Even though permanent teeth are supposed to last a lifetime, there are many reasons why tooth extraction may be needed. Whether it’s a damaged or decayed tooth, periodontal (gum disease), or because of a crowded mouth where there is no space for a tooth and it cannot erupt through the gum – if an extraction is necessary, you might be glad to discover that the procedure can be done in the chair. Paola Chellew delves into some dentistry options with Dr Sam Thandar.
The old adage of “Pulling Teeth” which usually refers to a painful task, is antiquated and should not really be associated with modern dentistry. Recently, my 85-year-old mom experienced a broken back molar which had to be removed, as it had served its purpose and was no longer needed. She is healthy and consequently heals well, so her dentist had no qualms about removing the ailing tooth in the chair.
All went well – apart from my overdosing on Rescue Remedy- and by that evening, she was enjoying a bowl of soup with ice cream for dessert. Paracetamol was the only medication prescribed, and I can honestly say that the anticipation caused more anxiety than the actual event.
I asked Dr Sam Thandar if extractions in the chair are the way to go and whether it’s more prevalent than the other option, which would be to have a general anaesthetic.
Why would you recommend that your patients have their teeth out in the chair as opposed to going under sedation?
“If it’s a simple extraction, the tooth is fully visible and there is no infection or gum disease, it is quite safe to extract the tooth in the chair”.
Could you take us through the process?
“I would begin with a mild local anaesthetic. Once the area is numb, the tooth is gently loosened with an instrument called an elevator. There is no pain; you might feel a bit of pressure as the tooth is rocked back and forth. The final step is the extraction itself, done with forceps. The whole procedure could take around half an hour. I would not pull more than two teeth out in one sitting”.
What are the advantages of doing the procedure in your practice?
For the patient, it is definitely a saving of time and money. One would also avoid the side effects of general anaesthesia, which can vary from one patient to the other. Recovery is quicker than when you have a general anaesthetic, but I would recommend that the patient takes a day off anyway, as rest is needed afterwards. The greatest advantage of in-chair procedures is a home ground advantage. We have access to all our state-of-the-art equipment as well as the familiarity of the environment.”
Any disadvantages?
“Patients who experience anxiety might not be suitable candidates for tooth extraction in the chair. Oral sedation may take longer to take effect and sometimes the level of sedation might not be strong enough”.
In the case of wisdom teeth, would you be able to pull them out using just local anaesthetic?
“If the patient requires a straight- forward extraction, then it can be done in the chair. If the teeth are deeply impacted, then general anaesthesia is a better option. It’s probably more economical to do it in the chair, as theatre costs vary from one hospital to the other. There is also the cost of the anaesthetist, as well as the oral surgeon’s fee.”
What is sedation dentistry – could this help with getting over the fear of having your tooth pulled out in the chair?
“Many people experience fear and anxiety when they know they have to visit the dentist, and even go as far as avoiding any oral care. Sedation dentistry is used to alleviate this phobia, even if it’s for a simple tooth cleaning. It is simply some medication to help patients relax during a dental procedure.
Patients are awake but relaxed. This could be an option if you are having a tooth extraction in the chair and are fearful of the procedure. You could have what is commonly known as “laughing gas”- nitrous oxide combined with oxygen through a mask that is placed over the nose. Your dentist controls the amount of gas given and the gas wears off fairly quickly. This means that you could even drive yourself home after the procedure.
Oral sedation is a pill taken for minimal sedation an hour before the procedure. This will make you drowsy, but you will be awake.
If the patient wants to opt for Intravenous Sedation, which is administered directly into the bloodstream, an anaesthetist would be required to come in. Depending on the dosage, the patient will experience a calming effect, some drowsiness and will feel no pain. Recovery is far quicker than a general anaesthetic, in addition to the cost being less. Patients should be driven to and from the appointment.”
Take us through post-procedure after extraction in the chair:
“A mild painkiller like paracetamol can be taken. Don’t drink hot liquids – this may increase swelling. Eat soft foods at first. Alcohol is not recommended. Don’t drink through a straw, as this could dislodge the blood clot. Smoking could also break down the blood clot and cause pain. Rest for at least 24 hours and after that, rinse your mouth with a salt solution (half a teaspoon of salt in 1 glass of water.
It is quite normal to have some discomfort, bleeding and swelling after you have had a tooth pulled out. The socket should heal within 10 days. Limit your activity for a couple of days.
Today we often couple these extraction procedures with PRF (Platelet Rich Fibrin – which accelerates socket wound healing) and LLLT (low-level light therapy) to decrease the inflammatory response and promote healing. In many cases we would consider preparing the site for future implant placement if an implant cannot be placed simultaneously”.
Conclusion
If the very thought of having your teeth pulled out overstimulates your sweat glands and you would rather go through multiple rounds of childbirth even if you’re a man, then this option is not for you.
A good candidate would be one with nerves of steel, one who is blessed with fairly good health and one who has a firm trust in his or her dentist. Another incentive is not putting a dent in your budget – so then you’re good to go!
The dentist chair, in this instance, is not going to have you on the edge of your seat.
A2 Disclaimer: This article is published for information purposes only, nor should it be regarded as a replacement for sound medical advice.
This article was written by Paola Chellew, with featured expert, Dr Sam Thandar and edited by the A2 team EXCLUSIVELY for the A2 Aesthetic & Anti-Ageing Magazine December 2020 Edition (Issue 35).
Issue 35 – Summer 2020/2021 Edition (Dec/Mar)
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