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10 September 2018

Dentist, Dr Minesh Patel, explains the reasons and methods for this common procedure

With modern dental methods and an increasing range of procedures at our disposal, any dentist will, quite naturally, want to preserve a natural tooth wherever this is possible. Even where a tooth has become badly decayed or broken, there are other options besides the common filling we can employ. Crowns, inlays, onlays and other methods can all be used to restore a tooth, depending on the type of work required.

Sometimes though, it simply may not be possible to save a tooth, or the prognosis for a damaged or infected one may be so poor that extracting it is the most sensible option available. When an extraction is needed, you can be sure that you will be in very capable hands at the Confidental Clinic here in Surbiton.

No gas?

Older patients who haven’t had any teeth removed for many years are sometimes surprised to hear that we no longer administer ‘knockout’ gas, as it was often known. It has been illegal for dentists to administer this since January 2002 (1) , and anyone who has medical needs that require this, will have to have their teeth removed in hospital, where a qualified anaesthetist is present. A good example of this is where a young child needs a tooth extraction. Whilst adults may be expected to work with the dentist using a local anaesthetic, a small child would be unable to do this and may present some danger to themselves during the treatment.

Instead of using nitrous oxide, modern dental practices use a very powerful local anaesthetic which works to prevent the patient from feeling any significant discomfort. This may appear to be little consolation to patients who are very nervous about invasive treatments; so to help them, we are pleased to provide IV sedation. This does not put the patient to sleep, but will leave them in a deeply relaxed state and able to undergo treatment without the stress.

We will also make sure that we are up to date with your current medical information. It is important that you do tell us any changes in medication as some of these may impact upon the treatment.

Removal of a damaged or decaying tooth

Once a tooth has been diagnosed as no longer fit for purpose and needing to be removed, the local anaesthetic will be given. After this has taken effect, the tooth will be gripped with a special tool and gently moved from side to side. This can feel strange and also sound unusual but should cause no discomfort. The purpose of this is to loosen the tooth from the bone and the cartilage which holds it in place. Once this has been done, the tooth is simply lifted from its socket.

Of course, there may be more complicated cases, such as where the crown has broken off, leaving just the root. This method cannot be used then, and, following x-rays, you may be referred to a specialist to have the tooth surgically removed.

Aftercare

To stop the bleeding, you will be given a piece of sterile gauze to press against the empty socket. This will allow a blood clot to form. Once we are happy that this has happened, you will be able to leave our Surbiton practice, armed with detailed aftercare information.

The most important part of this aftercare advice revolves around ensuring that the clot remains in place and this is essential to allow the wound to heal effectively. As the clot can easily be dislodged, special care will need to be taken to make sure that this does not happen. You must not ‘poke’ the blood clot with anything, including your fingers or tongue. Obviously, you will not be able to brush it, but you do need to keep it clean. Until it has hardened to the point where a soft brush can be used, you will need to use a warm (not hot) saline solution regularly, which should be tipped over the area and allowed to fall from the mouth. You should not spit as this may dislodge the clot.

Don’t do this!

A final word of warning to anyone suspecting that they need to have a tooth removed; please don’t attempt to do this yourself. There have been reports of people attempting to do this, sometimes encouraged by videos widely available on the internet. Using the ‘slamming door’ technique or even more original methods such as these (https://www.youtube.com/watch?v=-nTFyjQCOhc) may extract the tooth, but can also cause serious damage to the gum tissue and even the bone. This applies whether you are an adult or a child. Please don’t do this, and instead, allow one of our dental team to remove the tooth safely and with the minimum of discomfort.

Dr Minesh Patel has been a member of our Surbiton dental team since 2002 (GDC 73498)

Reference 1. https://www.theguardian.com/uk/2000/jul/22/sarahboseley

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