Hesperian Health Guides
How to Take Out the Tooth
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Once you are certain which tooth must come out, decide which instruments you will need. Lay them out ahead of time on a clean cloth:
Before you touch your instruments, be sure your hands are clean. Wash with soap and water, and put on clean plastic or rubber gloves.
Be sure, also, that your instruments are clean. Prevent infection — keep clean!
- Always begin by talking to the person. Explain why you must take out a tooth (or teeth) and tell how many teeth you will take out. Begin working only when the person understands and agrees.
- Inject some local anesthetic slowly, in the right place. Remember from Chapter 9 that the injection for a lower tooth is different from the injection for an upper tooth.
Wait 5 minutes for the anesthetic to work, and then test to be sure the tooth is numb. Be kind — always test before you start. If the person still feels pain, give another injection.
- Separate the gum from the tooth.
The gum is attached to the tooth inside the gum pocket. Separate the gum and tooth before you take out the tooth. If you do not, the gum may tear when the tooth comes out. Torn gums bleed more and take longer to heal.
Slide the end of the instrument along the side of the tooth into the gum pocket. At the deepest part of the pocket, you can feel the place where the gum attaches to the tooth.
Push the instrument between this attached part and the tooth. Then separate the tooth from the gum by moving the instrument back and forth.
Do this on both the cheek or lip side (front side) and the tongue side (back side) of the tooth. The attached gum is strong, but it is also thin. Control your instrument carefully so that it only cuts through the part that is attached to the tooth. Do not go any deeper.
- Loosen the tooth. A loose tooth is less likely to break when you take it out. Before you take out a strong tooth, always loosen it first with a straight elevator.
Caution: if you do not use it properly, a straight elevator can cause more harm than good.
It is important to hold a straight elevator properly. Place your first finger against the next tooth while you turn the handle. This will control it.
Remember that the sharp blade can slip and hurt the gums or tongue.Put pressure on the bone, not the tooth beside it. Do not loosen the good tooth!
The blade goes between the bad tooth and the good one in front of it. Put the curved face of the blade against the tooth you are removing.
Slide the blade down the side of the tooth, as far as possible under the gum.
Turn the handle so that the blade moves the top of the bad tooth backward.
- Now, take out the tooth. Push your forceps as far up the tooth as possible. The beaks of the forceps must hold onto the root under the gum.
Use your other hand to support the bone around the tooth. Your fingers will feel the bone expanding a little at a time as the tooth comes free. With practice, you will be able to decide how much movement the tooth can take without breaking.
To decide which way to move a tooth, think about how many roots it has.
3 roots1 or 2
roots1 root2 roots1 root
If a tooth has 1 root, you can turn it. If a tooth has 2 or 3 roots,
you need to tip it back and forth.
Take your time. If you hurry and squeeze your forceps too tightly, you can break a tooth.
Removing a tooth is like pulling a post out of the ground. When you move it back and forth a little more each time, it soon becomes loose enough to come out.
When you remove lower molars with the lower molar 'cow-horn' forcep, you use it in a different way:
- Fit the points under the gum, between the tooth’s roots.
- Squeeze the handles gently and move them up and down, then side to side. This will force the points of the forcep further between the roots and lift the tooth up and out.
Note: some lower molars come out toward the tongue.WARNING!Do not use the ‘cowhorn’ forcep to take out a baby molar. Its points can damage the permanent tooth growing under it.
When the tooth comes out, look carefully at its roots to see if you have broken any part off and left it behind. Whenever possible, take out broken roots so that they do not cause infection later inside the bone.
- Stop the bleeding. Squeeze the sides of the socket (the hole that is left after you take out the tooth) back into place. Then cover the socket with cotton gauze and ask the person to bite firmly against it for 30 minutes. A child should bite firmly on the gauze for 2 hours.
Whenever the gums are loose, join them together. To stop the bleeding and heal the wound, you must hold the gums tightly against the bone under them.
- Explain to the person what you have done, and what to do at home to look after the wound. Remember that her mouth is numb, so she cannot feel what is happening.
Taking out a tooth is like a small operation. There will be bleeding and later some pain and swelling. This is normal and should be expected. Tell the person this. Then give the following advice:
- Bite firmly on cotton gauze for an hour, and again later if blood comes from the socket.
Always give the person some extra cotton gauze to carry home, in case bleeding starts again later.Show her how to use the cotton gauze.
- Take aspirin or acetominophen for pain as soon as you need it, and then every 3 to 4 hours.
- Keep your head up when you rest. This reduces bleeding
because it is harder for blood to flow uphill. It also hurts less.
- Do not rinse your mouth. In some places people believe they should immediately rinse with salt water and spit a lot after a tooth comes out, but this is harmful! It is important for the blood clot to stay inside the socket and not wash away.
- Do not drink hot liquids like tea or coffee, because they encourage bleeding. However, cool liquids are good for you. Drink a lot of water.
- Continue to eat, but be sure the food is soft and easy to chew. Try to chew food on the side opposite the wound.
- Keep your mouth clean. Start on the second day and continue until the socket is well. To do this, rinse your mouth with warm salt water and keep your teeth clean, especially the teeth near the socket.