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Biologic Extractions

BIOLOGIC EXTRACTIONS of INFECTED TEETH

Written by Anthony Trovato, MSACN, LMT

If a tooth is to be removed for any reason, we recommend certain steps to optimize post operative healing and bone/tissue regeneration.

Periodontal Ligament

All teeth have a periodontal ligament.  The periodontal ligament (abbreviated PDL) helps hold your teeth in place and functions like a shock absorber.  When you bite down with force, the PDL protects your teeth from shattering by letting teeth compress a fraction of a millimeter (like a spring).

In an extraction, the PDL should be removed with the tooth as a preventive measure.

It is standard of care for an oral surgeon to leave the periodontal ligament behind.  The PDL is composed of collagenous bundles, loose connective tissue, blood, lymph vessels, and nerves.  If left behind, its continued presence in an extraction site prevents biologic recognition of the absence of the tooth; bone cells will not proliferate and migrate through a membrane intended by nature to define growth limits.  Another potential problem of leaving the PDL behind is that, if the remaining PDL retains infection, your body will wall off the remaining bacteria and toxins with calcium-dense bone (condensing osteitis or lamina dura); an anaerobic pocket called a cavitation can form.  

If the calcium-dense wall is already present around the base of the tooth to be extracted, as sometimes happens with a re-infected root canalled tooth, it should be removed, perforated, or roughened at the extraction visit in order to facilitate blood flow and post-extraction healing.

Cavitations

Cavitation pockets are impossible to detect by visual examination and often impossible to see on traditional radiographs.  (ICAT/conebeam technology is required to view.  Ask us about our conebeam technology.)  A cavitation interrupts oxygen and blood supply to the affected bone, resulting in a potential breeding ground for bacteria.  Infection can stay subclinical (producing no symptoms of redness, swelling, or temperature increase) indefinitely.  Trapped inside the bone, bacteria give off waste toxins that can affect surrounding bone as well as the rest of the body.  Over time, a cavitation site can host microorganisms like virus, fungi, and parasites.

Research by Dr. Boyd Haley, University of Kentucky, shows that ALL tested cavitation tissue samples contain toxins that shut off one or more enzymes used by the body to produce ATP (the molecule that supplies energy to your cells).  Other research indicates that toxins synergistically combine with chemicals (environmental toxins) and/or heavy metals (mercury, lead, cadmium) to form even more potent toxins.

NICO

Some people experience severe pain in cavitation areas.  The term used to describe this condition is NICO (neuralgia-inducing cavitational osteonecrosis).  NICO lesions can produce severe facial pain, neuralgia, headaches, or even a phantom toothache (tooth pain where there is no tooth).

It is important to note that not all standard-of-care extractions result in cavitations and that only a relatively small number of cavitations become NICO legions. Condensing osteitis is not always present. This page simply seeks to optimize your post-extraction healing through preventive measures.

Biologic Extraction Technique

When you opt for an extraction, communicate that your dentist requests complete removal of the periodontal ligament and up to one millimeter of spongy bone from entire bony socket, including apex, via a number 8 or #10 long-shanked surgical round bur.  Make this request prior to scheduling the extraction so you know if your oral surgeon is willing to comply. 

A bur is recommended because studies show that manual scraping of the PDL can actual push bacteria and toxins back into good cancellous bone, potentially resulting in lack of primary healing and in a greater chance of persistent or recurrent infection.  Use of a surgical bur after tooth removal insures complete extrication of the PDL as well as more thorough removal of the compromised bone surrounding an infected PDL.  Removing infected bone and/or surrounding calcium-dense wall (osteoectomy or alveoplasty) takes the socket down to good, bleeding, healthy bone, promoting natural nutrient flow into the area and waste flow out.

Expect to bleed slightly longer with a biologic extraction.  Bleeding helps remove residual infection and begins the healing process.  If you still experience a trickle of blood after an hour, place a wet, black tea bag over extraction site, clamp gently, and hold in place for a half hour to help the clot to form.

Oxygen-Ozone

We recommend a post-extraction healing injection with Heel/Sanum remedies and medical-grade oxygen-ozone, preferably the same day.  (Ask us for more information).
 
After Care Instructions

-Place gauze over the extraction site and bite firmly.  Replace gauze as needed for 30 minutes or until bleeding ceases.
-The anesthetic will wear off in a few hours.  Be careful not to bite your lips, tongue, or cheek while you are numb. 
-For at least 24 hours, AVOID the following: smoking, drinking through straw, blowing nose, excessive spitting, vigorous rinsing, hot foods/liquids (so as to avoid creating a dry socket by dislodging the forming blood clot and so as to avoid prolonged bleeding).
-Other than natural remedies indicated by your health provider, use only NON aspirin pain medication (Tylenol, Motrin, Advil) to alleviate discomfort as may be needed.
-After 24 hours, begin to rinse gently with warm saltwater.  Combine ¼ teaspoon salt and 1 cup water and rinse every four hours