If a dentist has decided that tooth extractions will be complicated, then a referral to the oral surgeon may be advisable. A complicated tooth extraction means that the affected tooth cannot be removed by simple prying and pulling.
The dentist may recommend extracting a tooth if most of the crown (the part of the tooth above the gum line) is lost due to fracture or severely decayed and impossible to repair. It is also possible that the tooth broke during the extraction procedure, potentially leaving a tiny portion behind. If a significant portion of the tooth is missing, the remaining part may be hard to grab or manipulate with dental tools.
Aside from the missing pieces of the broken tooth, the remaining portion may be delicate. The affected tooth may appear intact, but a close examination by the dentist may show that the tooth will fracture during extraction.
The simple extraction procedure involves applying forces. Unfortunately, the same extraction forces may break the fragile tooth apart. This may make the remaining portion the tooth’s socket hard to remove, which may result in a complication.
The level of difficulty surrounding an extraction lies in the configuration of the tooth’s roots. This is usually why dentists recommend having wisdom teeth removed early. It is generally harder to remove a tooth with multiple roots such as molars, especially if they have curved, crooked or hook-like roots. Aside from the obvious complications, the process of pulling the teeth may demand excessive force that may lead to tooth breakage or damage to the gum and jawbone.
Similarly, larger, longer roots require more force to extract than those with smaller, shorter roots, such as the lower incisors. Longer, thinner roots are also prone to breakage during the tooth extraction process. This problem does not only occur with small teeth. The roots of molars and premolars are sometimes small and fragile and can break easily.
If a tooth with a long root has to be extracted, the dentist will not want to use excessive force, as that may injure the supporting tissues or cause jawbone fracture.
Impaction is a situation where the tooth is unable to erupt correctly. This could happen if the tooth tries to erupt at an angle or there is not enough space on the jaw. Therefore, the teeth will be buried in the gum tissue or even the jawbone. The teeth often prone to impaction are the third set of molars, also known as wisdom teeth. If a tooth is impacted, a surgical extraction would be necessary to remove it.
There are situations where the bone encasing the root of the tooth has an issue. This includes excess bone density, usually caused by excessive tooth grinding and clenching and age-induced bone inelasticity. Some patients may have surplus bone deposits in their jaws (exostoses), which may cause complications with teeth extraction.
Complicated tooth extractions must be handled by an experienced oral surgeon to prevent additional damages to the oral cavity.
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