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Extracting Teeth

I have a toothache and am worried I might have to get it taken out. Does a sore tooth always have to be extracted?

“Do all tooth extractions cost the same? Are there alternatives to having your tooth extracted?”

– Question from Jane from Everton Hills, Brisbane

Dr Darryl Marsh replies:

Dr. Darryl Marsh is the founding dentist at Today's Dentistry in Brisbane.When you have a toothache the severity and the depth of the problem will generally determine the treatment that is required.

The worst case is that the tooth is un-saveable and that you are going to need to have it extracted but often there are other situations that are aren’t as dire or as drastic as that.

Toothaches don’t always mean the tooth has to be extracted

In many cases, the tooth can be saved with just a filling.

In other cases it might be something that is not a toothache at all, it could be a muscular problem. We had a patient at the surgery that ended up in hospital, and the severe pain she had was all coming from his jaw joint.

Don’t jump to dental conclusions!

Ultimately it is very difficult to make a diagnosis without seeing the patient. It’s also very dangerous for patients to jump to conclusions about what treatments they think they need. They may be phoning dentists to find out the cost of a tooth extraction when an extraction is not what they need at all!

Treat infections rather than extracting a tooth

Toothaches may result from an infection that can be prevented rather than needing the tooth to be extracted. The following are cases where this may be the case:

  • a gum infection
  • the bite on the tooth
  • muscular spasms
  • Trigeminal neuralgia: a nerve infection of the facial nerves.

Dental pain is one of my five dental warning signs that should not be ignoredThe mouth and the head is an area which has a lot of nerves, so there are a lot of possible complications that might cause a toothache. As a dentist step number one is to spend the time to work through all the symptoms and options in a systematic and comprehensive way.

Our textbooks are full of people that have lost numerous teeth or had a dozen root canals when the teeth weren’t the problem at all; the pain was coming from somewhere else.

So does a toothache always mean extraction? No, there are alternatives to prevent tooth extraction in some cases.

Does a tooth or gum abscess always mean an extraction?

Not necessarily. A gum abscess might only require the tooth to be deep cleaned and then treated with antibiotics. Tooth abscesses can sometimes be saved with a root canal treatment.

Extraction is always an option, but it’s only one option. Extraction is rarely the only or best option.

Why extraction is not the best option for toothache?

Most often extracting the tooth is the worst option. Whilst it is the quickest, cheapest and easiest option, it’s very rarely the best long term technical option. We believe that most people who have to use dentures or implants would have preferred to keep their own teeth if that was an option for them.

Do I have to get my wisdom teeth extracted?

No, not all wisdom teeth have to be extracted. About 1 in 3 people need to have their wisdom teeth extracted so it’s not even the majority of people. Many people don’t actually have wisdom teeth. Those people that do have wisdom teeth and enough room and they can come through and be functional teeth.

Wisdom teeth need to be extracted when they’re:

  • Not coming through on their own
  • Impacted on other teeth
  • Coming through at a funny angle
  • Difficult or impossible to clean and maintain them

Another solution for wisdom teeth is if they’re not fully through the dentist can remove a bit of gum around the teeth so that the patient can keep them clean easily, I’ve done that many times in preference to removing the whole tooth because wisdom teeth can be just as useful and just as functional as any other molar.

Where do the cost variations come in for tooth extractions?

Generally the cost of a tooth extraction depends upon time and difficulty. We are reluctant to advise extraction costs over the phone without seeing the case as we don’t want anyone to get false expectations. We advise people to come in for a consultation appointment, which is not costly, and from that get a proper assessment, quote and discussion about what is happening in their case.

When tooth extractions are technically difficult

We look at each individual case of tooth ache to determine what needs to be done and the cost of tooth extractionIf you have an extraction that’s going to take a long time or is technically very difficult, then it is better to be referred to see a surgeon. We will always try and do what is in the patient’s best interest. If they’re case is risky and the position of the tooth is very close to a main artery or a main nerve there’s a high risk of causing collateral damage.

Those are the situations where I’ll be honest and say: “Look I’m not the person to be removing this. You’d be better off to have this done by a surgeon because they’re have the extra skills and training to deal with the complexities of this extraction.”

We had a lady in recently who had a medical condition where her skin problems meant it would have been very difficult to stitch her. In addition, she had history of allergic reactions to various medications. Extracting her tooth would have been easy but if she has an anaphylactic reaction and this comes with the risk of death. We recommended she have this extraction done in a hospital.

In other cases if a patient has had some history of difficult extractions, one possible reason might be that their teeth are fused with their bone. For us this means their tooth has to be cut out of the bone and that’s not a comfortable thing to be having done while you’re awake.

In cases such as this, just for the comfort and ease of the patient we’ll recommend that they see a surgeon at hospital, have this procedure done whilst they are asleep. It’s just a more civilised way of having things done than sitting there for 3 or 4 hours when someone’s trying to get you to open your mouth that bit wider! If you’re asleep your muscles are relaxed making it a lot easier for the surgeon because you can open wider and they can hold your tongue away without you having to swallow all the time etc.

How to tell the difficulty, risks and costs of a tooth extraction

We can generally make a fair assessment of the difficulty, risks and costs through a consultation. At this consultation we will:

  • Look at X-Rays so we can see the position of the tooth
  • Have a chat with the patient about their previous experiences
  • Have a look in their mouth and just see how the anatomy is

After these things then we’ll generally have a good idea of what the case involves, the options open to a patient and the related costs.

The condition of the tooth matters when it comes to an extraction

Todays Dentistry uses state of the art Digital X-RaysIf a tooth has multiple fractures then we know as soon as you touch it it’s going to crumble and we will often end up having to cut the bone away to get the tooth out. If the tooth is very badly decayed that can be a real problem because the tooth will just crumble. This will be one of the main reasons extractions can be more complicated than first expected.

Shop around, find all your options and someone you trust

When a patient comes in looking for a cost of a tooth extraction we will do our examination and then have a discussion about what we think is going on, their options and our recommendations and the associated estimate of costs. If they want to compare costs and get second opinions then I would recommend that they visit each chosen dentist to get the most accurate dental quote possible.

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