Why Can Extracting Rotten Teeth be Challenging?

Rotten tooth extraction: Risks and Complications
The extraction of severely damaged teeth becomes necessary when they can no longer be repaired effectively. While the procedure is usually straightforward, some complexities can make it challenging, increasing the risk of complications.

In this article, we will explore the difficulties of extracting rotten teeth, potential complications, and the recovery process.

Extracting a Rotten Tooth Can Sometimes be Challenging

Rotten teeth are teeth that have been severely damaged by decay or injury. It may also be a tooth with a large old filling and a recurring cavity.

The biggest challenge when it comes to extracting rotten teeth is their fragile and brittle nature. As a result, they are more likely to break and fracture under the forces applied by the forceps to loosen and remove them.

(Note in the images below that severely damaged teeth come out in several pieces rather than as a whole.)

A common scenario is the top visible portion of the tooth (the crown) separating, leaving the roots trapped within the bone.

While removing roots is usually safe and easy, some complexities arise when roots have unusual shapes, such as curvature or divergence, when they are fused tightly with the surrounding bone, or when there is an underlying infection.
Curved root shape
In these instances, an advanced technique called alveolectomy may be necessary. This procedure involves cutting the gum and trimming the bone surrounding the roots to expose them, making extraction more accessible.

Clinical images of rotten tooth extraction by alveolectomy: Before and After

For severely damaged back teeth with multiple roots, a method known as "tooth sectioning" might be employed. This technique involves cutting the tooth to separate the roots so they can be taken out one piece at a time.

clinical images of infected tooth extraction using tooth sectioning technique: Before and After

Although these approaches effectively address the challenge of extracting severely decayed teeth by making them easier to get out, they can be more traumatic for the surrounding tissues, potentially leading to a longer healing period and a higher risk of complications.

Risks and complications of extracting rotten teeth

Much like the extraction of regular teeth, the removal of damaged teeth is typically a straightforward and low-risk procedure. Complications are relatively rare, and are more often associated with complex or lengthy procedures.

For example, the longer it takes the dentist to extract the tooth, and the deeper it is embedded in the bone, the greater the risk of post-operative complications. Fortunately, these are usually not that serious and can be managed effectively.

Here are some of the potential risks associated with the extraction of infected, brittle, or severely damaged teeth.

Bone Damage during Tooth Extraction

Bone damage complications are more common when dealing with teeth that are hard to pull out from their sockets.

This often occurs when a tooth is deeply embedded in the bone or has an atypical root shape. In such cases, it may be necessary to exert extra force during extraction to remove the tooth, which can potentially damage the surrounding bone and cause a fracture.

The same goes for decayed teeth where only the roots remain. The process of cutting away the bone to expose the roots can weaken the bone further, possibly resulting in a bone fragment coming out.

This is even more likely if the tooth has an infection or abscess. In this case, the bone surrounding the tooth may already be too weak due to the infection, making it easier to break during the procedure.

Although it's usually a minor issue, if a small bone piece is unintentionally left in the socket, it can lead to post-operative infection. In some cases, substantial jawbone loss may happen if a significant part of the bone is damaged during the procedure.

Sinus Complications

The sinuses are air-filled cavities located on either side of the cheeks. They are positioned just above the back teeth of the upper jaw.
maxillary sinus and underlying teeth
During the extraction of the upper back teeth, the overlying sinuses can be accidentally damaged or perforated. This is especially true when the roots of the teeth reach into the sinuses, making an injury unavoidable.

The most common issue is the communication between the mouth and the sinus, which, if not treated, can lead to an infection called sinusitis.

When dealing with severely damaged upper back teeth, there is an additional risk of sinus complications during the extraction process. The fragile tooth might break, and a piece could move into the sinus, needing surgery to take it out and avoid possible infection.

Infections After The Procedure

By the time a tooth requires extraction, there's a good chance it might have an infection. After extraction, the infection might not completely clear up. As a result, it can linger or even spread to nearby tissues like the jawbone and facial soft tissues.

Recognizable signs include worsening symptoms over time instead of improving, such as persistent pain, swelling, redness, and bad breath.

Dry Socket

Extracting an infected tooth and a long, complex procedure are two major risk factors for a common postoperative complication known as dry socket.

Dry socket is an intensely painful post-operative complication reported in 0.5% to 5.6% of cases. It arises from the premature loss of the blood clot covering the empty socket in the first few days after surgery. The results are bone exposure, severe pain, delayed healing, and an increased risk of infection.

Bone Spur

During extractions that involve cutting away some bone, a small root or bone fragment may remain trapped inside the socket.

The body perceives it as a non-functional, dead tissue and treats it as a foreign object, trying to expel it from the mouth. During this process, the unwanted root or bone fragment may emerge, pierce the gum, and eventually completely come out during or after the healing period.

Why Should a Rotten Tooth be Removed in the First Place?

Tooth extraction, although a common procedure, is considered a last resort when no alternative solutions are viable or when attempts to save the tooth have been unsuccessful.

While our primary goal is always to preserve your natural teeth, there are instances where tooth extraction becomes necessary.

This typically occurs when a tooth is extensively decayed, has a deep and irreversible crack or fracture, or becomes excessively mobile due to the loss of bone support. In these situations, fixing and restoring the tooth isn't practical, so removing it makes the most sense.

Another common reason for tooth extraction is the presence of an abscess or persistent infection that fails to resolve despite treatment efforts. In such cases, removing the tooth is crucial to stop the infection from spreading, preventing potentially severe complications.

Recovery After Tooth Extraction

Following tooth extraction, the recovery process is typically smooth and swift. In the initial days, some reactions are usual and completely expected. Unlike post-operative complications, these are temporary and fade away as healing progresses.

Overall, here is what to expect during the recovery period:

Day 1-3: Blood Clot Formation and Inflammation

  • What Happens? Immediately after the procedure, the socket is filled with a blood clot, protecting the wound, stopping bleeding, and promoting healing. Inflammatory reactions are triggered to clean the area and set the stage for the next steps.

  • Symptoms: The socket appears filled with a shiny dark red mass (the blood clot). It's normal to experience some pain and swelling. The discomfort peaks on the first day and then gradually decreases over the following days.

Day 4-5: Granulation Tissue Formation

  • What Happens? The blood clot turns into firmer, pale pink granulation tissue.

  • Symptoms: Pain and swelling decrease as inflammation subsides. The socket is now filled with granulation tissue.

Week 1-2: Early Bone Formation

  • What Happens? Bone formation starts filling the socket. Initially fragile and immature, it gradually mineralizes to become a more solid bone over the following weeks.

  • Symptoms: Pain and swelling should be fully resolved, and the wound gradually closes with new gum tissue.

Week 4-16: Complete Bone Formation and Maturation

  • What Happens? The bone completes maturation, becoming firmer and more resistant. The wound is fully healed, displaying a normal and healthy appearance.
  • Takeaway

    Extracting rotten teeth is usually quick and straightforward, like removing regular ones, and rarely leads to complications.

    However, if a tooth is deeply stuck within the bone or has an unusual shape, the dentist takes extra steps to make the removal easier and safer. No matter the method used, it's vital to follow the recommendations and tips of your dentist to ensure proper healing and avoid pain or infection afterward.