Extractions

While we do our very best to save teeth, some teeth require extraction.

Most common indications for tooth extraction:

  • A "baby" or deciduous tooth that is over retained (reluctant to fall out), severely decayed, or damaged

    In most cases, a baby tooth will fall out as scheduled as the underlying permanent one begins to erupt into place. However, occasionally a baby tooth continues to remain firmly attached to the bone. Either the roots of the baby tooth have failed to resorb and shrink as intended, or the baby tooth has become anklylosed and fused to the supporting bone. The problem is that over-retained baby teeth can disrupt the development and alignment of your child's smile. As we monitor your child's smile as they grow, we'll advise you if and when an extraction of a baby tooth is required to facilitate the eruption of its underlying permanent successor.

  • A permanent tooth that has extensive decay and is deemed non-restorable
    Beginning as a simple pinpoint defect on the outermost enamel layer of your tooth, untreated dental decay will continue to compromise healthy tooth structure as it works its way to the inner layers of the tooth. Without proper care, a cavity can lead to significant damage to tooth structure, irreversible damage to the nerve of the tooth, a dental infection, and serious consequences to your oral health and overall well-being. When the tooth has sustained far too much structural damage and cannot be restored, a dental extraction may be required.

  • A permanent tooth that has been severely fractured or cracked and can not be restored
    There are many different types of chips, cracks, and fractures that can affect your teeth. The extent of the damage that it causes will determine if there is enough intact tooth structure to save the tooth and the type of treatment required. In cases where too much tooth structure or the root of a tooth has also been compromised, an extraction may be necessary.

  • Advanced gum disease that has significantly compromised the tooth's supporting tissues
    The most common cause of tooth loss in adults is gum disease. When left untreated, periodontal disease, which affects the hard and soft tissues supporting your teeth, can lead to gingival pocket formation, gum recession, and diminishing alveolar bone. As advanced and untreated gum disease progresses, the teeth ultimately loosen, fall out, or require extractions.

  • Poorly positioned, impacted, or decayed wisdom teeth
    Wisdom teeth, which are also known as the third molars, are the last permanent teeth to develop in the oral cavity and the final ones to come into place. However, as is often the case, many wisdom teeth do not have sufficient room to erupt, are not developing correctly, develop extensive decay, or cause issues for the adjacent teeth and the surrounding tissues. Although the extraction of wisdom teeth sometimes gets recommended for an older patient, the early removal of troublesome or potentially problematic third molars in young adults is more often the case.

  • Overcrowded Teeth
    A tooth size to jaw size discrepancy often results in a crowded and misaligned smile. More simply put, the upper and lower jaws are not large enough to accommodate all the permanent teeth. As part of an orthodontic treatment plan to optimally align teeth and establish an attractive, healthy, and functional bite, the extraction of select permanent teeth may be required.

What to expect

At the time of the extraction, your doctor will numb the tooth and surrounding areas with a local anesthetic. Once you are completely numb, we will wiggle the tooth and use an ultrasonic tool to widen the ligament space within the bone for gentle removal. During this process, you will feel pressure but not pain. If you are anxious about having your tooth extracted, please let your provider know, who may discuss an anxiety alleviating medication to help you feel relaxed and comfortable during the procedure. We also recommend to bring some headphones along with your favorite playlist to put you most at ease!

Post-Operative Instructions

Once your procedure is complete, it’s important for a blood clot to form to stop the bleeding and begin the healing process. That’s why we ask you to bite on a gauze pad for at least 45 minutes after the appointment. Do NOT talk. Do NOT spit. If the bleeding or oozing still persists, change the gauze when it becomes saturated or every 2 to 3 hours. When the bleeding stops, the gauze may be removed. A small amount of ooze (bloody saliva) is normal for the first 24-48 hours. Hint: cover your pillow with a towel to prevent blood stains.

After the blood clot forms, it is important not to disturb or dislodge the clot as it aids healing. Do not rinse vigorously, smoke, use straws, spit, drink alcohol or brush teeth next to the extraction site for 72 hours. Also, avoid heavy exercise. These activities will dislodge or dissolve the clot and retard the healing process. Limit vigorous exercise for the next 24 hours as this will increase blood pressure and may cause more bleeding from the extraction site.

Warm salt water rinses (1 tsp./6 oz. water), 3-4 times per day, beginning the day after your surgery will aid in healing. Do not rinse or spit forcefully.

After the tooth is extracted you may feel some pain and experience some swelling. Keep your head elevated (use some extra pillows) relative to the rest of your body. An ice pack or an unopened bag of frozen peas or corn applied to the area will keep swelling to a minimum (Do not apply ice directly on the skin). Use the ice pack as much as possible for 24-48 hours (30 minutes on and 30 minutes off). Stop using ice after 48 hours. Start utilizing heat on the 3rd day. If you have a removable gel pack then place it in the microwave at 5 second increments until hot. Place gel packs into a sleeve or wrap to avoid injury and direct contact of the heat with your skin. Swelling usually peaks between 48 to 72 hours.

Take pain medications as prescribed for pain. Hint: Do NOT take any medication on an empty stomach especially pain medications. Usually pain is greatest after the local anesthesia wears off and gradually improves within the first 48 hours. Even if you have no pain whatsoever, it is recommended you take ibuprofen (only if you are not hypersensitive or allergic) 400 mg by mouth every 4 hours for the first 24-48 hours. If you are taking any medications on a regular basis, please continue to do so, unless instructed otherwise. Call the office if the medication doesn’t seem to be working. If antibiotics are prescribed, continue to take them for the indicated length of time, even if signs and symptoms of infection are gone. Drink lots of fluid and eat nutritious soft food on the day of the extraction. You can eat normally as soon as you are comfortable. Do NOT drive while using narcotic pain medications.

Initial Food suggestions (examples only) – Start soft and advance as tolerated. Start with room temperature or colder water or soda to make sure the stomach is settled but DO NOT drink with a straw because it may cause dry socket. Avoid hot liquids. Avoid alcoholic beverages. For the first 2 days consider foods that require very little jaw movement and will minimize soreness during the healing process including:

  • Ensure with protein, Milkshakes or Smoothies
  • Soups or Broths
  • Ice Cream or Sherbet
  • Pudding, Jell-O or Applesauce
  • Oatmeal, Cream of Wheat or Grits
  • Scrambled, Poached or Fried Eggs
  • Pancakes or French Toast
  • Pasta
  • Mashed Potatoes
  • Fruit

These are only suggestions! Avoid seeds, nuts, popcorn, potato chips, and crumbly foods.

It is important to resume your normal dental routine after 24 hours. This should include brushing and flossing your teeth at least once a day. Rinsing may be performed after bleeding ceases and should be performed gently. This will speed healing and help keep your mouth fresh and clean.

Nausea and vomiting can and does occur, usually because of swallowing blood. Medications can also cause nausea. Taking small sips of a carbonated beverage and rest sometimes will help ease an upset stomach. While nauseated, gently continue clear liquids to prevent dehydration. For severe or persistent nausea, do NOT take anything except Advil or Tylenol for pain; use lots of ice. Once nausea ceases you may resume the medications as directed. If nausea and vomiting continue for longer than 15-24 hours, call the doctor for further instructions.

After a few days you will feel fine and can resume your normal activities. If you have heavy bleeding, severe pain, continued swelling for 2-3 days, or a reaction to the medication, call our office immediately.

Frequently Asked Questions

What are the most common reasons for an extraction?

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The most common reasons for tooth loss include advanced periodontal disease, extensive tooth decay, and facial trauma. According to statistics, gum disease is responsible for close to 70% of tooth loss in adults. Although less frequent than the preceding three reasons, it should also be noted that specific diseases, drugs, smoking, and poor nutrition contribute to the risk of tooth loss.

How common is tooth loss?

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The Centers for Disease Control and Prevention report that in the United States, an average of 12 teeth (including the wisdom teeth) are lost by the age of 50. Also, 26% of adults between 65 and 74 years of age have lost all their teeth.

Does it hurt to have a tooth extracted?

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Every patient and every situation is different. However, when a tooth and the surrounding tissues are numbed with a local anesthetic, you should only expect to feel a bit of pressure, but no pain as the tooth is being loosened from the surrounding tissues and extracted. For patients who are apprehensive and for some surgical extractions, our office will discuss our options in dental sedation to provide further relaxation and reduce any sense of discomfort.

What will I feel when the anesthetic wears off?

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While it's normal to feel some tenderness and swelling following an extraction, the degree of these sensations can vary. It mostly depends on the complexity of the extraction and the body's response to the procedure. We'll recommend or prescribe the appropriate pain medication to help ensure your comfort and give you specific instructions for maximum effectiveness and safety.

How long does it take to recover from a tooth extraction?

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Typically, the recovery period following a simple extraction is shorter than a surgical extraction. However, a patient's overall health, habits, and the size and location of the tooth, and other variables can influence recovery and healing. To speed up the recovery and avoid any complications, patients must follow the given at-home instructions diligently. We'll carefully review what to expect following your procedure and go over your post-op instructions.

Why should one refrain from smoking following a tooth extraction?

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Smoking interferes with blood clot formation, which is an essential first step in the healing process. Blot clot formation not only provides a protective layer to cover the underlying exposed bone and nerve endings, but it also supports the growth of new tissue. Cigarette smoke also contains chemical toxins that can disrupt the healing process and lead to problems such as continued inflammation, infection, or dry socket.

What is dry socket?

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In a very small percentage of cases, a condition known as dry socket can develop in the aftermath of a dental extraction. This painful condition can arise when the blood clot in the extraction site doesn't form properly or gets dislodged. With dry socket, you may experience throbbing pain and symptoms such as bad breath and an unpleasant taste in your mouth. As skilled providers of care, our office will provide immediate treatment to alleviate your discomfort and promote healing.

Will I need my wisdom teeth extracted?

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The last teeth in your mouth to develop, wisdom teeth often do not have enough room to fully erupt or may be positioned in the wrong direction. These issues can affect your dental health as well as overall wellbeing. While some individuals never develop all their wisdom teeth, and a few have sufficient space for them, there are many people with partially or fully impacted third molars. Our office will monitor the development, position, and health of your wisdom teeth and will advise you if and when extractions are indicated.

What is the reason for a bone graft immediately following an extraction procedure?

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After a tooth is removed, bone-grafting material is sometimes placed in the socket to promote healing and encourage new bone development. This procedure is often performed to support the eventual and successful placement of a dental implant.

How much does getting a tooth taken out cost?

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At the office of Smiles Elevated, we strive to make dental care affordable and accessible. Depending on the type or complexity of the extraction and other variables, the cost of the procedure can vary. Based on our diagnostic findings, our office will inform you of the healthiest choices in care, explain the fees, discuss insurance coverage, and explain your payment options.

Are tooth extractions covered by dental insurance?

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Many dental plans offer some level of coverage for tooth extractions. We'll advise you if your plan covers the full cost of the procedure and if there is any out-of-pocket expense. Our business office will work with you to maximize your insurance benefits as much as possible while helping you minimize any out-of-pocket expenses.

Office Hours

Monday
7:45 AM - 4:30 PM
Tuesday
7:45 AM - 4:30 PM
Wednesday
7:45 AM - 4:30 PM
Thursday
7:45 AM - 4:30 PM
Friday
7:45 AM - 4:30 PM

Contact Us

5530 Wisconsin Avenue
Suite 1535
Chevy Chase, MD 20815

(240) 465-9066

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