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Tooth Extractions

Most patients have suffered from the enduring pain of a toothache at various times during their lives. The reasons for tooth pain may or may not require tooth extraction, so it’s important to understand what conditions might require Dr. Flewelling to remove a tooth.

The foremost reason for tooth extraction is when a tooth is badly damaged from deep decay into the tooth, an infection that has destroyed the bone area supporting the tooth, or a fracture of the tooth that renders it non-repairable.

Another very common issue is that of rear molar teeth, often called “Wisdom Teeth” which are painful for some persons. These are more difficult to maintain and often subject to higher rates of tooth decay, as well as a source of crowding of nearby teeth. 


The problems are so frequently encountered that many patients elect to have problematic wisdom teeth removed as young adults.

Apart from the issues described above, other reasons for tooth extractions can include children who have baby teeth that do not fall out on their own in time for the arrival of adult teeth.

Other patients needing tooth extractions could be people who have “extra teeth” that are not a part of the regularly counted dentition, or people with genetic abnormalities of their teeth, that make it impossible to keep the tooth healthy for a lifetime. 

Infection Risks

A secondary concern giving rise to the need for pulling a tooth is that of infection. When tooth decay is significant enough to reach the very center of the tooth where nerves and blood vessels exist, (also known as the “Pulp”), bacteria can enter the Pulp and cause serious levels of oral infection to develop. If infection cannot be permanently corrected, tooth extraction is one of the options available to halt the spread of infection. The risks associated with oral infection are significant for all patients, but even more so for those having compromised immune systems.

Finally, when an infection of the bone and gum tissue causes a tooth to be loosened, it can be necessary to undergo tooth extraction. This condition is also referred to as Periodontal Gum


Medical and Dental History

Before a tooth is removed, Dr. Flewelling will conduct a careful review of your medical history to ensure there are no health issues or medications of concern. He will need your medical history, as well as all medications and supplements that are being taken. This information is of special concern when patients have a history of damaged or man-made heart valves, congenital heart defects, compromised or impaired immune systems, diseases of the liver such as Cirrhosis, or a history of Bacterial Endocarditis.

Once your medical history review has been completed, he will review dental history, and then take dental X-rays to determine the exact length, shape and position of the bone area and tooth in order to determine the degree of procedure difficulty.


As with any procedure, sometimes the use of a specialist for treatment will be necessary. An Oral and Maxillofacial Surgeon (OMFS) referral may be required if the tooth will require extensive treatment to remove.

Extraction Procedures

Once Dr. Flewelling has determined the appropriate procedure, the tooth and the area surrounding the tooth will be numbed using local anesthetic. This will involve giving you an injection of a local anesthetic around the tooth to be extracted. 

After a brief period of time to allow the anesthetic to take effect, Dr. Flewelling will use a dental surgical instrument called an elevator to loosen it from the ligaments and bone that anchor the tooth, then gently extract with forceps. In some cases, an especially deep rooted, hard to pull tooth is removed in pieces to minimize undue pressure to extract the tooth.

After a tooth has been extracted, Dr. Flewelling uses dental gauze to have the patient gently bite down, as this serves to help control any bleeding and begin the formation of a blood clot in the extraction socket. For some patients, use of self-dissolving stitches may be used to close the gum edges over the extraction area, as this helps the blood clot in the socket from breaking loose (which is known as a “dry socket”) and exposing the bone in the socket after the procedure. This condition can cause discomfort, so if this happens, a sedative dressing is placed over the socket for a few days to protect it as a new clot forms. This clot is very important to
the healing process and proper closure of the socket.


Following a tooth extraction, it’s important to minimize the risk of infection, as this helps speed recovery time to only a few days.

Steps that help ensure the best outcome include gently biting on the gauze pad placed in the socket area in place for three to four hours after the extraction and taking pain medications as prescribed.

Patients are encouraged to avoid spitting or rinsing, or using a straw for drinking for at least forty-eight hours after the extraction. This will help to avoid dislodging the clot that forms in the socket, as this can cause unnecessary pain or discomfort. Many patients like to apply an ice compress over the extraction area in ten minute increments immediately after the procedure, as this helps reduce swelling. Rest, relaxation and reduced activity is encouraged for a day or two if possible. Smoking can inhibit healing, so it is best to avoid this completely.

Woman with Toothache
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