Wednesday, August 31, 2005

How to Extract Teeth

This is in response to a comment yesterday from Dave L, a first year dental student at UMB in Baltimore. You can check out Dave's site from my sidebar. Dave asks: "we haven't gotten to oral surgery yet I was wondering what is it about extracting teeth that makes it so difficult. I haven't seen a tooth extraction yet, but evidently there's a lot more to know than 'take a pliers and pull'."

Non Dental Types and the Squeamish might want to take a pass here....

Hey, thanks for the comment, Dave. To answer your question: Extractions are not hard, per se. Certain TEETH are hard. Go open your dental anatomy text and compare, say, #3 to #24. The molars, especially uppers, have three roots. If your text is like mine, it should show molars with a variety of roots, from convergent to highly divergent. if there's just one root, no problem, 2 minute extraction. 2 roots is harder. 3 is harder still. NOW pretend that the tooth is super decayed, so there's a minimal of cornal structure to grab on to! THAT was my patient yesterday. And there were two of those.

No, you don't just pull. You "luxate." Think of pulling up a fencepost. "Yanking" won't get you anywhere; you have to wiggle wiggle wiggle. bone is more flexible and less dense than tooth. So you can expand the socket. Then the tooth is ready to come out. If your roots are particulary divergent, you section into 2-3 pieces to remove in parts. If you don't have the access, you have to lay a perio flap (which is the gingival equivalent to peeling a banana) and then drill away the bone holding the tooth in. This is called a surgical extraction. To quote Dr. Hank, "If you're gonna take away bone...take away bone!"

A lot of dentists don't do surgical extractions, or extractions at all. They realize this is unpredicatble. The amount of time spent doing a surgical extraction (especially if you're not super good at it!) would be more economically spent doing a few crowns. So maybe you don't even have the equipment. This is what oral surgeons are for. This is why OSs can get up to $350 per tooth, as well.

Hank and I work in Community Health clinics and our uninsured patients are not super popular with the oral surgeons. So we end up doing a lot of it. We also end up getting pretty good at it; even a bit cocky. Some patient comes in, "Oh, Dr. Smith said I had to see an oral surgeon for that." Five minutes later, you're casually tossing that #16 onto a tray, making a flip remark like, "Congrats; it's a boy!" The patient is stunned. "Why did Dr. Smith think I needed an oral surgeon?" The temptation is to say, "Well, my friend; Dr. Smith is a, conservative practitioner." But we all know sometimes the tooth that looks easy isn't. So be careful of that.

Oh, and Dave - Please call them "forceps" from now on! If you even whisper "pliers" up in the clinic, the 4th years will peg you as the guy to send off in search of an "amalgam shade guide" when you start assisting.... word to the wise - Good luck!


chpetros said...

Extractions are the most basic dental procedure, but also one of the sneakiest ones. There are teeth that will come out in a few seconds and others that will leave you sweating and swearing. And whenever you have a busy schedule and you're running late, Murphy's Law states that you will get one of the latter extractions to completely mess up your day.
For anyone interested, I will soon cover (sorry Nate, not trying to steal your thunder here :) ) my adventures with broken apices and hedstrom files.

Dr Hank said...

Good commentary, Nate. I just finished slicking #1 and #16--approx 30 seconds each. (Of course, the signing sonsent and getting numb part took longer--2 minutes.)

Dave L said...


Lee said...

Very Slick Nate !
I am a fan!
Keep Blogging !

mysterious code blue said...

exos are not tricky. its the patients that are tricky...... i had a 35 yo fit man with no med hx watsoever. all cleared. the moment we pulled out the 36 and the 47 (decoronated so had to do root resection to remove the rest) he started trembling. and not just post-op kinda shaky. like full-on the dental chair was quaking! we were all like ... r u with me mate? and rushing about to get cold towels, call an code blue etc ...
and among all the chaos and commotion he was still conscious and said to me:
its alrite. i always get a shake after a tooth got pulled out.
and u just had to think: thanx for telling me NOW not earlier!
so there. i still dont kno wat his prob was. but he's off my hands now since the medicos took him to recovery room in 5 mins. oh well. sh*t happens.
yeah btw im a dental student who was so bored that she was google-searching for "vitrebond" thus finding jean's website (who happened to b someone in my course but 2 yrs below) which linked to yours. (gosh i must be bored.)
keep blogging. Qing

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Jen said...

Oh, I remember getting teeth pulled! And for what? BRACES, or as I like to call them, traintracks! I was upset about having 4 perfectly healthy teeth pulled...but hey...I want straight teeth, and this is the only way to make room! But I think that making a special blog for someone is so great. You probably help so many people and you must feel so great!