Almost weekly, we see emergency patients referred for completion of teeth extractions already initiated by their dentist. Here is a common scenario: Dentist tells the patient that the tooth extraction is an easy one. He begins the procedure but gets stuck in the middle due to either difficult and strong roots or tooth fractures during extraction. After unsuccessful attempt of the extraction for an hour or two, the dentist finally stops and calls an oral surgeon for assistance. The patient meanwhile being awake during surgery has already suffered greatly through a difficult experience. The extraction site has been traumatized with torn gum tissue or excessive bone removal. Many of these patients never return to their dentist because of their bad experiences.
In my experience, any tooth that looks easy to extract, usually is not. Here are the most difficult teeth to extract:
- Erupted visible teeth that have been in function for years- As people age, the bone surrounding teeth becomes dense and hard making extractions more difficult.
- Teeth with prior root canal treatment- Such teeth break very easily and often require surgical sectioning and unique instruments for successful extraction.
- Wisdom teeth- Third molars often have multiple curved roots and are impacted in different positions. They are also close to a nerve that if damaged, can compromise sensation to the lip and chin. These factors make wisdom teeth extractions quite challenging without the right approach, experience, and instruments.
- Baby (primary) teeth- It may be counter intuitive, but baby teeth can be very difficult extractions. The roots are usually thin, relatively long, and often partially resorbed that can break very easily. The broken root tips must be removed carefully because they are often right next to the permanent teeth that are in development to replace them.
There are some dentists who may be more skilled with extractions, but it is important that patients inquire about their experience and ask for referral to an oral surgeon when appropriate. Remember, if it looks easy,it probably isn’t.