With dental extractions, it is first imperative to make sure the patient does not feel pain and that he/she is not the least bit anxious. Patients that may not do well awake for oral surgery will need general or IV anesthesia. The rest receive local anesthetics injected into the back of the mouth and into the trigeminal nerve. After the anesthetics have kicked in, the dentist begins the process of a dental extraction, which goes something like this.
Using Separators to Make Opening Gaps Between Teeth
Any extraction that has at least one neighboring tooth next to the tooth to be extracted will require separators. These instruments are akin to clamps, except that instead of forcing things to stay together, these separators force things apart. The spacing created between the tooth to be extracted and the neighboring teeth is just large enough for the dentist to see what he/she is doing without doing any permanent harm to the neighboring teeth. The separators will stay put until the bad tooth is at least partially extracted.
Breaking the Tooth
If the tooth is already dead, drilling it until it fractures will help remove the tooth in chunks, which is much faster than trying to cut the tooth free and pull it out. If the tooth is still a viable living tooth but it cannot stay in the patient's mouth because of overcrowding, then the surgical dentist proceeds to the next step; incisions.
Cutting the Tooth Loose
A living tooth is connected to nerves, blood vessels, bone, and gum tissue. It will not come out half so easily as a dead tooth, so the dentist has to cut the tooth free. To do this, he/she makes sure the dental separators have given him/her enough room to work. Then he/she makes a lateral incision in the gum tissue to expose the jawbone underneath. This also loosens the gum tissue and makes it easier to pull away from the tooth that is to be extracted.
Next, the dentist will use a drill and a small bone saw made for dental procedures. It will cut through the base of the tooth just below the crown. This helps loosen the tooth from the socket in the jaw. The dentist has to work all the way around the tooth, especially if it is a molar because molars tend to have four roots where other teeth have only one root. As soon as the dentist feels the tooth wiggle just a little bit, he/she will take a pair of dental pliers and begin to wiggle and pull. This process is repeated until A) the tooth is out, or B) the dentist cannot get the whole tooth out this way and it becomes necessary to break up the tooth and remove it in pieces.