Dear Doctor,

I have a tooth that needs to be removed as soon as possible; however, the thought of the extraction process shakes me to the core. You see, about a year ago, I had a baby and when it was time for stitches, no amount of anesthesia would work so I had to endure an hour of excruciating pain as the needle and thread worked their way through my skin. Since then, I literally get goose bumps from merely thinking about needles.

I need you to help me and answer two questions. One, what causes this to happen. Two, what can I do about it?

Wendy

--

Dear Wendy,

Removal of a tooth is usually the last measure taken by a dentist, particularly in a young person. In the past 2 decades or so, technology has evolved in the field of dentistry to the extent that several other measures exist for salvaging a diseased tooth or teeth. These include root canal treatment, cleaning of teeth and gums, giving suitable antibiotics and anti inflammatory drugs. Removal of inflamed and or dead tissue around the base of affected tooth or teeth. Dental extraction or removal is done as a last resort, when other measures fail to restore the affected tooth to normal health. Another situation, where it is done is when the decay is fairly well advanced on first visit to the dentist and nothing much can be done about it.

The most common cause for toothache is infection and resultant inflammation at base of tooth and around it. This occurs most commonly due to poor dental hygiene. Eating substances with white sugar like cakes, candies, drinking alcohol and sodas and not cleaning the teeth well after are some of the risk factors. Use of tooth brushes with hard bristles, use of worn out tooth brushes, a cracked or half broken tooth, impacted 3rd molar, recurrent gum infections, e.t.c. are some of the other causes of toothache and may necessitate dental extraction if tooth decay has already started.

In situations like advanced dental decay, a fractured tooth hanging from roots, etc., the affected tooth comes out very easily just by pulling lightly. Here no anesthesia may be needed. In other situations, local anesthesia may be needed to avoid pain, during the dental intervention. Local anesthesia like xylocaine is used to numb the site of intervention so that the individual does not feel any pain. This may be given in form of spray or injection. Choice of form of local anesthetic drug depends on likely duration of intervention, site of intervention and choice and experience of dentist. Usually dose of anesthetic agents is fairly well titrated these days, depending on gender, body weight of a person, use of alcohol, presence or absence of liver diseases, etc. factors. This ensures that one gets adequate amount of pain control medication. However for similarity in other factors, a person would need more anesthesias for pain control than another person. Regular use of alcohol necessitates extra dose of the anesthetic agent to be effective in numbing the pain. Genetic factors also play a part.

It is advised that you discuss this problem in advance with your dentist, so that suitable dose of anesthesia can be given, while carrying out the intervention.