Although permanent teeth were meant to last a lifetime, there are a number of reasons why a tooth extraction may be needed. A very common reason involves a tooth that is too badly damaged, from trauma or decay, to be repaired. Other reasons include:
Infection. If tooth decay or damage extends to the pulp — the center of the tooth containing nerves and blood vessels — bacteria in the mouth can enter the pulp, leading to infection. Often this can be corrected with root canal therapy, but if the infection is so severe that antibiotics or a root canal do not cure it, extraction may be needed to prevent the spread of infection.
Risk of infection. If your immune system is compromised (such as you are receiving chemotherapy or are having an organ transplant), the risk of infection in a particular tooth may be reason enough to pull the tooth.
Periodontal (Gum) Disease . If periodontal disease — an infection of the tissues and bones that surround and support the teeth — have caused loosening of the teeth, it may be necessary to the pull the tooth or teeth.
Removing a tooth is necessary when decay or an abscessed tooth is so severe that no other treatment will cure the infection. A tooth that is severely damaged may need to be removed using local or general anesthetic. After the tooth is removed, you may or may not need stitches. The removed tooth can be replaced with an implant, a denture, or a bridge.
Sometimes dentists pull teeth to prepare the mouth for orthodontia. The goal of orthodontia is to properly align the teeth, which may not be possible if your teeth are too big for your mouth. Likewise, if a tooth cannot break through the gum because there is not room in the mouth for it, your dentist may recommend pulling it.
Dentists and oral surgeons (dentists with special training to perform surgery) perform tooth extractions. Before pulling the tooth, your dentist will give you an injection of a local anesthetic to numb the area where the tooth will be removed. If you are having more than one tooth pulled or if a tooth is impacted, your dentist may use a strong general anesthetic. This will prevent pain throughout your body and make you sleep through the procedure.
If the tooth is impacted, the dentist will cut away gum and bone tissue that cover the tooth and then, using forceps, grasp the tooth and gently rock it back and forth to loosen it from the jaw bone and ligaments that hold it in place. Sometimes, a hard-to-pull tooth must be removed in pieces.