Oral surgery

When a tooth can no longer be kept

Extraction is always the last resort: a natural tooth, even repaired, is worth more than its replacement. It becomes necessary when the tooth is no longer restorable, when keeping it threatens the neighbouring teeth, or when an infection does not respond to root treatment.

• A tooth broken down below gum level, with no usable structure
• A vertical root fracture
• Terminal mobility from bone loss (advanced periodontitis)
• An impacted wisdom tooth, symptomatic or preventing proper cleaning
• A retained root left after an old fracture

How it is done

An X-ray always comes first: it shows the shape of the roots and their relationship to the sinus in the upper jaw and to the nerve in the lower. It is what determines whether the extraction will be simple or surgical.

Local anaesthetic removes the pain, not the sensation of pressure: that remains, and it is normal. The procedure is quicker than people expect; it is the waiting that weighs.

Aftercare, and what makes it worse

• Bite on the gauze for two hours, without constantly changing it
• Do not rinse or spit on the day itself: the clot that forms is what closes the site
• Cold on the cheek in fifteen-minute spells on the first day
• No tobacco, no alcohol and no physical effort for forty-eight hours
• Resume brushing the next day, avoiding the surgical site

Tobacco is the leading cause of dry socket — intense pain appearing on the third day, when the clot breaks down. It is the most common complication, and the most avoidable.

Think about replacement at the time of extraction

The bone that surrounded the root is no longer stimulated: it starts to resorb in the following months. Deciding on a replacement early — implant, bridge or denture — means working on bone that is still intact.

So the question arises at the moment of extraction, not a year later.