Tooth extractions and removal
Dentistry for the 21st Century is about preserving as much natural tooth tissue as possible. You have been used to these structures since they erupted into your mouth, and teeth are important in maintaining the supporting bone contours, as well as providing surfaces to function with. By this we mean speech, biting and chewing. Teeth in one jaw also offer support to those in the opposing jaw, to maintain their position in the dental arch. Research has also indicated that the shape and position of your teeth also push food material over the gum tissue in a very special way, massaging and cleaning the tissue as you eat. There are several occasions where tooth extraction is necessary, and these are decay, infection, fracture and severe crowding.Dental decay is caused by the destruction of the outer enamel surface of the tooth structure, allowing bacteria to penetrate into the less dense dentine tooth body. As the process of decay progresses, the advancing wave of bacterial products begin to irritate, then kill the nerve tissue. Once the nerve tissue dies, depending on the bulk of the tooth remaining, it may be possible to save it by root canal treatment, or if the destruction is too great, accompanied with infection in the supporting bone tissue, removal or extraction becomes the reluctant treatment of choice. There have been many theories why dental decay begins and progresses, but it is generally accepted that the following processes occur. Decay occurs at sites where bacteria accumulate and convert sugars to acid by-products of living and reproduction. These acids dissolve the mineral components in enamel, and leave rough areas, which may be stained. These 'early lesions' can remineralise and 'heal' if recognised and you, the patient, become more motivated and efficient in your cleaning routines. As further minerals are dissolved out of the decaying area, more bacteria collect in the rough area and the lesion penetrates through into the dentine. Dentine is a living tissue. If you can imagine a tooth as follows, then you will understand of the process of decay better. The centre of the tooth is soft tissue, comprising nerve and blood supply tissue. The outer surface of the nerve tissue is similar, to a Medusa's head, with millions of fine 'hairs' that are minute nerve ends. Each 'hair' runs up inside a single small tube with in the dentine. So if you can imagine the dentine as an enormous bundle of straws centred around a ball ( the nerve tissue), these hairs would run up inside each straw. Covering the outer ends of the straw tubes is the enamel which is a very hard crystalline material. This outer surface is the surface that takes all the abuse of the food we eat, fluids we drink, and trauma when we bite and chew, or get hit in the mouth during sports, brawls and accidents. The reason that our teeth do not fracture all fall apart after each knock is their unique design. The dentine is 50% water, and the tubular construction when wet with nerve fluids keeps this material flexible, and able to absorb energy. So, you may well have many fracture lines that you can see in your own teeth, but the properties of the dentine bind the whole tooth together and keep it intact and functional. Now once the acids and bacterial by-products gain entry into the dentine, the rate of penetration and destruction is increased by its unique 'straw-like' construction. Depending on where the decay area started in the tooth, and the shape of the advancing decay, structural failure of portions of the tooth, or the whole crown, can occur. Unless this stage is quickly stabilised, the nerve tissue will die, leading ultimately to infection within the supporting bone tissue. Infection in the bone tissue is not a reason per se to remove the tooth, as many patients that we see have teeth where the nerve tissue has been removed and the tooth restored once the infection has been eliminated. This process is called root canal treatment. However, re-infection can occur if the technique in cleaning, sterilisation and filling of the root system is poor, or some of the cheap, outdated techniques are used. Bacterial toxins that are left in the dentine structure of the root system can cause an area of infection to develop at the tip of the root, and this occasionally can be controlled by specialised surgical procedures to remove the root tip and the area of infection. But even this extreme measure will ultimately fail if the canal system still harbours bacterial toxins. For a more predictable result, the canal system should be opened, re-cleaned and sterilised, and then filled whilst being able to access both ends of the root system. If this fails at some time after, then I personally feel the tooth should be removed with care to preserve as much of the bone structure as possible.
ther reasons for the removal of teeth are infection, fracture and severe crowding. Infection may not be due to decay. Impacted 8's or the teeth more commonly know as the 'wisdom teeth' often try to erupt into the mouth at an abnormal angle, and so are termed as impacted. The areas at the back of your mouth are difficult to get at , at the best of times, but now, with the added complication of the partially through tooth, it becomes a real hassle. If a food fragment zips into the space between the tooth and gum tissue, this can led to a low-grade infection of the gum. When this happens, the normal tight 'collar' of tissue around the tooth slackens off, and more food packs into the space. This food then becomes colonised by your normal bacteria within 30 to 40 seconds. You cannot usually clean this stagnating food and bacterial heaving mass out, and the material putrefies. read more
