Molar extraction: extraction or exodontia

And the removal of a molar, and exodontics, and extraction - no matter what this dental procedure is called - its essence is the same: the tooth will be pulled out... By the way, the first Emperor of All Russia Peter I was a great master in this matter, who always carried tools with him, among which were pliers for removing teeth.

When talking about the removal of a molar, we mean a chewing tooth - a molar or premolar. In total, an adult has 28-32 permanent teeth: 8 incisors, 4 canines, 8 premolars (small molars) and 8-12 molars (large molars).

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Extraction of a molar: when is it unavoidable?

Emergency tooth extraction is usually used in cases of acute purulent inflammations that affect the bone, or in cases of unbearable toothache that does not allow treatment. However, there are other reasons for removing a molar. Extraction is used when:

• the root canal of the tooth is impassable (in case of chronic periradicular inflammation of the gums - periodontitis);
• the crown of the tooth is so destroyed by caries that it is impossible to restore the tooth;
• the tooth is very mobile and loose (due to periodontitis);
• anomaly of the dental row disrupts the function of chewing, articulation and injures the oral mucosa;
• “extra”, that is, teeth that did not erupt on time (impacted) cause pain or inflammation;
• a tooth root fracture occurred;
• the teeth were on the fracture line of the jaw;
• one or another tooth interferes with full or partial dental prosthetics;
• the eruption and growth of wisdom teeth have deviations that lead to discomfort, abnormalities of the dental row or trauma to the oral mucosa.

Method of extraction of a molar tooth

Today, before tooth extraction, dentists in many cases (after examining the patient's teeth) prescribe an X-ray of the jaw - to clearly see the position of the tooth roots. The extraction of a molar is always performed under local anesthesia. In dental surgery, tooth extraction from the dental alveoli is divided into conventional (simple) and surgical (complex). Simple extraction is performed when the root of the tooth is normally visible, and the tooth itself can be well fixed with instruments.

By the way, the first special forceps for extracting teeth - called "pelican" - were invented by the French doctor Guy de Chauliac in the middle of the 14th century. Now dental surgeons have a whole arsenal of tools.

And the method of removing a molar depends on which tooth needs exodontia. Tooth (and root) extraction is performed with pliers, with the help of which the tooth is loosened (to disrupt the integrity of the periodontal tissues), rotated around its axis and... done! And the correct choice of instrument by the doctor is the key not only to the successful implementation of the procedure, but also to the absence of complications.

The shape of the forceps varies - depending on the anatomical shape of the teeth and their location in the dental row. For example, premolars of the upper jaw are removed with S-shaped forceps, premolars of the lower jaw - with forceps with wide cheeks, and molars of the lower jaw - with forceps with special spikes (which go between the roots of the tooth). Moreover, for teeth on the right and left sides of the jaw, "right" and "left" forceps are intended. Elevators are also used to remove teeth (and tooth roots) of the upper jaw. The doctor takes up this instrument when the removal of a molar or its root with forceps is not possible or is fraught with damage to the mucous and bone tissue of the alveolar process.

A surgical (complex) method of tooth extraction is used when it is not possible to reach it with either forceps or an elevator: the tooth is covered by mucous or bone tissue (this happens with retained and atypically located teeth). And also when the gum tissue completely covers the apical (upper) pieces of the roots of long-extracted or broken teeth.

In some cases, the surgeon cuts the soft tissues covering the tooth, in others, he cuts the jaw bone. There are situations when the dentist has to remove the tooth in parts, having first divided it.

Consequences of molar extraction

Naturally, the consequences of molar extraction depend on the degree of its complexity. But the most common of them are swelling of the gum or cheek and pain.

Swelling of the gum and cheek tissues after tooth extraction is the result of their injury during surgery. If all recommendations are followed, the swelling will go away in a few days. To reduce and relieve swelling, doctors recommend applying cold compresses to the cheek for 8-10 minutes, repeating the procedure 3-4 times a day every half hour.

Quite often, the swelling of the gum (where it passes into the cheek) increases, the pain increases and the body temperature rises. At the same time, the blood clot in the socket is dense, and after a few days, the skin on the cheek on the side of the extracted tooth acquires a bluish tint. These are characteristic signs of the formation of a hematoma with suppuration, in which case you should go to the doctor. Nothing will go away on its own, but it can result in an abscess or phlegmon.

Pain is a natural and, unfortunately, inevitable consequence of the extraction of a molar. Moreover, in case of a complicated extraction, it can last for a whole week. If the cause of the pain is a tooth fragment left in the socket, the doctor must remove it and clean the socket. In this situation, dentists recommend rinsing the mouth with a 0.05% aqueous solution of the bactericidal drug Chlorhexidine (2-3 times a day). The drug can cause staining of tooth enamel, tartar deposition and taste disturbance. It should not be used by children, pregnant and lactating women.

Recently, doctors most often recommend taking Nurofen (or its analogues - ibufen, ibuprofen) as a painkiller. Nurofen is prescribed to adults at 0.2-0.8 g 3-4 times a day - after meals or with plenty of water. This drug is usually well tolerated, but it has contraindications: acute ulcers and exacerbations of ulcers of the stomach and duodenum, ulcerative colitis, suppression of hematopoiesis and hemorrhagic diathesis, diseases of the optic nerve, portal and arterial hypertension, heart failure and pregnancy.

If on the 3rd-4th day after the extraction of a molar there is a dull pain that rises from the extraction site to the ear, and there is also an unpleasant taste in the mouth, then this is the so-called symptom of a dry socket. This consequence of the extraction of a molar is the result of the displacement of a blood clot. There is no blood or purulent discharge. However, to treat a dry socket, you must consult a doctor.

The consequence of the extraction of a molar is alveolitis. This is an acute inflammation of the socket walls, which manifests itself as severe pain on the second or third day after the tooth extraction. No painkillers help relieve the pain. The general condition worsens, the temperature can rise to +37.5-38 ° C. Due to the pain, eating is difficult. At the same time, the remains of the blood clot decompose in the socket of the extracted tooth: the socket is covered with a gray coating with a putrid odor, its mucous membrane turns red and swells. The lymph nodes under the lower jaw enlarge and become painful when pressed. With such symptoms, you need to go to the dentist without delay, since alveolitis after tooth extraction can cause osteomyelitis of the jaw, phlegmon or abscess.

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What to do after a molar is removed?

First, about what not to do after removing a molar.

After removing a molar, you should not:

• rinse your mouth and even spit during the day so as not to disturb the blood clot that is in the socket of the extracted tooth (this clot is extremely important for wound healing - later, fibrous tissue is formed from it, which then turns into bone);
• brush your teeth (during the day) and use mouthwash;
• during meals, chew with the teeth located in the tooth extraction area, drink and eat hot things (at least for the first 24 hours after extraction);
• expose your body to physical stress for at least 24 hours (sports, hard work, etc.);
• Smoking and drinking alcohol – for at least 48 hours.

And now - what should you do after removing a molar:

• If bleeding does not stop 8 hours after tooth extraction, you need to bite down on a gauze pad quite hard for 45 minutes. If it does not help, go to the surgeon who removed the tooth;
• 24 hours after tooth extraction, very carefully rinse your mouth (after meals and before bed) with a slightly warm solution of table salt - a teaspoon per glass of water;
• After meals, do soda, salt (a teaspoon per glass of water) or herbal baths of the mouth cavity with a decoction of chamomile, sage, oak bark, calendula, St. John's wort (a tablespoon of dry herbs per glass of boiling water). When the decoction cools to room temperature, take it into the mouth (do not rinse!), hold for half a minute and spit out.

Price of molar extraction

The price of molar extraction, like the cost of all dental procedures, depends on their complexity, the level of the private clinic and the location of the institution. Moreover, the last two factors have the greatest influence on the price list of Ukrainian dentists.

For example, in Kyiv, the cost of tooth extraction fluctuates between 150-1440 UAH plus 50-70 UAH for anesthesia. Wisdom tooth extraction will cost 450-650 UAH. In Kharkov, for the extraction of a molar they ask from 150 UAH to 420 UAH, and for anesthesia for this procedure - on average 50 UAH.

Dnipropetrovsk dentists indicate in their price lists the cost of extracting one tooth at 180-350 UAH and anesthesia - from 40 UAH to 140 UAH. In dental clinics in Simferopol, the price of extracting a molar is 60-150 UAH, and you will have to pay from 20 to 70 UAH for anesthesia. For residents of Sumy, tooth extraction costs at least 90 UAH, and taking into account the anesthetic injection - 130 UAH.

But in the Russian city of Krasnoyarsk, the extraction of a molar cost 300 thousand rubles (that is, 75.6 thousand UAH). This is the amount that a patient of a private dental clinic will receive by a court decision, since the specialists damaged bone tissue during the extraction of a diseased tooth. As a result of the poor quality of medical services, the woman had to spend a week on sick leave with swelling of her entire face. First, she sought help from another doctor, and then filed a claim in court.