Understanding Pet Tooth Extraction
Tooth extractions are by far the most common oral surgery performed in animals. However, to a veterinary dentist, extraction is often viewed as a defeat. Most teeth are salvageable, but sometimes the degree of disease, health status of the patient, inability of the owner to perform home care, and financial constraints make extraction the best option. Indications include advanced periodontal disease, fractured teeth, extra or crowded teeth, feline oral restorative lesions, inflammatory disease, and orthodontic disease that is causing oral trauma.
For fractured teeth, we would generally prefer to refer the patient to a specialist for a root canal procedure and save the tooth. This is especially true of the canines, upper fourth premolars, and lower first molars. These teeth are very important to the patient, and the large size of the roots makes extraction very difficult if the tooth is periodontally healthy. Based on the severity of the disease, periodontal disease can be treated with surgery; however, the owner must be willing and able to perform home care if this avenue is to be explored.
The first step we perform is to take a dental radiograph, or X-ray, of the tooth to ensure that there is no root pathology or unusual anatomy that would affect the extraction. Extractions are performed by using a dental elevator to fatigue the periodontal ligament enough so that the tooth can be removed easily with extraction forceps. For teeth with more than one root, the tooth is sectioned into single root segments and each root removed as a single root entity. The veterinarian may or may not use sutures to close the extraction site, depending on the size of the hole. Dissolvable suture is typically used so the patient does not need to be sedated for suture removal. We generally recheck all extraction sites two weeks post operatively to ensure that they are healing well.
Canines, upper forth premolars, and large molars that are broken but are periodontally healthy are a very different matter. The roots on these teeth are very large. The root is approximately twice the length of the crown (the area you can see) and sometimes larger in diameter. This makes standard extractions very difficult but not impossible. Generally, we will perform a surgical extraction to save time, effort, and animal discomfort. This procedure entails creating a flap in the gingival tissue on the outside of the tooth to expose the underlying bone. Using a high-speed dental bur, the bone on the outside of the tooth root is removed. Then, the tooth is removed from the socket. Finally, the harvested flap of gum tissue is sutured over the extraction site to cover the defect.
All patients undergoing extractions are treated pro-actively with antibiotics, narcotic analgesics, or local anesthetics before and after the procedure. The patients are also sent home with pain medications as needed to keep them comfortable and eating. Most patients, even those with multiple large extractions, are eating within hours of surgery.