Hesperian Health Guides
Chapter 11: Taking Out a Tooth
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Not every painful tooth needs to come out. You must decide how serious the problem is, and then decide if you can treat and save the tooth. Some problems — such as root canal treatment for a tooth with an abscess, or wiring for a loose tooth — require the skills of an experienced dental worker. Even if you cannot treat every person, a more experienced worker can help you by taking care of the more difficult tooth problems.
Remove a tooth only when it is necessary. Here are three reasons to take out a tooth:
- It hurts all the time or hurts enough to wake the person at night.
- It is loose and hurts when you move it.
- It has a broken root or a broken top with an exposed nerve.
It is important to learn from another person, not just from a book. Find an experienced dental worker who can show you how to take out a tooth and who can then watch you as you try it yourself.
Before you begin: ask questions!
Before you take out a tooth, you need to learn about the person’s health. Tell the person what to expect, and then ask:
- Do you bleed a lot when your skin is cut? (If so, you may bleed a lot when your tooth comes out.)
- Do you have swollen feet and difficulty breathing? (You may have heart disease.)
- Do you have any allergies? (You may be allergic to some medicines we give when we take out a tooth.)
- Are you a diabetic? (If you have diabetes, your wound will take a long time to heal.)
- Are you pregnant? (Some problems can be treated during pregnancy, but sometimes it is better to wait.)
If the person answers “yes” to any of these questions, you must take special precautions.
Five problems to watch for
- A person who bleeds a lot must know how to prevent bleeding afterward. Explain very carefully the steps to stop the bleeding. You may also want to place a suture to hold the gums tightly together.
- Persons with heart disease often take aspirin or medicines called anticoagulants that do not allow the blood to clot normally. Ask what medicine the person takes. Heparin and warfarin are examples of anticoagulants. Another heart medicine, digitalis, is not an anticoagulant. If the medicine is not an anticoagulant, you can take out the tooth. But do not use more than 2 cartridges of local anesthetic. The epinephrine inside the anesthetic can harm a weak heart.
- A person with allergies may be allergic to aspirin, penicillin, erythromycin, or other medicines you often use. Find out which medicine has caused problems and give a different medicine, one that will not cause a reaction.
- A diabetic’s wound may become infected. Watch carefully the place where you took out the tooth and give antibiotics if an infection begins.
- During the last month of pregnancy, a woman may be too uncomfortable to have a tooth taken out. Control the infection with a 5-day course of penicillin, and take out the tooth after the baby is born. It is also better to wait if the woman has high blood pressure, because she may bleed too much when you take out the tooth. See more information about treating pregnant women, and a story about pregnant women and dental problems.
Be patient, careful, and considerate
- Inject local anesthetic slowly in the right place, so the tooth becomes numb and you do not hurt the person when you remove it. If the person says the tooth still hurts, it is probably true! Inject again.
- Use the correct instrument in the correct way. If you are careful you can avoid breaking the tooth. When you take out a baby tooth, be extra careful not to hurt the new tooth growing under it.
- Explain everything to the person. Tell the person if something is going to hurt, even a little. When you take out the tooth, you can explain, for example, that there will be a feeling of pressure. Press on the person’s arm to demonstrate what it will be like. When you finish taking out the tooth, explain what you have done and what the person can do at home to help the mouth heal.