Taking Out a Tooth

Not every painful tooth needs to come out. Sometimes it is possible to prevent such a final step. You must decide how serious the problem is, and then decide if you can treat and save the tooth. Some problems—such as root canal treatment for a tooth with an abscess, or wiring for a loose tooth—require the skills of an experienced dental worker. Even if you cannot treat every person, a more experienced worker can help you by taking care of the more difficult tooth problems.

Remove a tooth only when it is necessary. Here are three reasons to take out a tooth:

• It hurts all the time (or if the pain starts by itself, often waking the person at night)
• It is loose and hurts when you move it.
• It has a broken root or a broken top with an exposed nerve.

It is important to learn from another person, not just from a book. Find an experienced dental worker who can show you how to take out a tooth and who can then watch you as you try it yourself.

Before You Begin: Ask Questions!

Before you take out a tooth, you need to learn about the person's health. Tell the person what to expect, and then ask:

• Do you bleed a lot when your skin is cut? (If so, you may bleed a lot when your tooth comes out.)
• Do you have swollen feet and difficulty breathing? (You may have heart disease.)
• Do you have any allergies? (You may be allergic to some medicines we give when we take out a tooth.)
• Are you a diabetic? (If you have diabetes, your wound will take a long time to heal.)

If the person answers "yes" to any of these questions, you must take special precautions.

FOUR PROBLEMS TO WATCH FOR

A person who bleeds a lot must know how to prevent bleeding afterward. Explain very carefully the steps given below. You may also want to place a suture to hold the gums tightly together.

Persons with heart disease often take medicine called anticoagulants

that do not allow the blood to clot normally. Ask what medicine the person takes. Heparin is an example of an anticoagulant. Another heart medicine, digitalis, is not an anticoagulant. If the medicine is not an anticoagulant, you can take out the tooth. But do not use more than 2 cartridges (3.6cc) of local anesthetic. The epinephrine inside the anesthetic can harm a weak heart. (Sen p. 131, #2).

A person with allergies may be allergic to aspirin, penicillin, erythromycin, or other medicines you often use. Find out which medicine has caused problems and give a different medicine, one that will not cause a reaction.

A diabetic's wound may become infected. Watch carefully the place where you took out the tooth and give antibiotics if an infection begins.

BE PATIENT, CAREFUL, AND CONSIDERATE

• Inject local anesthetic slowly in the right place, so the tooth becomes numb and you do not hurt the person when you remove it. If the person says the tooth still hurts, it is probably true! Inject again.
• Use the correct instrument in the correct way. If you are careful you can avoid breaking the tooth. When you take out a baby tooth, be extra careful not to hurt the new tooth growing under it.
• Explain everything to the person. Tell the person if something is going to hurt, even a little. When you take out the tooth, you can explain, for example, that there will be a feeling of pressure. Press on the person's arm to demonstrate what it will be like. When you finish taking out the tooth, explain what you have done and what the person can do at home to help the mouth heal.

The Four Basic Instruments

You can take out most teeth with these 4 instruments:

A spoon or probe

Use this to separate the gum from the tooth.

... an elevator

An elevator will loosen a tooth, or lift out a broken root.

and two forceps

upper universal forcep

lower bicuspid forcep

Use forceps to pull out the tooth. There is one for upper teeth and one for lower teeth.

Other forceps can be useful, especially for taking out a strong back tooth. They have pointed beaks that are made to fit between the roots of a back molar. As a result, you can hold onto the larger tooth better.

Curved elevators are good for taking out broken roots. You can force their pointed ends more easily between the root and the bone that is holding it.

Cryers elevators

Unfortunately, forceps and elevators are expensive. If you want to order more than the 4 basic instruments, remember the cost.

WHERE YOU WORK IS IMPORTANT

Work wherever it is light and bright. You must be able to see what needs to be done. Sunlight or light from a lamp is usually enough. Use a dental mirror to direct more light into the mouth.

Use a chair that has a back high enough to support the person's head.

Think about how you can stand and work the most easily:

To take out a lower tooth, you need to push down and then pull up.

So the person should be sitting down low.

If you stand on a box, the person will be lower.

To take out an upper tooth, you need to push up and then pull down.

So the person should be sitting up high.

If the person sits on cushions, he will be higher.

HOW TO TAKE OUT THE TOOTH

Once you are certain which tooth must come out, decide which instruments you will need. Lay them out ahead of time on a clean cloth:

Before you touch your instruments, be sure your hands are clean. Wash with soap and water. Be sure, also, that your instruments are clean. Prevent infection-keep clean!

To take out a tooth, follow these 8 steps:

• 1.  Explain what you are going to do.
• 2.  Inject local anesthetic.
• 3.  Separate the gum from the tooth.
• 4.  Loosen the tooth.
• 5.  Take out the tooth.
• 6.  Stop the bleeding.
• 7.  Explain to the person what to do at home to look after the wound.
• 8.  Help the person to replace the tooth with a false tooth.

1.  Always begin by talking to the person.

Explain why you must take out a tooth (or teeth) and tell how many teeth you will take out. Begin working only when the person understands and agrees.

2.  Inject some local anesthetic slowly, in the right place.

Remember that the injection for a lower tooth is different from the injection for an upper tooth (see Injecting In The Mouth).

Wait 5 minutes for the anesthetic to work, and then test to be sure the tooth is numb. Be kind-always test before you start. If the person still feels pain, give another injection.

3. Separate the gum from the tooth.

The gum is attached to the tooth inside the gum pocket. Separate the gum and tooth before you take out the tooth. If you do not, the gum may tear when the tooth comes out. Torn gums bleed more and take longer to heal.

Slide the end of the instrument along the side of the tooth into the gum pocket. At the deepest part of the pocket, you can feel the place where the gum attaches to the tooth.

Push the instrument between this attached part and the tooth. Then separate the tooth from the gum by moving the instrument back and forth.

Do this on both the cheek side (outside) and the tongue side (inside) of the tooth.

The attached gum is strong, but it is also thin. Control your instrument carefully so that it only cuts through the part that is attached to the tooth.

Do not go any deeper.

4. Loosen the tooth.

A loose tooth is less likely to break when you take it out. Before you take out a strong tooth, always loosen it first with a straight elevator.

Caution: if you do not use it properly, a straight elevator can cause more harm than good.

It is important to hold a straight elevator properly. Place your first finger against the next tooth while you turn the handle. This will control it. Remember that the sharp blade can slip and hurt the gums or tongue.

The blade goes between the bad tooth and the good one in front of it. Put the curved face of the blade against the tooth you are removing.

Slide the blade down the side of the tooth, as far as possible under the gum.

Turn the handle so that the blade moves the top of the bad tooth backward. 

Put pressure on the bone, not the tooth beside it. Do not loosen the good tooth!

5. Now, take out the tooth.

Push your forceps as far up the tooth as possible. The beaks of the forceps must hold onto the root under the gum.

Use your other hand to support the bone around the tooth. Your fingers will feel the bone expanding a little at a time as the tooth comes free. With practice, you will be able to decide how much movement the tooth can take without breaking.

To decide which way to move a tooth, think about how many roots it has.

If a tooth has 1 root, you can turn it.

If a tooth has 2 or 3 roots, you need to tip it back and forth.

Take your time. If you hurry and squeeze your forceps too tightly, you can break a tooth.

Removing a tooth is like pulling a post out of the ground.

When you move it back and forth a little more each time, it soon becomes loose enough to come out.

Front teeth come straight out:

Back teeth usually come out toward the cheek:

When you remove lower molars with the lower molar 'cow-horn' forcep, you use it in a different way:

Fit the points under the gum, between the tooth's roots.

Squeeze the handles gently and move them up and down, then side to side. This will force the points of the forcep further between the roots and lifts the tooth up and out.

Note; some lower molars come out toward the tongue.

Warning: Do not use the 'cowhorn' forcep to take out a baby molar.

Its points can damage the permanent tooth growing under it.

When the tooth comes out, look carefully at its roots to see if you have broken any part off and left it behind. Whenever possible, take out broken roots so that they do not cause infection later inside the bone.

6. Stop the bleeding.

Squeeze the sides of the socket (the hole that is left after you take out the tooth) back into place. Then cover the socket with cotton gauze and ask the person to bite firmly against it for 30 minutes. A child should bite firmly on the gauze for 2 hours.

Whenever the gums are loose, join them together. To stop the bleeding and heal the wound, you must hold the gums tightly against the bone under them.

When you remove two or more teeth in a row, it is a good idea to join the gums with a suture (needle and thread).