Help me prepare for my 1st tooth extraction (yipe!)

In My Humble Opinion
1

Hey all. This is a continuation of the merry adventures of my teeth, first related in my What the heck is going on in my mouth? thread.

After dealing with an Evil Tooth that turned out to be the answer to the above thread’s main question (despite most of us assuming it was just referred pain from the cavity in the tooth next door), I’ve been assiduous in taking good care of my teeth. There are four remaining cavities that have to be dealt with, and two root canal crowns that needed to be replaced, but generally I was relieved not to have anything major.

Well, my teeth had other plans. Yesterday morning I stupidly bit into a fairly hard cluster of granola, promptly feeling a craa-aa-aa-ck and looseness in one of the two former crown sites. (Upper right bicuspid, if you care.) The visible portion of the tooth was now wobbly and uncomfortable/mildly painful.

I was able to get an emergency appt. with one of my dentist’s colleagues, who gave me the option of doing nothing that day but scheduling an extraction for later, or having the annoyingly wobbly part removed immediately and scheduling an extraction for later. I opted for the latter, and one quick jab of local plus a very brief yanking left me with no more pain, and a big freakin’ Jack-o-Lantern smile.

(In an unfortunate coincidence, my new dentist had only just told me a few weeks ago that despite having not had a crown on it for 10 years, the remaining tooth was strong enough to accept a new crown, and so I wouldn’t need an extraction. No more! Sigh.)

Now I’ve scheduled the extraction for August 18, and of course I need to know as much about it. I’ve got panic disorder and the fewer “unknowns” I have in my life, the better.

Oh, and I’m assuming that this will likely be a surgical extraction (I forgot to ask this of my dentist, mainly because until I Googled extractions I didn’t realize there were any other kind). There’s no tooth above the gumline so I don’t see how it could be anything else.

My questions for anyone who’s had this type of extraction:

  1. What should I expect the day of the appointment? For example, will they be taking more x-rays (I didn’t have any yesterday, but my whole mouth was x-rayed less than a month ago.)

  2. What have your experiences been regarding anesthesia options? Is there any possibility that I could just have a local, rather than either sedation or general anesthetic?

The truth is, I’m weird in that I’m not nearly as concerned about pain as I am about anesthetics. Given my panic issues, I actually fear being unconscious more than I do pain. So if possible I’d prefer the least “powerful”/sedating method that’s realistically possible.

(More than anything, physical reactions are what trigger my attacks, rather than specific things like elevators or height or crowds or even dental work; for example, the description of what Nitrous Oxide feels like—tingling in legs, dizziness—are usually what I feel when a panic attack is about to start, so I’d really prefer to avoid those.)

In short, I’d rather be conscious than unconscious, and have less numbness than more. So a local would be preferable to sedation. Is this at all realistic?

  1. Probably a weird question, but I like to be prepared: I’ve already got gauze squares if I should need them while the area is still healing/forming a scab, but is there anything else that would be useful to have in advance? What do you wish you’d had waiting for you at home once you were done?

  2. If you’ve had an implant afterwards, what is that like?

Thanks very very much!

2

Usually, for a single tooth, is local anesthetic. You’ll keep a gauze pack in your mouth for 18-36 hours, then eat fairly normally, just chewing on the other side. It is unlikely you will need any painkillers, the pain should be gone by the time the anesthetic fully wears off. A couple of ibuprofen should be enough, if you do feel pain later on, but he’ll probably write you an Rx for vicodin. Hint: fill it and save them…

Although I certainly would not be looking forward to my next one, it’s not really all that bad.

3

sorry to hear that** choie**.

From your other thread you probably remember I am a dentist. As for the x-ray, I wouldn’t take a new one if I had a periapical (shows the whole root) from a month ago.

As far as anesthetic, sure a local is fine. We (my partner not me) do surgical extractions all the time with just a local. Everything I do is with just a local, just don’t do surgicals.

Most likely they will make an incision in the gum to fold enough back to expose the bone. Then using a handpiece(drill) remove enough of the bone to expose enough tooth to get a grip on. Extraction and then a couple of stitches.

With local you will feel pressure but shouldn’t be pain.

The nitrous should just relax you, if you are getting the tingling in extremities it is up a bit much. It is a great thing for most people but isn’t for everyone and you are the best judge of that.

As for healing we always give our folks extra gauze. Only need it if it bleeds after initial biting on gauze to stop bleeding after extraction. They should go over post op instructions. Mostly nothing hard like chips or peanuts for a couple of days. Also we always say no smoking, alcohol, carbonated drinks or straws that day. Not sure other than smoking that it matters much but that is how we are all taught. Carefull eating for a day or so. Treat your self to ice cream for first meal, cold helps, its is easy to eat and tastes good when you don’t feel like eating. Kids love it when I tell mom this. Also won’t really form a clot like on skin. Since it is moist it just sort of plugs the area. Gently rinse the socket starting the next day to keep food out. Will be a fair sized depression for several weeks.

Implant is like a screw placed in the bone. Placed in a predrilled hole not screwed in. It just looks like a screw. Usually will be placed after healing. After it is placed it is usually heals a ffew months prior to placing the restoration.

Hope all this helps.

4

Sorry started typing before jtur88’s post but I’m slow.

Most people bite on the gauze 20 minutes to an hour. Unless you have bleeding problems this is almost always enough.

Sorry forgot pain meds, glad he/she didn’t. Yes most people are fine with 800 mg Advill, (four OTC pills) it does come as an RX but why bother. Many docs RX Hydrocodone(Vicodin) works about the same as Ibuprophen(Advill) but lots of people want it. Placebo effect of narcotic v. non narcotic I’ve also thought. Also Advill is antiinflamatory Vicodin isn’t. I prefer advill. Take it as soon as you get home so it will be in your system when the local wears off.

5

Speaking as a patient, not a dentist, you know that old comedy meme where a fellow has a terrible toothache and immediately after Curly pulls it or Moe knocks it out the pain is gone and the guy is happy? It’s a lot like that. My oral surgeon was a butcher with the needle (okay, I’m comparing him with my old dentist who taught needlework at Loyola) and the site was far from numb, but it didn’t hurt much happening and it was a great relief when it was done. The sutures did hurt some, but if you want pain try getting your teeth cleaned under the gumline with that ultrasonic probe after the Novocaine wore off. The dental assistant was pretty and flirty so there was no way I was going to admit it hurt, even when she claimed she had turned it to 9 on a 10 scale. Guys are shallow and easily manipulated like that.

6

I’ve had quite a bit of dental work, including gum surgery, extractions, root canals and implants. (A combination of mid 20th century British dentistry, no fluouride in childhood and genetically crappy teeth led to me having a LOT of dental work and reconstruction later in life.)

Many years ago I tried nitrous but found it weirdly unpleasant - the sort of thing I would have greatly enjoyed recreationally in my druggie days, but was just…weird for dental work. Since then I’ve turned down anything but local numbing (and lots of it please) and won’t even take a Vicodin or whatever calming pill they offer before hand. As rsat3acr says, I’ve felt nothing but pressure and some unpleasant crunchy sounds - not at all fun, but not really painful.

Even after the bone grafting part of my implants, and even though I was sent home with seven days of Vicodin and instructions to rest for the rest of the day, I ended up going to work and not bothering with the Vicodin because it really didn’t hurt much at all.

I agree with dropzone that the worst is having cleaning done! Pain-wise, I’d rather have a root canal than get my teeth cleaned under the gum. That’s some nasty-ass discomfort right there.

7

I’ve had one extraction/graft/implant and I’m scheduled for another on Monday (actually possibly two - the oral surgeon sees an issue with the crown on the tooth next to this one and has concerns that crown may come off/not be fixable, but they did say that if it comes off they’ll be calling my regular dentist to consult before just taking it. And if it doesn’t come off, I’ll be making an appointment with my dentist for a week or so after the extraction to see what the options are on his end.)

Both my first one and this next one will be done under local: they offered me the option of being put out, but I don’t really see the need. Plus I don’t have anyone to drive me to/from and so I need to be able to transport myself. Both these teeth are root canaled and as long as they numb the gum well, I’m not stressed about that. If it’s like the last one, I won’t touch the pain med (they said they’d give me a packet of 4 pills while there), but I will take a tylenol/advil combo for the first 24 hours. I’ve tentatively scheduled Tuesday off work, but if I’m as fine as after the last one, I may well go in.

Follow their post-op instructions, especially in terms of soft foods/straws - for the last one I had a special rinse I was supposed to use afterward, but I don’t know if this one will do the same thing. Have some ice packs or bags of peas in your freezer, so you have that ready for afterward.

Good luck!

8

I missed your implant question.

In some ways, it was even easier than the extraction. It was a good 2 years post extraction for me, because I moved cross-country and had to find a new professionals. But a periodontist did the implant and my dentist did the crown on top of it. I also did the implant under local. I had no issues with it or the recovery.

I was highly amused by the mini ratchet my dentist used when placing the crown: it sounded like when you take the oil filter off your car to do that part of the oil change, only in your mouth.

9

Many years ago, my dentist yanked a wisdom tooth the old-fashioned way, with a pair of pliers. He gave me a nice local anaesthetic, and, really, it didn’t hurt a bit.

But all the rest of the afternoon, I felt woozy. I phoned him and asked if I might be having a reaction to the local.

He said, no, I’m just having a reaction to having a tooth yanked by main force. It’s a little like getting slugged in the jaw. Not enough of a shock to cause a concussion, but enough of a shock to make one feel a bit dazed.

“Just because you didn’t feel it doesn’t mean your body didn’t.”

I hope it all goes well! Come back after and tell us everything!

10

Wow, thanks to everyone for the detailed replies! It’s encouraging to know that a local might very well be all I need. I would do my best to stay away from Vicodin or any of the __codone meds. I’m already on Xanax for panic disorder, I don’t need yet another physically addicting medication. In any event, I still have half a bottle of the Tylenol/Codeine from my last dental adventure, which I didn’t even need past the first day.

(Although that may soon be used up since all of a sudden tonight, the Evil Tooth started hurting again! I guess the filling wasn’t enough to help the fracture after all, sigh. This bastard may need to be pulled too–and if the pain keeps up I don’t think I’ll be able to wait until August 18! I’m telling you, ever since I went to a dentist my teeth have become total attention whores. Is there such a thing as Munchausen by Dental Epoxy? :D)

I didn’t realize that the implant was one of those little screw thingies. Is that the same thing that they use for crowns–a post? Because I have one of them already on the matching bicuspid on the left side, which about 10 years ago very thoughtfully required a root canal at the same time the right one did. I don’t even remember the dentist implanting the post in the first place, it was so painless, so assuming my current dentist(s) are as skilled as my old one, hopefully this will be as smooth.

The soon-to-be-extracted bicuspid remnant has no pain at all, although it is annoying to eat stuff with this canyon between the two teeth on either side of it. Between this and my stupid Evil Tooth (which is diagonally opposite, in the left rear of my jaw), chewing food tonight was uncomfortable in every direction. I may be consuming a lot of soup, soft cereal and pasta for the next couple of months.

The pressure and the noise I’m definitely expecting. They offer Netflix and Pandora at this place so maybe earbuds will at least save me from hearing various crunchy/chopping noises, or things like “GET THE HACKSAW!” that might be a tad distressing. :smiley:

I don’t even want to think about what all this is going to cost me when it’s all over. (It’s all out of pocket since I don’t have insurance.) Luckily they’re letting me pay it in monthly installments.

Thanks again so much for the info and the good wishes, everyone. And best of luck to you on Monday, Lsura!

11

no the post goes inside the remaining tooth to give it strength, think rebar, while an implant goes in the jawbone and takes the place of a tooth root. It gives you something to put a crown on.

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Thanks! And as for the implant screw: my understanding is that it’s different (if I could show you my xrays you could absolutely see how it looks different from a root canaled tooth - it’s a (very small) screw that’s in your jawbone. When it was put in, I didn’t notice anything particularly different from the post aspect of a root canal. They numbed me well and set to it. It did take longer (pee before they start!), but that’s about all I remember. That did have a number of appointments after it (all covered in the implant cost) to make sure it was healing well. There was a cap over the top of the screw, but after about 24 hours I didn’t notice that. They gave me a script for stronger painkillers with this too, and I didn’t even fill that one.

13

Not wishing to insult or malign any dentists I would advise never to have an extraction done by a dentist. Go to a specialist dental surgeon.

14

I had to have general anesthesia for removal of one wisdom tooth. I tried local, but the one site that was painful was the stupid nerve serving that tooth. The rest of my mouth and face was numb. So I had to wait and go to the oral surgeon.

Luckily the oral surgeon didn’t press for me to remove my other teeth, and agreed on just taking that really decayed tooth.

After surgery, they said the tooth was so decayed they threw it away. I’m sad I don’t have it, but the recovery was so easy and swift that I feel my mouth was happy the tooth was out. No pain, and by the weekend I had started to chew some foods. By the week I was back to chewing normally, something I hadn’t been able to do for months due to the tooth.

15

Ahh thanks Lsura and rsat3acr for the correction re: the post vs. the implant. That does make sense. KarlGrenze, that does sound complicated–I’ve heard wisdom teeth are often tough to extract, especially if they’re impacted. Now it’s interesting that you wanted to keep the tooth. Is there a reason for that, or just sentimental? :slight_smile:

someone11… that’s a good point about the specialist. The guy who’s doing the extraction is a periodontist and I’ll be hearing from him today whether he believes this’ll be a surgical or simple extraction. The office does have an oral surgeon on staff, but I’m wondering how I can best approach the question tactfully–“say, shouldn’t Dr. Gold be doing this considering she’s an actual surgeon and you’re naught but a periodontist?” probably wouldn’t be a great idea. He’ll go all Orin Scrivello on me for sure. :slight_smile: The bicuspid is a single-root tooth (right? it looks that way on x-rays) so I’m hoping it’ll be straightforward!

Oh, that does remind me of a weird question. When he first examined my x-rays last month, he surprised me by saying my teeth were actually pretty strong and in decent shape, especially considering I’ve been lax in taking care of them. He also said–and it sounded like a compliment–“You have nice long roots.” Now… why is having long roots a good thing?

16

None of my wisdom teeth are impacted. This one did grew out the most and in an outward angle. I used to be able to use it in biting and chewing. But it got bad cavity that just got bigger.

Why not? I wanted to keep it as a souvenir and I wanted to see how it looked. Alas, it was tossed out before I woke up. :frowning:

17

choie, bicuspids have lots of variation. Much of the time they appear one root on the radiograph but about half the time they are two roots. Often the roots are somewhat fused so not two separate roots but one wit a bit of branching at the apex. Once in awhile they will have three roots, I’ve only taken out two like that, but that would be obvious radiographicly. Uppers are more likely two have two roots than lowers.

Having long roots is a good thing because the teeth are more able to resist forces placed on them. Just like a fence post dug deeper into the ground.

As far as oral surgeon v. general dentist or periodontist, most of the time it shouldn’t make any difference. I don’t do impacted teeth but my partner does. He had a year of extra training after dental school and there aren’t many teeth he can’t do just as well and a lot cheaper then an oral surgeon. Can’t do sedation though, if they want that we refer to the o.s.

I still have my wisdom teeth at home in a box. Only looked at them once in the last 37 years and that was freshman year of dental school. I just keep stuff.

I have had two patients who made earrings out of their wisdom teeth. To each his own.

18

As depressing as the thought of losing another tooth is, I’d still say an extraction is not as unpleasant as a root canal. With an RC, there’s.
always the possibility of damage, more pain…intense pain, I’ve been there----and the even worse pain in the wallet when you have to pay $2500 for a crown to cover the canal. Also, they don’t always last forever…two of mine were removed. I’m doing the extraction, implant route now…cheaper in the long run

19

At least you’re not this kid

20

Thanks for the clarification, rsat3acr! Informative as always. I suspect my ‘nice long roots’ will turn out not to be a great thing when it comes to extractions!

I did notice that on one of the diagrams/maps of the teeth I’ve been researching, the upper bicuspids are depicted with what looks like a fused pair of roots, they sort of have two little nubs at the end even though the rest looks like just one. I couldn’t figure out if it was just a bad angle or a bad drawing.

I’m not gonna be in a mind to keep them when extracted, although I can see why one might after all. Surprising considering I’m someone with definite cluttering tendencies! :slight_smile: Hmm, I remember my mom used to keep our baby teeth in these little plastic containers that looked like toy barrels, in pastel colors. That fascinated/creeped me out as a child. She also kept a patch of very light hair, whose it was I never knew, but I suspect it was my late brother’s. It seems almost Victorian.

So anyway, I doubt I’ll want 'em, especially since they’re not going to be whole teeth (one is just this root canal remnant, the other has a filling and I resent it too much to ever want to see the thing again!).

Do wisdom teeth always have to come out? I have one that doesn’t seem to be causing me any trouble, although I suppose it’s possible some of the back teeth are being crowded a bit–still, I can easily floss. But the way my 2nd dentist was talking, it seemed like a fait accompli that wisdom teeth are usually removed. It seems weird that evolution gives us these teeth that apparently serve no purpose.

Don’t you need a crown (or I guess a bridge, depending) with an implant as well? So that cost would be the same, right? I do see on my dentist’s firm website that extraction/implants are cheaper than root canals. It’s probably moot for me since the broken tooth was a root canal, and the Evil Tooth (which caused me more pain last night…sigh) is cracked and as I understand it, not a candidate for a root canal.

I must’ve really been lucky with my RCs. I remember my parents having root canals and it was like they’d been through some spy movie torture scene, the way they described it. Both of mine were no worse than my cavity filling, thank goodness, so I have no fears of RCs at all. Sounds like it’s a crapshoot depending on a bunch of different factors.

DUDE. What are you tryin’ to do to me?!!! That’s horrible. Happy ending, though. At least you didn’t link to the woman who died during her teeth extractions. That was the article that made me terrified last month.