tissues, and the blood system creating chronic infection and diseases in other areas of the body. Also, chronic inflammation beginning in this restricted area in the jawbone could spread systemically and affect other organ systems.
Sometimes these infected areas or lesions are called “cavitations”. To prevent these “lesions” from occurring, the dentist should clean out the socket thoroughly immediately after the tooth is removed as I have described.
To remove these lesions, the general dentist or oral surgeon will need to enter the area surgically.
First, the inner surfaces of the bone lesion must be “curetted” or scraped to remove unhealthy tissues. Then, some dentists might use a laser light or ozone to help “sterilize” the bone lesion. When necessary, a “bone graft” could be placed into the damaged hole inside the bone to strengthen and help remineralize the area. On some occasions, the dentist might insert PRF into the space in the jawbone to help healing.
You probably will not tell your dentist how to extract your tooth. But you could ask your dentist to explain the procedure. Ask specific questions. If you don’t hear what you want to hear, ask more questions. If you are not satisfied with the dentist’s responses, find another dentist!
You may have your general dentist perform the extraction, or you may want an oral surgeon to extract your tooth. Oral surgeons, who are dental specialists, usually perform more complicated extractions than general dentists. No matter who removes your tooth, most extractions will not cause excessive discomfort, pain, or other complications when performed correctly.
I had a tooth with a root canal extracted correctly (bone burred, soft tissue removed, ozone and PRF used) yet the dentist thinks the bone isn’t as dense as he’d like it to be 22 months later (as per a cone beam xray of the jaw). Is there another test that can be done to confirm whether it’s a cavitation vs slow bone growth (perhaps due to being 2 years into menopause at the time)?