Removing the root of a damaged or rotten tooth: does it hurt, the removal process

1. Removal cost
2. Indications
3. Preparation
4. Methods and steps
5. Complications
6. What to do after the procedure
7. Our doctors
8. Reviews
9. To make an appointment with a doctor

In practice, specialists at Plomba dentistry periodically encounter cases of complete destruction of the crown of a tooth and infection of the root system, in which a purulent-inflammatory process occurs. Most often, this problem can be solved only by removing the root and remains of the tooth. But sometimes the root system can be preserved for subsequent prosthetics. How the removal will be carried out, what measures and tools will be used, the doctor will be able to decide after familiarizing himself with the clinical picture.

Indications for tooth root removal

• Complete destruction of the coronal (supra-gingival) part, affecting the root system;
• extensive purulent-inflammatory process at the root: cyst, abscess;
• longitudinal axial fracture;
• previous incorrect extraction - during removal, fragments remained in the hole, causing an inflammatory process that affected nearby tissues.

The damaged area of ​​the tooth is easily identified visually. Additional symptoms of the need for urgent medical intervention and even possible removal of a diseased tooth are:

• twitching, throbbing pain;
• acute pain due to mechanical action - pressing, biting, chewing food;
• unpleasant odor;
• gum hyperemia;
• a purulent process is a direct indication of the need to remove the root of a diseased tooth;
• elevated body temperature.

If one or more symptoms are present, the destroyed units are removed. In some cases, incomplete removal is performed - resection of the tooth roots. This usually occurs when the root apex is affected by periodontitis, a small cyst, or granuloma. Often in such diseases the coronal part is preserved. In this case, the damaged part is removed through an incision in the gum. Subsequently, installing a crown solves the problem of restoring the chewing unit.

Tools used for complex removal

When extirpating figure eights, a number of instruments are used:

• Pliers consisting of cheeks, a handle, and a lock are used if the crown is not destroyed or is slightly damaged (there is something to grab onto). They differ in shape, structure, and size. Different forceps are used to extract the upper or lower tooth.
• The elevator acts like a wedge - it loosens the dental unit, tearing the ligaments and pushing it out of the socket. The tip is immersed in the periodontal fissure, then rotated around the axis using a handle. It removes fragments well from a damaged crown, a shallow fracture, and is suitable for the extraction of dystopic, impacted teeth.
• An excavator is used to extract softened parts and root fragments. It has an angular shape with pointed edges. Easily inserted between the alveolus and the remaining tooth.
• The chisel allows you to destroy the interroot connection, actually gouges out the tooth, but is rarely used for the figure eight.
• The drill is used to divide a multi-root system into parts, especially in cases of crown destruction, atypical location, impacted teeth. The gradual extraction of dental elements causes less trauma to surrounding tissues.
• An osteotome is used to cut and remove part of the bone that is blocking the removal of a molar.

Modern techniques include the use of laser or ultrasound equipment. In this case, fewer complications arise, and the recovery period takes less time.

Preparing for tooth extraction

Removing a tooth or its roots is a rather complex surgical dental procedure, but it will not be difficult for the patient to prepare for it. If local anesthesia is planned to be used for pain relief, the patient should eat a large meal before visiting the dentist because:

• After removing a tooth or root, it is forbidden to eat for several hours;
• salivation after eating is significantly reduced, which will make the dentist’s work easier;
• after eating, blood glucose levels are normalized and the risk of loss of consciousness under the influence of local anesthesia is reduced

In the case of general anesthesia, on the contrary, it is necessary to abstain from eating for several hours before the removal procedure begins. Drinking alcohol before visiting the dentist is prohibited. Alcohol affects the structure of the blood and does not combine well with anesthetics, not to mention the negative impact on the human psyche and behavior.

Inflammatory and infectious diseases of any nature must be cured before surgery to remove a tooth or its roots. The dentist must be warned about the presence of allergies to certain medications, in particular to anesthesia drugs.

A normal pregnancy in general is not a contraindication to dental procedures. However, during this period the use of a number of drugs used in dentistry is prohibited, so information about pregnancy is entered into the patient’s dental record. Also, detailed information about the patient’s chronic diseases, especially heart pathologies, is recorded in the dental record.

Anesthesia (pain relief)

To minimize discomfort during an injection, you need to treat the injection site with a special anesthetic gel. This is the so-called topical anesthesia. It is very often used in pediatric dentistry, but we also use it in working with adults. As practice shows, there are fewer unpleasant sensations, and the taste is pleasant... at least some kind of joy.

When removing teeth from the upper jaw, as a rule, a simple infiltration of anesthetic into the area of ​​the tooth being removed is sufficient. It is carried out using a special syringe with specially selected anesthetics and is called infiltration .

When removing teeth on the lower jaw, infiltration anesthesia is usually not enough (with the exception of the frontal group of teeth, from canine to canine). Therefore, the anesthesia technique changes somewhat - the anesthetic, using a long but very thin needle, is applied directly to the nerve bundle responsible for the innervation of the desired areas. This anesthesia allows you to “turn off” sensitivity not only in the area of ​​the tooth being removed, but also in the lip, chin, part of the tongue, etc.

It should be noted that during and immediately after anesthesia, a number of interesting phenomena may be observed - increased heart rate, trembling of limbs, an inexplicable feeling of anxiety. Many patients begin to panic about this. But there is no need to panic! These are side effects of most modern anesthetics and go away on their own within 10-15 minutes.

Well, the anesthesia is done! Now you need to make sure that it was carried out successfully?

Those places that should ideally be numb are listed above. Also, using a special instrument and pressing on the gum in the area of ​​the operated tooth, we determine whether the pain still remains or no longer exists. The only thing that should be felt is the sensation of “something” touching the gum. That is, tactile sensations are still preserved, but pain is no longer present.

And then our actions differ depending on what type of wisdom tooth we are dealing with.

Methods and stages of removing teeth or their roots

Most often in modern dentistry, only two methods of removing teeth or their roots are practiced:

• removing a tooth from the gum using forceps;
• rocking of the tooth and its rotation around its axis by elevators.

In cases where the roots are deep, the gum tissue can be cut with a scalpel. In general, the process of removing teeth or their roots is divided into the following stages:

• separation of the round ligament from the neck of the tooth (ligamentotomy);
• applying (installing) forceps to the tooth;
• advancing the fixing elements of the forceps under the gum;
• final fixation of the forceps;
• rotation (rotation) or luxation (swaying) of the tooth;
• extracting a tooth or its roots from the socket.

Dystopic tooth

Removing such teeth can be called a simpler case compared to others, but only if the tooth has one straight root. Then the removal can take place quite quickly. But such clinical cases are extremely rare. And, looking at the picture, we see hooks, not roots, which, with proper pressure, can simply break. There are usually 2 roots, and in this case we just need to separate one root from the other using the same tool - the “raising” tip. And carefully remove each of the roots separately. The beginning and completion of the removal of such teeth is the same as for all others.

Common complications after tooth extraction

Tooth extraction is essentially a full-fledged surgical intervention. Symptoms such as pain and inflammation in the surgical area are considered normal for the rehabilitation period, unless they are too severe and are not eliminated 3-4 days after tooth (root) extraction. The rehabilitation period may also be characterized by increased body temperature and enlarged lymph nodes.

More serious clinical complications include:

• renewed bleeding from the socket after tooth (root) removal - methods for eliminating minor bleeding can be discussed by the dentist; in case of intense bleeding, it is necessary to urgently consult a specialist;
• incomplete removal of the tooth root - the presence of residues is diagnosed by x-ray and follow-up and quickly eliminated;
• alveolitis is a dangerous, but easily eliminated by antibiotics, inflammatory process in bone tissue, characterized by a significant increase in body temperature, swelling, severe pain, and requires immediate treatment, as it can lead to sepsis.

In the first hours after removal, the patient should not eat. Cotton swabs from the surgical area can be removed 30 minutes after completion of all manipulations. In the first days after surgery, it is not recommended to eat sour, sweet, salty, very chilled or hot foods. Short-term cold compresses can relieve pain in the first days after tooth extraction.

Tooth extraction is a last resort in modern dentistry. A qualified specialist must strive by all means to save the tooth even in the most difficult cases.

The final stage of restoring oral health is not the removal, but the replacement of teeth (except for wisdom teeth).

Main stages of the operation

• Syndestomy;
• Forceps delivery;
• Advancing the forceps to the area of ​​the tooth neck under the gingival margin;
• Fixation;
• Luxation (rotation);
• Traction (extraction).

When removing a tooth with forceps, you must follow the following basic rules:

• Apply the cheeks of the forceps only to the vestibular and internal surfaces.
• The longitudinal axis of the cheeks of the forceps must coincide with the longitudinal axis of the tooth being removed.
• Avoid placing the tip of the cheeks of the forceps on the edge of the alveolar process and avoid subperiosteal resection of the edges of the socket.
• When dislocating a tooth, you must remember the possibility of a fracture in the neck or at the apex of the root.

When removing the upper teeth, the patient sits in a dental chair with the back slightly reclined, resting the back of his head against the headrest. The chair is raised to a position in which the tooth to be removed is at the level of the doctor’s shoulder joint. The doctor stands to the right and in front of the patient. When removing lower teeth, the chair is lowered so that the tooth being removed is at the level of the elbow joint of the doctor’s lowered arm. When removing lower incisors, canines, premolars and left molars, the doctor stands to the right and in front of the patient; when removing right molars, the doctor stands behind and slightly to the right.

What to do after tooth extraction

The operation cannot be prescribed without an X-ray examination, which makes it possible to determine the amount and degree of root destruction and the extent of the inflammatory process. Before root removal, the patient is given anesthesia, after which the gum is separated from the neck of the tooth. The surgeon's further actions are determined by the clinical picture. Dentists call the most difficult operation the removal of the deep and often twisted roots of the “figure eight” – the eighth tooth in the dentition. But the specialists of the Plomba clinic successfully cope with this too.

Removal methods

There are two main types of extirpation - a simple removal method and a complex method.

Complex removal method

It is carried out in cases where there is no access to the tooth, application of forceps is impossible and additional access must be made through an incision in the gums. During a complex operation, the tooth is not removed immediately, but in parts.

For this, a whole set of special tools is used:

• laser,
• saw,
• scalpel,
• burs.

Complex removal may be indicated in the case of a cystic formation under the causative tooth, fistula, dystopic wisdom tooth, or retention. Contraindications to the procedure are pregnancy, allergies to anesthetic drugs, mental illness, problems with the endocrine system. But if certain conditions are created, extirpation can be carried out even in the presence of these contraindications.

Simple operation

This method does not require additional preparation; it is removed by applying standard forceps, after which the bleeding stops and further measures are taken to restore the dentition.

Price

The cost depends on the technology used:

The case includes:

• anesthesia;
• operation;
• removal and application of sutures.

Additional services:

Contraindications

• acute diseases of the cardiovascular system;
• high blood pressure numbers;
• infectious processes in the body;
• menstruation period in women, since blood clotting time is increased, which threatens bleeding after extraction;
• acute, severe diseases of the central nervous system;
• pregnancy, lactation period;
• purulent-septic processes in the oral cavity, which provokes sepsis; mental disorders.

The possibility of extracting a diseased tooth appears after treatment of these pathologies and stabilization of the patient’s condition. In case of an emergency, the doctor performs removal in a patient with concomitant diseases. Severe pain syndrome is the cause of exacerbation of chronic pathology.