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Extractions/Oral Surgery
Why are teeth extracted?
Teeth may need to be removed for a variety of reasons. Below are some examples.
Very large cavity/ caries that cannot be restored.
Periodontal diseases or in simple words diseases of the gums.
Fractured or broken teeth
Teeth that are traumatized leading to infection and inflammation of the pulp.
Teeth that fail to erupt or are unable to erupt into the mouth and are deep inside the bone. They are called impacted teeth and may have to be removed.
Long standing infection or an Abscess in relation with any tooth.
Teeth that are abnormal in development i.e., structure, shape, size, etc.
Teeth that are involved in cysts or tumors.
Ectopic teeth that have erupted in a wrong place.
Sometimes the orthodontist may remove some teeth to correct crooked teeth.
How is a tooth extracted?
tooth extracted
tooth extracted
There are two basic methods of tooth removal. The first method requires dental forceps and is suitable for the majority of teeth that have erupted. In this method the tooth is held at its neck by forceps and rocked gently to expand the surrounding bone socket. This action can be likened to removing a post set in the ground by rocking it sideward.
The second method is reserved for those teeth which are not erupted (impaected), those teeth whose roots either cannot be gripped using the forceps or the roots are of odd shape and defy all efforts to remove them by using forceps. In this method, the gums are cut open and the bone around the tooth is cut to allow removal of the teeth 
Does it pain while removing a tooth?
Extractions are done after administration of local anesthesia that makes the tooth and the surrounding tissues numb. Thus extraction procedure generally are not painful. But a feeling of pressure may be experienced by the patient during the procedure.
What care should be taken after extraction?
The following care should be taken after extraction:
Bite on a gauze pack for 15-20 minutes.
Do not spit or gargle on the day of extraction.
Take rest and avoid physical activities.
Avoid eating till the numbness of the anesthesia persists.
Avoid warm food as it can result in bleeding. In addition soft food is advised.
The dentist may advise cold fomentation for some patients to reduce the inflammation and swelling.
After 24 hours warm saline mouthwash helps in keeping the wound clean.
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Why is the wisdom teeth removed so often?
wisdom teeth removed
The wisdom teeth are the third molars, which are the last teeth in the dental arch. The teeth usually erupt between 18 and 25 years of age. In many individuals, the wisdom teeth remain in the bone as there may not have adequate space in the dental arch to emerge out. This condition is called impaction. In addition the third molar may erupt in abnormal inclination thus affecting the health of the adjacent teeth. So the wisdom teeth need to be removed often.
wisdom teeth removed
Upper impacted wisdom tooth
Lower impacted wisdom tooth
Why is it difficult to remove the wisdom tooth?
The wisdom teeth are often inside the bone and therefore cannot be removed easily by using the forceps. In addition their position and angulation may be abnormal. They often require surgical extraction by cutting open the overlying gums and cutting the bone around the teeth.
wisdom teeth removed
wisdom teeth removed
Impacted Molar
Soft tissue & underlying are removed
The teeth is Loosened by using an elevator
The tooth is Lifted with the elevater
The tooth is extracted and the site is sulsrrd
Why does a swelling appear after extraction?
Some extractions are followed by appearance of swelling. There is nothing to worry about, as it is a part of normal healing process. In reaction to the extraction, the tissues show an inflammatory reaction to heal the wound created by the removal of the tooth. Swelling is a part of the normal inflammatory process. However the dentist may advice you to have cold fomentation over the area to reduce the swelling. 
What are sutures and why are they given?
Sutures are stitches which maybe given after an extraction. These stitches help in approximating the gums and therefore restrict the size of the wound. Sutures also help in controlling the bleeding.
Should sutures be removed?
Sutures are of two types: absorbable and non-absorbable. The absorbable sutures are broken down by the enzymes in the human body. So they just dissolve in a few days and need not be removed. The non-absorbable sutures need to be removed after 7-10 days.   
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What is local anesthesia or LA?
Local anesthesia is temporary loss of sensation to pain and other sensations such as pressure, temperature and touch in a localized area. This is done by injecting a local anesthetic drug around the tooth being extracted. This numbness lasts for a few hours. Most extractions are done under local anesthesia.   
What is general anesthesia?
General anesthesia is reversible loss of consciousness along with loss of all sensation. General anesthetic drugs also help in controlling pain and relax the muscles of the body. General anesthetics are used in complicated surgical procedures that may take a long duration and when the surgery is done in multiple sites. They are also useful in unco-operative patients.         
Can extractions be done on a patient having medical problems?

The dentist must be informed of any medical problems that you may have or had in the past. There are certain systemic problems, which may require certain precautions during the dental treatment so as to avoid complications. In some cases the dentist may require consent from your physician before he can extract. Some of the systemic conditions are mention below.

Blood pressure problem or cardiac problem
HIV infection or AIDS
Hepatitis A/B/C/E
Thyroid disease
Hyper acidity or gastric problem
Cancer Chemo therapy or radiation
Taking anti platelet agents like aspirin
Taking immunosuppressive drugs or steroids
Any major surgery done
Can extraction be done on a heart patient?
Usually extractions may not pose any problems for heart patients. However the dentist may require your physician's consent. Patient is Advised to Stop any Antiplatelet drugs (Aspirin) Prior to any Procedure. In addition prophylactic antibiotics may be prescribed prior to the extraction as a precautionary measure.
Can extraction be done on a diabetic patient?
Patients who have their diabetes under control by diet and medication can undergo extraction. However the dentist may give you a prophylactic antibiotic prior to the procedure. He would also advice you to have normal food and medicine before the appointment. 
What is a cyst?
A cyst is a fluid filled cavity that can occur in the soft tissues or the bone. They are of different types and may be asymptomatic or may be associated with swelling and pain

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How are cysts treated?
cysts treated
Cysts are usually filled with a fluid and are lined by a layer of tissue. Cysts are treated by surgically removing the lining and draining the fluid that is found inside. The normal tissues grow into the cavity in due course of time. However sometimes the cysts have a tendency to reform in the same area.
cysts treated
cysts treated
cysts treated
What is a tumor?
A tumor is uncontrolled duplication of certain cells in the body. Tumors are of 2 types - benign and malignant. Benign tumors are relatively harmless while the malignant tumors are serious and tend to spread to nearby and far tissues and pose a threat to life.
What are the causes of oral cancer?
Oral cancers can occur due to a number of factors such as chewing of tobacco and betel nut, excessive alcohol intake, smoking, tissue irritation from sharp tooth or ill fitting denture etc.
How do oral cancers present?
Most oral cancers may appear as a swelling or painless ulcer. Sometimes a patch of whitish tissue or red tinged tissue may be seen. Pain is usually a feature in the late stages due to infection of the lesion. The cancer can spread to nearby and far tissues.     
How are oral cancers treated?
Oral cancer is treated by one or more of the following:
1. Chemotherapy: This means the tumors are treated by drugs or chemicals that kill the tumor cells. These drugs are usually very toxic to the body.
2. Radiation therapy: The tumor is exposed to radiation, which is found to cure certain tumors.
3. Surgical removal: The entire tumor is removed along with a border of normal tissue. In case the tumor has spread to nearby lymph glands, they may also be removed surgically.                         
What are precancerous lesions?
They are certain lesions of the oral tissue that show an increased risk of transforming into malignant oral cancer. These lesions are called precancerous lesions. The dentist will try and determine what type of lesion it is and take treatment measures so as to prevent malignancy from developing.           
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