When The Best Option Is Removal
The Smile Anchorage and Dr. Ranney are always in the mindset to save teeth. Sometimes, however, they can’t be repaired and the best option becomes removing the tooth. If you are experiencing pain from a damaged tooth, call us right away at (502)243-9200 and schedule an appointment to evaluate your problems and get solutions.
A time may come when you need to have a tooth extracted. If your tooth cannot be saved then removing it and replacing it would be the next best option. There are a number of reasons that you might need a tooth to be extracted. The top reasons for removing a tooth from the mouth include:
The tooth is decayed, broken or damaged too much to be repaired
- The tooth or teeth need to be removed to allow space for braces to straighten your smile
- There is too much bone loss around the tooth for it to be saved
- Due to other medical treatment (radiation, chemotherapy, organ transplantation)
- Wisdom teeth that are problematic
There are two basic forms of extractions, the simple or the surgical. When your tooth is visible in your mouth, and not too broken down to warrant a surgical extraction, the tooth is removed by the process of simple extraction. During a simple extraction, the tooth would be numbed using a local anesthetic. Once numb, the tooth can be removed with some simple instruments.
If the tooth is very decayed or damaged, broken off at the gum line or below, or has other complications, then you might require a surgical extraction. During a surgical extraction, the process differs in that an incision must be made and typically a small amount of bone around the tooth must be removed.
Occasionally, a simple extraction can become a surgical extraction during the process or removing a tooth. If the tooth breaks apart during the extraction, it may have to be removed in pieces.
Extractions Of Wisdom Teeth
Wisdom tooth extractions are more often than not a surgical extraction. Only about 4% of all people have room for their wisdom teeth within their jaws, without causing problems to the other teeth. For the remaining 96% wisdom tooth extraction is often required in order to maintain a properly aligned and healthy mouth.
Wisdom teeth, also called third molars, are often impacted. This means that there isn’t enough room for them to grow in properly, and they can become stuck completely in the bone, or they can be partially in the mouth and partially stuck in the bone. Often they grow in the wrong direction or at an unusual angle, and may need to be removed. The wisdom teeth may need to be removed if:
- They are causing pain
- They get an infection
- Their growth causes damage to the tooth next to them
- A cyst develops around them
- They are causing your other teeth to move or become crowded
- You want to prevent future complications due the wisdom teeth
Preventive or prophylactic removal of wisdom teeth is sometimes recommended. If your wisdom teeth are not causing you any problems, and they do not look like they would cause problems in the future, we may recommend that you do not have them removed. However, it is impossible to predict the future behavior of wisdom teeth, and so we may recommend that you have them removed. Having them removed at a younger age has some benefits. Older patients experience greater complications and longer healing times than younger patients. The decision to remove wisdom teeth is sometimes split, and perhaps only one or two may warrant extraction. Call The Smile Anchorage and get a complete exam and consultation regarding your wisdom teeth.
Frequently Asked Questions
The Smile Anchorage and Dr. Ranney get many questions about tooth extractions. Here are some of the more common questions we get in our office.
The cost of any particular procedure is going to vary depending on a number of factors. For example, you may have an insurance plan that has a specific contracted payment amount, or you may have an insurance co-pay or deductible. For an accurate cost on any particular treatment, please contact our front office staff and we will gladly help you determine your out-of-pocket costs.
The only way we can tell you for certain that you need an extraction is after an examination in our office. Call us right away at (502)243-9200 and schedule a time to see Dr. Ranney.
Just because your tooth is hurting doesn’t necessarily mean it must be extracted. There are treatments that may be able to relieve your symptoms without losing your tooth. However, if the tooth is too damaged to repair, a tooth extraction may be needed. Some of the reasons that might lead to a tooth extraction are:
- Decay that has progressed too far to fix
- Broken or damaged due to an accidental trauma (baseball to the face, kicked, etc)
- An infection that has abcessed
- Cracked or broken tooth
- Teeth that must be removed to make room for braces to work
Patients tell us that they like having all of their work done in one office. When possible, The Smile Anchorage will take care of your needs right in our office. However, if Dr. Ranney feels you should be fereffer to a specialist, you can rest easy knowing that you are being sent to someone we trust with your care and well being.
We recommend that our patients stick to a soft diet of cool-to-the-touch foods immediately following tooth extractions. Items such as pudding, yogurt, cottage cheese, applesauce, or gelatin. Hot foods (in temperature) and spice foods should be avoided. Until the wound in healed, it is best to avoid foods that are crunchy or hard, like potato chips, popcorn peanuts or other nuts. These can break into pieces that can become lodged in the wound and delay healing.
As time passes you may add foods that are more solid. For example, moving from applesauce and yogurt to mashed potatoes and well-cooked pasta. After that you may move into eating regular foods but you should be conscious of the wound and take care not to irritate or damage the area.
Sometimes a tooth might not hurt at all, but it may still need to be extracted. If the tooth was previously treated with a root canal, there would often be no pain associated with the tooth. However, that tooth can still be in terrible shape, and deeply decayed or damaged to the point that it requires extraction.
In order to properly diagnose your problem, x-rays are necessary. Without them we would just be making a guess as to the complete extent of your problem
The cost of an extraction can vary greatly depending on the circumstances. Will the extraction be routine or surgical? Are the teeth impacted in the jaw bone? Are there only root tips remaining? These are just a few of the factors that will determine the cost of the extraction. Call our office and schedule an appointment and consultation regarding your specific needs.
Most of the time The Smile Anchorage will be able to perform your extraction in our Louisville office. Our office performs both routine and surgical extractions, including impacted third molar wisdom teeth. If your extraction will be complex or we determine that you have medical needs that warrant the services of a specialist, we will refer you to one of our trusted colleagues.
Extraction Healing Factors
The length of time for healing can vary tremendously for multiple reasons. The two primary factors include the complexity of your extraction and how well you follow the post extraction instructions for the care of the wound. Avoid hot foods and beverages after an extraction. Avoid touching the extraction site. It is very important to suspend smoking for AT LEAST 48 hours after the extraction. For simple, routine extractions the healing time is usually a short time and with little or no symptoms that would keep you from your regular activities.
Some Pain & Bleeding Is Normal
It is not uncommon to have some bleeding for a couple of days after an extraction. Immediately following the extraction, keep a damp gauze on the wound with firm but not strong pressure. Continue for 20-30 minutes. Change the gauze and repeat a few time. A moistened tea bag can be placed over the site as well. Tannic acids in the tea help the blood to clot. Get a tea bag damp and place over the wound. Change as you would the gauze.
In general, pain or discomfort from an extraction is at it’s greatest 24-36 hours after the extraction. The tissues have time to react and some swelling occurs during that time period. So, the day after is typically the worst time, if there is any discomfort at all. Many patients report very little post extraction pain. After that you should feel a bit better as each day passes, provided that you are following the post extraction instructions. If pain persists, or intensifies, you may have a complication. Those complications include infection and dry socket, but could also indicate other problems. Foreign objects in the extraction site, bone fracture or other problems could be present. Bone sequestra, or fragments of dead bone, are possible. These problems are usually managed easily.
When To Seek Help
Call your dentist if the pain does not subside, or if it intensifies 36 hours post-extraction or beyond. Additionally, if the extraction healing is delayed due to a dry socket or other complication, call the dentist right away. If bleeding does not stop, or the bleeding is extensive, call the dental office as well. If you had sutures (stitches) placed, you may need to return to our office in 7-10 days to have those removed. In summary, if your symptoms are not improving after the second day, then you should contact our office to be sure that there are no complications from the surgery.
Dry Socket Defined
Before discussing what to do or how to prevent a dry socket, let us first understand what exactly is causing the problem. A “Dry Socket” is a condition called Localized Alveolar Osteitis. When the blood clot that initially formed in the extraction site is dislodged or dissolves too early it could lead to exposure of the bone or nerves inside that wound. Likewise, if the clot never formed in the first place the same problem arises. This exposes bone or nerves to the bacteria of the mouth, the air, liquids or foods that are eaten and other stimulants that cause pain. The pain is often intense. The problem can persist for a week or more.
Know The Symptoms
Pain after an extraction is normal. Post-extraction pain is usually the most intense on the night following your tooth removal. That means about 24 or 36 hours after the tooth is removed. Dry sockets are typically noticed a few days after an extraction. Pain is increased. Pain can be intense, even more so that the tooth that was causing your initial problem. That pain is often described as throbbing. Missing blood clots look like an empty hole in the jawbone. A lost blood clot often visibly reveal bone. Patients often state that they “see something white” in the extraction area. That white is often bare, exposed bone. The pain can often radiate, moving from the tooth site to your ears, eyes, neck or side of the head on the side where the tooth was removed. An unpleasant taste is often described. Additionally, a foul odor is often a sign.
Lower Your Risk Factors
While a dry socket can happen to anyone, they are more common in women. Smoking and tobacco use greatly increases the likelihood of problems. Use of oral contraceptives, less than acceptable oral care and not following the post-op instructions after an extraction are other factors. If you are experiencing a dry socket, it’s too late for prevention. But, if you have had an extraction and are looking to minimize your risk, there are steps you can take. Use medicated rinses if prescribed. Don’t smoke or use tobacco. Avoid alcohol. Don’t touch your extraction area. Stop drinking carbonated drinks for several days. Eat the recommended soft diet after an extraction.
Treatment & Relief
If you think you have a dry socket, call us immediately so that we can evaluate and treat the problem. If you are experiencing osteitis, we will clean and irrigate the area and place a medicated dressing. This medication-filled gauze usually begins to reduce the pain associated with dry socket within an hour. The medicated gauze must then be changed out every two to three days until the dry socket heals. This can take from just a few days and up to two weeks. Until you can get to our office, you may use over-the-counter medications like Tylenol (acetaminophen) or Advil (ibuprofen) to reduce the pain. Use an ice pack during the first two days to relieve swelling and pain. Avoid dehydration by drinking room temperature water.
We find that the best way to manage post surgical pain in the immediate days following an extraction is to use both a non-narcotic pain reliever and a narcotic pain reliever. Typically, if you have no allergies, we will prescibe a prescription strength Ibuprofen as well as a narcotic pain medication.
Each are to be taken every 6 hours. We have found that these work best when they are staggered by 3 hours. This means that while you take them each every six hours, you are not taking them on the same time-frame. For example, as seen in the infograph, you could take the narcotic at noon, and then take the Ibuprofen at three. This would mean that a new dose of medication would be entering your system every three hours.
By alternating the dose times you are able to maximize the benefits of the medication. After a period of about 3 days, you should be feeling well enough to discontinue the pain medications.
**NOTE: The medication in the image is for illustrative purposes only. Your medication may not look the same.
Bleeding after an extraction is normal, and some bleeding is actually a good sign. If there is some blood flowing to the site it typically means there is healing underway. You were likely given gauze after your extraction. The purpose is to use the gauze over the wound, and to bite down with continuous firm pressure for about 45 minutes, then change the gauze and continue the firm pressure. You should do this for a few hours or the rest of the day you have your extraction.
- Do not take the gauze in and out of your mouth as the pressure needs to be constant and consistent
- Make sure you are applying some pressure to the gauze, if it is just sitting on the wound it isn’t helping
- When you remove the gauze it will be red and wet, a little saliva mixed with a few drops of blood looks like a lot of blood
- Bleeding a little is normal, even for a couple of days
- You may have heard to use a tea bag to help stop bleeding. It’s TRUE! The tannic acid in the tea helps the clot to form
The blood or blood soaked gauze should look red. If it appears very dark, then you may want to call us to follow up. If you have blood filling your mouth, then contact us right away and we can assess the problem.
Most of the time when a suture (stitch) comes out it is not a problem. The stitches are put in place primarily to help with the control of bleeding and the formation of a blood clot after an extraction. If you have lost a stitch, even on the same day the extraction was performed, it is probably not an emergency.
An exception to this would be if you had a socket preservation or bone graft performed and the stitches have come looses. This can be a problem, and you should call us right away to find out if we need to see you in the office immediately.
Dental Insurance Plans
Our dental office is a participating provider for a number of dental insurance plans. The Smile Anchorage accepts the insurance plans of most of the major employers in the area. Notably this includes United Parcel Service UPS, Humana, Ford Motor Company, Yum! Brands, Papa John’s and many others.
Please keep in mind that your insurance coverage may be different that that of your co-workers. Even though you have the same provider, you may be enrolled in a different plan. Hence, plans can vary greatly. For example, your co-worker might have coverage for braces. In contrast, you may have no coverage for those procedures. By the same token your co-worker may pay $25 for a filling. Instead, you might pay nothing for a similar filling. The Smile Anchorage does not have any say in what your plan covers. Call or come by our office. Speak to one of our insurance specialists. They can tell you about your exact coverages.
You Have No Insurance
We know that many of our patients have no insurance. So, The Smile Anchorage has an in-house dental plan for those without insurance called The Smile Program. Firstly, The Smile Program covers twice per year cleanings. Secondly, exams are included two times per year. Likewise, all necessary x-rays are included. Thirdly, there are discounts on certain treatments. Additionally there are no claim forms. Equally important other benefits are explained on our New Patients page. Click here to learn more about The Smile Program.
The list of dental insurance plans that are accepted at The Smile Anchorage is not a static list. Correspondingly, changes sometimes occur. With this in mind, we advise that you call to confirm that your insurance is accepted in our office before you make an appointment.
A current list of insurance providers that are accepted in our office is shown below. Providers change. The list is updated as of July 2017.
LHI Logistics Health Incorporated
Lincoln Financial Group
United Concordia & ADDP United Concordia