Why pulling teeth is not like extracting them
Some veterinarians pull teeth and others extract them. But do you know the difference?
Extraction is really just a medical term for surgical tooth removal (or dental "amputation," if you will) while "pulling" implies an easy fix to an ailing tooth. But it connotes an important difference in how teeth are dealt with in a veterinary setting.
Because nothing could be further from the reality of what high-end veterinary practices offer than a simple "pull." In fact, a dental extraction is a complex procedure that took me years to master.
In veterinary school, most students do not have the luxury of learning how to carefully manage a tooth as if it were an individual patient. To move beyond the basics of dentistry, most of us have to learn the hands-on stuff in private practice––which means we need excellent (and patient) mentors or additional coursework (usually where dental procedures are performed on cadavers and skulls).
(While the latter approach might sound gruesome, consider that you'd rather us not learn on the job if it means practicing on your pet, right?)
The cynics among you may say, "Sure, it all comes down to price. 'Extraction' just means a veterinarian is able to charge more." And yes, it’s true. A veterinarian who will extract a tooth surgically is typically doing far more than twisting and yanking (as it was done in "the old days").
Today, an extraction often comes down to this:
- Basic bloodwork and a physical examination are undertaken.
- Antibiotics are administered before the procedure if moderate to severe periodontal disease is present.
- An animal is anesthetized using drugs selected for his or her individual needs.
- Monitoring equipment is employed to continually evaluate the pet’s heart rate, rhythm, blood pressure, temperature, and blood oxygen levels.
- An IV catheter is placed and fluids may or may not be intravenously administered, depending on the animal’s needs.
- The teeth are individually cleaned (usually with an ultrasonic device) and assessed for damage.
- X-rays are taken to assess the extent of the damage below the gumline.
- Teeth are carefully considered for their ability to be salvaged through treatment options that may include root canals, root planing, topical antibiotics, and other measures.
- For teeth that require extraction, a local anesthetic is injected at the site of the appropriate nerve.
- Systemic pain relief may also be required, depending on the tooth’s likelihood of yielding significant pain upon extraction.
- An incision is made in the gumline and the gum is "flapped" away from the tooth and often sutured out of the way.
- A high-speed drill (usually specifically designed for pets) is used to clear away overlying bone to free the tooth from its bony attachments.
- Multi-rooted teeth may be drilled in between their roots to facilitate extraction.
- The tooth is carefully removed to ensure no fracture of the roots occurs.
- The bone is carefully smoothed out to minimize crevices where bacteria may proliferate.
- X-rays are again taken to ensure no remnants of tooth remain.
- The flap is then replaced over the sulcus (the hole where the tooth was)––sometimes after filling the area with a "bone replacement" powder––and it’s sutured in place.
- A dental chart is filled out to describe the mouth and provide a formal record of the procedure.
- The pet is carefully recovered with individual attention.
How’s that for an extraction? Now that you know what goes into it, is it any wonder I can’t stand the idea of "pulling"?
So the next time you head to the vet’s and he/she recommends an extraction, don’t be alarmed if your provider corrects your English. An extraction has earned its fancy nomenclature.
Dr. Patty Khuly