Retained tooth roots can cause considerable pain and discomfort for the patient. They can also result in serious complications. What is a retained tooth root, and what occurs after a tooth root that is causing pain and mouth infections is surgically removed?
What is a retained tooth root?
The portion of a tooth that is buried in the upper or lower jaw bone is called the root. A tooth can have up to four roots. If roots are causing mouth infections and discomfort and can no longer be repaired or made infection-free, they need to be removed. The same holds for teeth that have not fully emerged from the jawbone, often known as impacted or un-erupted teeth. After lying dormant for many years, roots or teeth may begin to cause problems in the gum. This frequently happens when a patient has a denture in place over the gum in this area for a while. The issue persists if you leave things the way they are. There are no adequate alternatives to surgery.
How is the operation performed?
Depending on the circumstances, a local anesthetic, with or without sedation, or a general anesthetic will be administered to you. An injection of anesthetic numbs the surgical site. You will experience very little pain or none at all, but you will be awake and c conscious and feel pressure on the surgical site. Local anesthesia is sometimes combined with sedatives to help you relax and make the procedure more comfortable,
If you are put under general anesthesia during the procedure, you will be unconscious and unaware of what is happening. In this condition, you won’t feel any pain and will be sleeping throughout the procedure.
You and your surgeon will talk about the type of anesthetic before making a choice. These procedures can be carried out comfortably and safely with only local anesthesia. However, it is preferable to receive some sedation or a general anesthetic if the procedure is anticipated to be challenging, such as when a tooth is deeply embedded in your gums and hasn’t fully erupted.
Frequently, only specialized forceps are required. The gum may need to be partially cut to allow access to the roots of the teeth/teeth easier. The tooth or root may need to be loosened by removing a small portion of bone. The tooth/root may need to be split into two or more pieces to facilitate its removal.
After the tooth is removed, the gum will often be sutured, frequently using sutures that dissolve in 7 to 10 days.
Most patients will return home on the day of the procedure. You can typically return home two to three hours after the procedure if only a local anesthetic is used. If you undergo a general anesthetic for the operation and the anesthetic’s effects linger for a while afterward, you might need to spend the night in the hospital.
A portion of the gum tissue has probably developed over a retained root if it has been there for several years. The entire root may occasionally be covered. Bone or gum tissue may need to be removed in this situation. A bone graft may be used to restore the bone that the dentist removes during the extraction of a retained root. The dentist can use dental forceps to extract the trapped roots in uncomplicated circumstances where the roots are exposed.
Before the procedure
Stop smoking and lose weight if you’re overweight before having a general anesthetic.
Ask your family doctor to make sure your blood pressure, heart, or lungs are under control if you have any of these conditions.
Check the hospital’s recommendations about using the Pill or hormone replacement therapy (HRT).
Sort out any pills, inhalers, or medications you are taking. Keep them in the boxes and packs they came in. Bring them with you to the hospital.
To make sure you are prepared and can have the procedure as securely as possible, you will have various tests and have your past health history examined on the ward. Please inform the nurses if you have any pill, drug, or dressing allergies.
Make sure you have a friend or relative who can accompany you to the hospital, drive you home, and take care of you for the first week following the procedure.
You will have the procedure explained to you and will be requested to sign an operation consent form. Make sure you thoroughly comprehend all the information provided to you regarding health issues, suggested therapies, and any potential hazards before you sign the consent form. If you have any other questions, please ask them.
Any tissues taken out during the procedure will be tested to determine the best course of action. After the testing, any leftover tissues will be discarded. As part of the consent process, you might be asked to consent to use these “leftover” tissues by the hospital for medical studies before the procedure. Whether you agree to this or not is entirely up to you.
Nowadays, many hospitals operate specialized preadmission clinics where the necessary examinations are conducted a week or so before the procedure.
After the procedure- in the hospital
Your mouth will be swollen and feel bruised. The pain can be mild to severe, and your jaw will be slightly rigid. There may be some mild swelling and skin bruising on your cheeks. The discomfort will be treated with painkillers. The jaw’s swelling, bruising, and stiffness will go away in a week to ten days.
You will be slow, clumsy, and forgetful for roughly 24 hours after receiving a general anesthetic. Sedation works similarly, albeit to a lesser extent. Until you can take care of yourself, the nurses will assist you with anything you need. During this period, refrain from making significant decisions, using machinery, driving a car, or even boiling water in a kettle.
The stitches used usually fall out, but you will typically be required to go to a brief outpatient visit to check on healing two weeks after your procedure. If necessary, the stitches can be taken out. At that visit, an after-surgery X-ray might be taken.
Occasionally, additional visits may be scheduled to keep track of your recovery after tooth extraction. Some hospitals organize a hospital checkup. Others trust your regular dentist to handle checkups. The nurses will offer advice on certificates, illness notes, etc.
After the procedure- at home
You may be given a small “take-home drug pack” including an antibiotic, painkillers, and antiseptic mouthwash. Please be aware that taking antibiotics may reduce the contraceptive pill. While taking the antibiotics and for about a week after they are finished, take additional care to avoid becoming pregnant.
You should initially avoid particularly spicy and vinegary foods, and it could be difficult to chew regularly for a while, so you should also choose a softer diet. While your diet is temporarily changed, adding a little extra daily fiber in the form of bran cereals or porridge can often help prevent constipation.
To avoid infection of your wounds, it’s crucial to have a cleaner mouth than usual. After brushing your teeth, take a warm salt water mouth bath for one minute on each side three times a day (a teaspoon of salt added to 0.2 liters of warm water).
After using the salt water for a minute, you should also use the antiseptic mouthwash that was provided. Use painkillers as prescribed and finish the entire course of antibiotics.
After having your teeth/roots removed, you will notice the hole(s) left behind for a few weeks, but after the bone and gum have had time to heal, it will be difficult to tell you even had surgery there.
In a day or two, you ought to be able to resume your job. However, you can experience significant fatigue for one to two weeks following your operation.
What complications can occur?
There is a minimal possibility that issues with your heart and lungs will arise if you undergo this procedure under general anesthesia. Sedation works similarly, albeit to a lesser extent. The examinations you will do before surgery will ensure that you can have the procedure in the safest manner possible and will reduce the risk of these complications even further.
Rarely, bleeding can occur after surgery. It often ceases when the physician applies pressure to the surgical site using a sponge. In rare instances, you may require a second procedure to halt the bleeding.
If you suffer growing pain at the site of the operation, feel more bloated, and have a temperature, it is quite likely that the antibiotics you were given to prevent infection were insufficient, and the location of the operation has become infected.
Rarely, if the infection is more severe, you may need to return to the hospital to get intravenous antibiotics through a tiny plastic tube inserted into an arm vein. Only a small percentage of patients may experience severe infection, which may result in an abscess (a collection of infected fluid or pus) around the site of the operation. In this case, you will require a second procedure to remove the contaminated pus or fluid.
You have a 5- to 10% chance of developing a “dry socket” issue after having an impacted tooth removed. This occurs because, either after the tooth was removed, no clot formed in the region or socket where the tooth formerly was, or one did develop but later became dislodged. You often feel this four to five days following the operation, and it can be painful and frequently results in repulsing bad breath.
For a few days, the socket must be packed with medicated gauze to relieve the symptoms while the healing process continues and begins to fill the socket. Every other day, the gauze needs to be changed. Most patients require just two to three changes before their symptoms significantly improve, and packing the socket is no longer necessary.
The tooth socket may occasionally become a dry socket and become infected if it is not carefully cared for or for unknown reasons. It is recommended not to smoke for the first 24-48 hours after the tooth extraction because this condition is more likely in smokers.
When you have a dry socket, you will initially experience only the expected amount of pain associated with an extraction. However, after a few days, the clot dislodges from the tooth socket, and the agony worsens. Healing takes longer than expected.
It is thought that people who smoke or women who use birth control pills are more likely to suffer from this issue. A “dry socket” can be extremely annoying, but with the proper treatment, it settles fully and reasonably fast.
other common complications of tooth extraction
Broken root
When trying to extract teeth, thin, bulbous, and brittle roots are likely to break. When the root is broken off, it can usually be safely left behind if the dental nerve is not infected, especially if the root is less than 2 mm long. Sometimes, leaving the root behind is safer than searching for it.
The root remnant may subsequently become permanently incorporated into the bone. Sometimes, particularly with baby teeth, the remaining material may be resorbed away or eventually float to the gum surface and be easier to remove. In other instances, particularly if the tooth was previously infected, the root will get infected and should be removed rather than left.
Perforated sinus
The roots of the upper teeth can be very close to or even reach inside your sinuses. Because of this, the tooth could act like a plug, and when the tooth is removed, a small hole might develop between the sinus and your mouth.
If it is a small hole, it generally closes up on its own, but if it is a larger hole, it will need to be repaired. You should still take precautions even if a hole is not noticed on the day of extraction, as the bone between the sinus and mouth can be thin. So even if no hole is apparent, a hole may develop later if you are not careful.
Simple precautions include not drinking through a straw in the first 24 hours. If you have to sneeze, sneeze with your mouth open.
Nerve damage
This bothering risk is extremely rare, but if it occurs can be debilitating, so it is worth mentioning. In the lower jaw, the nerves that supply sensation to your face and tongue travel close to the roots of the teeth, especially the lower molars.
These nerves may be permanently damaged or temporarily affected during an extraction. This may lead to altered sensation in the areas the nerve supplies. Although the risk is low, dentists should carefully evaluate the area and take precautionary x-rays, including 3D scans in complex anatomy cases. They refer suspected cases to specialist oral surgeons.
Sore jaw
This symptom is common and, in certain situations, expected given the nature of tooth extraction. Similar to vaccination, even locations far from the extraction site can feel bruised and the muscle strained. In most cases, the soreness disappears on its own over time.
Damage to nearby teeth
When a tooth is extracted, the teeth nearby may sustain damage. Such damage includes chipping of the restoration or the tooth, and occasionally, if the neighboring tooth has a crown, the crown may come off as the tooth is wiggled out. Such problems can typically be foreseen by examining the state of the teeth next to the tooth to be extracted, but not all these problems are preventable.
Retained root, a special complication of tooth extraction
In certain instances, retained roots can become particularly troublesome after tooth extraction. Let’s take a closer look at retained roots now that we have a general overview of tooth extraction complications. We begin with a general introduction to the problem of retained root:
Dental practitioners frequently disagree on whether to remove retained roots, and it might be difficult for clinicians to develop a treatment plan that meets the needs of each unique patient. Here, we emphasize the risk-benefit matrix of the removal or retention of residual root pieces.
In the 1920s, there was widespread agreement that all root tips should be removed because partial removal of the crown-root complex was considered to harm patients by causing discomfort, infection, and cyst development. However, today we know that most retained root pieces do not harm patients and are only discovered as unintentional radiography abnormalities, according to studies on the occurrence of retained roots.
Many studies have examined how extraction sockets recover when shattered root pieces are present. The investigations demonstrated that, under specific conditions, root fragments could be successfully kept in place while normal healing occurred and a cementum layer formed on the dentine to facilitate bone development, encasing the root fragment within the bone.
In order to assist conserve alveolar bone for potential prosthodontic treatment, the submerged-root concept was developed. This line of study led to the practice of coronectomy, which involves removing a wisdom tooth’s crown from its roots (in a healthy tooth). The idea was to prevent inferior alveolar nerve injury, which can result in a numb lip.
However, residual roots can be a source of infection and can be painful for patients, especially if they are damaged during the extraction of a non-vital tooth. Retained roots can also make it more difficult to create complete dentures because they may result in pain and numbness if the base or flange of the denture comes in contact with the root fragment. The pain can come either immediately or years later due to the reshaping of the alveolar ridge. Dentures that push against retained roots may suffocate the nerves.
Clinicians might do a risk-benefit analysis when considering the removal of retained roots for each particular patient. If it is decided to leave a retained root fragment in place, the dentist must inform the patient and maintain routine clinical and radiological follow-up while following safe radiation exposure recommendations.
When to remove a retained root?
Unless they intend to use those roots to support a denture, dentists often remove both the crown and the roots when extracting a tooth. In this manner, there won’t be any residual tissue to act as nourishment for invasive germs. But occasionally, the tooth’s roots are left after a tooth has suffered severe stress or decay.
When this occurs, the gum tissue repairs partially or entirely over the roots. Many residual roots will cause issues, though not all of them will. You might go years or more without having any problems. But if an infection develops, it might be time to have the retained root taken out.
Retained roots can become infected
Retained roots have the potential to become infected, much as impacted teeth that become trapped in the bone or gum. If the roots are just partially covered, the risk will be higher. The roots can become food for bacteria as they are essentially dead material. Similar to how bacteria infect teeth or gums, retained roots become infected by bacteria by being exposed to them. When bacteria colonize retained roots, an abscess can develop. This abscess, which is entrapped inside your gum, will swell with dead bacteria, white blood cells, and other debris. If the abscess is not treated right away, your jawbone will start to suffer damage since the pus is toxic to biological material such as bone. Additionally, infections may repeatedly occur, eventually weakening the nearby bone. Without a bone transplant to restore the lost bone, you might not have enough bone for dental implants after the damaged bone is removed.
Conclusion
When teeth are removed, root tip fractures can happen. The clinician must next choose whether to undertake root fragment removal or leave it in place. A similar choice is made when retained root fragments are discovered on routine oral radiography. According to reports, retained root fragment prevalence ranges from 11 to 37%. Visit your dentist as soon as possible if you have retained roots and suspect something is wrong. The sooner you receive dental care, the sooner the infection can be treated.