Extracting the Truth: Exploring a Holistic Approach to Tooth Extractions

Years ago I decided I'm going to clean up my cupboards and stop using chemical toothpaste, chemical mouthwashes. And I started different brands of natural toothpaste and I found that some of them didn't taste very good. They were very medicinal because of the herbs that were in there. But the biggest problem is that they were not good cleaners. And I really wanted a toothpaste that actually cleans my teeth. It brings up the white and strengthens my teeth.

Because I didn't find what I wanted.

I actually went and created the Orasana probiotic tooth powder and I sourced the best nano calcium hydroxyapatite that actually had studies to show that it can whiten your teeth. And I started brushing with this and I wanted to add also the probiotics for gum support and gum health. And I noticed that my teeth are whiter, brighter and it cleans the plaque so well. So that's why I created the Orasana natural probiotic mineralizing tooth powder to give you that nice clean benefits from the probiotics, the calcium hydroxyapatite to keep your teeth strong and bright.

Hi everybody, I'm Dr. Sandhya Moldovan, periodontist and nutritionist. Welcome to the Holistic Dentistry Podcast, the show that gives you the tips and tools that to detoxify your mouth for a healthier body. As we explore together the root cause of disease. Remember, you're not healthy until your mouth is healthy. So take care of it in the most natural way. Welcome to today's show. I will be talking all about teeth extractions, why we have to do them, how do we do them correctly, what you should be asking your dentist in order to ensure that you're going to remember receive an adequate extraction. And certain questions that some of you actually sent me, such as do I need antibiotics? Are bone grafts necessary? What is prs? Is ozone a good thing? But let's start with why we need a tooth extraction. So for example, if you have a crack in the tooth and why would you get a crack in the tooth? Well, some of you love popcorn. So let's say you go to the movies, you get a popcorn kernel and it could be a totally virgin tooth. You crack on it the wrong way and you can get actually like a windshield cracks, a crack in your tooth that extends way beyond the gums into the bone, that can actually be very painful. And by the way, if you actually have a root canal treated tooth without a crown on it, that's going to be prone to cracking even more when a tooth cracks Way beyond the gum. Unfortunately, we cannot save it, so. So we're looking at removing it also. Another reason why we might need to have a tooth removed is because there's a large filling that's starting to hurt now. It's all the way to the nerve, and the cavity itself that's found under the filling has really started to eat up the entire tooth, where there's just nothing left of the tooth except for the roots inside. And in that case, there's just no possible way for us as dentists to build that tooth back. Also, if you have unexplained pain in a tooth, maybe from a root canal treated tooth, that's still causing you pain, and there's no other solution that. We're also recommend to have that tooth removed. Some of my patients, because I am a periodontist, come in and the tooth is very loose. When a tooth gets very loose because it has 80% bone loss due to gum disease or periodontal disease, also we would recommend for that tooth to be replaced as we cannot build the bone back. So there are many different reasons why we need to remove a tooth. Some teeth also are recommended by orthodontists to be removed. In the past, actually, there was a lot more removal recommended, especially of the premolar teeth, which are actually present right on the side when you're having a lot of crowding. Orthodontists may say, well, let's take out some teeth to ensure that we can align everything else. Today, we don't recommend that as much. The reason being is once you take out some teeth and you start to push everything back. Studies have shown that people are more prone to TMJ problems and also breathing issues because we're constricting the room for the tongue. So those are not so common anymore. Let's get back to extractions. So your dentist recommended for you to have a tooth removed. So what goes through someone's mind is, oh, my God, he's gonna pull out the old rusty pliers, take out my tooth. He's gonna, I'm gonna be in a lot of pain. I'm gonna experience a lot of force on my tooth. No, that's the old technique. You don't have to worry. I mean, the newer techniques in removing teeth have changed so much. In the past, you're right, we had huge old pliers. We have to actually take out the tooth by rotating it to the outside, and that would cause a lot of bone damage. But today, we do everything we can to ensure that we don't lose bone we want to maintain that bone because eventually we want to replace this tooth with an implant, which is the standard of care for us today. From a biological perspective, when we remove a tooth, there's a hole left behind. And in this hole, sometimes there's like periodontal ligament, there's infection, root fragments. So how do we ensure that we're going to clean this properly? That's really the number one more, most important thing in the healing process. Let's understand a little bit about the anatomy of the tooth. We have front teeth that have a single root, and then you have back teeth that have maybe two or three or sometimes four roots that are attached there. And of course we need more support in the back because those are our mastication teeth. Those are most of the chewing takes place. The more roots we have, the more difficult the procedure is. The longer the roots, the more difficult the extraction is. The more curved the roots are versus the straight ones, the more difficult the procedure is and the harder it is not only for the dentist, but also for the healing. Obviously, if there's a single rooted tooth, it's much easier to remove. In the front, as the teeth go in the back, we have, on the top we have sinuses, which is a big open hole. We all have it. And some roots of the back teeth actually can extend into the sinus. For the bottom, it can be very close to the nerve. So these are all factors that play a role. For that reason, I highly recommend every time a tooth is to be removed to take a cone beam CT scan. Why a cone beam CT scan? Because that allows me to see things in three dimensions. I know ahead of time how many roots I have, which way they're pointed. There's no way we can tell this from a two dimensional X ray. So in order to have a procedure done correctly, a CT scan is definitely a must. Now what do we do? When I do the procedures, I always look at the amount of bone that's in the side. Do I have a lot of bone? Do I have a little bone? Is it very fragile? Is it soft? And when I'm dealing with multiple roots, such as a molar, my recommendation is always to remove each root at a time, not to try to remove the entire tooth because the roots are pointing in all different directions. So now more stress is put on the surrounding bone that can crack, it can break off and come out with the tooth. So really, strategizing to take out each root individually becomes very important in maintaining the bone and causing the least amount of trauma. After the root pieces Are removed. We have to remove also the periodontal ligament. What is the periodontal ligament? It's actually a small little muscle attachment that holds the tooth into the jawbone. It's almost like a spring, like a shock absorbing mechanism. So that's why teeth get loose. When teeth get loose, this muscle attachment actually becomes a little bit looser. It is important to remove this muscle attachment when we do a tooth removal. Why? Because we don't want to leave muscle fibers in the side that will not allow the site to heal properly. What's the best way to remove this? Using a piezo device. Of course, a rotary bur is fine too, Like a little basically drill. But the problem with drills, they cause too much heat in the site. So always ask your doctor, do you have a piezo device to remove my tooth? The piezo actually is more like an ultrasonic device that helps to remove gently any kind of infected bone, Any kind of muscle attachment called periodontal ligament, maybe even root fragments that are in the place. It really allows me as a surgeon to clean this site nicely after we remove the periodontal ligament and any kind of cysts which are very important to remove. Also dead bone, Very important, like such in a cavitation. Let's say you had our old root canal tooth that is leaked into the jawbone. And we have this necrotic bone that must be removed until we have a nice bleeding socket and fresh cells left in the site. Ozone gas is an important part of detoxifying the site. Why do I love ozone gas is because ozone allows me to sterilize bacteria, viruses, fungi and any parasites. The mouth has over 600 different species and trillions of microorganisms that are living together. We're doing all these surgical procedures in that environment because we cannot sterilize the mouth. Yes, of course, a mouthwash or ozone water rinse prior to any kind of oral surgery procedure is an absolute must. But still, we're now able to fully get rid of all the microorganisms that live in the mouth. Ozone gas ensures that during the procedure, let's say from saliva, if some microorganisms got inside or from that infection, maybe that you had, we can sterilize the site. And what we see when we apply ozone gas inside open wound is the blood turns immediately red because it also oxygenates the site. So if somebody has like a darker blood or like oozing or pus, it really helps to get rid of all that in a gentle manner. And it also the gas gets pick up, picked up. In the vasculature and it carries it away from the site as well. After the site is detoxified with ozone gas, the next thing that goes inside a extraction socket would be platelet rich fibrin. The studies on platelet rich fibrin or any kind of platelet derivatives taken from your own blood really has been exploding lately. We know so much more about the healing power of our own stem cells that are naturally circulating in the blood. So my, the process of the way I do extractions has changed so much. And a lot of other biological dentists don't place bone grafts in the site because bone grafts actually delay the healing. But platelet rich fibrin increases the healing. And you might ask why, how come bone grafts delay healing? Well, if you put bone grafts in a site now, the cells have to actually consume those bone grafts and then reapply them to able to connect that bone and kind of turnover process, which actually takes longer. When we put prf, it's like miracle growth for plants. They just explode in growth. PRF actually is able to call in a lot of the bone cells to help the regeneration of the site before, let's say, the gum cells have a opportunity to get inside. So how do we make prf? We actually draw blood from you, separate the fibrin growth factors, any adult circulating stem cells that are naturally present in your blood, and we actually concentrate them inside this fibrin yellowish clot. There's also immune cells. The reason why I like the immune cells, which it's something their PRP actually doesn't have, is the immune cells actually help to fight off any kind of bacteria that's from the oral cavity that is getting into the site. A PRF cells typically last in a site for about two weeks, but during those two weeks, they amplify this healing signal to speed up healing and also to basically get rid of dry sockets. I had a question here from Tim. Tim had a tooth removed and every time I drink water, he says it comes out through my nose. What happened? Well, let's say, Tim, you probably had a molar removed out in the upper back jaw. What happened was probably your dentist didn't have a CT scan when that tooth was removed. The roots of your teeth were actually in the floor of the sinus. So when the tooth was removed, a hole opened up and a communication between your mouth, the sinus and of course the maxillary sinus communicates through a channel with your nose. So now every time you drink water comes out through your nose. It's called the oroantral defect. This actually can be repaired. And I highly recommend that you don't wait for this too long, and you go to have it repaired. How we repair this. And, you know, these kinds of openings actually happen from tooth extractions, but typically we want to repair them when they happen to prevent this kind of communication, because it makes you prone to sinus infections. So the site needs to be opened up. We need to repair that site using different collagen membranes and potentially even your own bone to be able to repair that floor of the mouth. I have another question here. My dentist told me a tooth fragment was left behind. What should I do? That's a great question. You know, and these things happen. Whenever we take out a tooth that has really convoluted roots, really curved roots, it could be that a tooth is left behind, especially wisdom teeth. Wisdom teeth, which are angled sideways, you know, a little piece of the tooth may break off, and sometimes the surgeon doesn't even see it. When we take an X ray, usually like a panoramic X ray or a CT scan, I can identify it. Oftentimes, root fragments left behind. Sometimes these root fragments are left behind intentionally. Why? Because they're maybe too close to a nerve, and we don't want to endanger injuring that nerve. Today, with a piezo technology, we can actually get very close to the nerve, because a piezo device, interestingly enough, only cuts bone. But if you put it next to any soft tissue or gum, it does not cut the gum. It does not cut the nerve, even in close proximity. So we have great technology to be able to pick these roots off, even that are close to the nerve. So what do you do now? My recommendation is if your dentist told you he left a root fragment behind, I would have that root frame checked a year later via CT scan. Sometimes these root fragments that are left very deep, they start migrating their way upward, so they won't fully come out of the jawbone by themselves, but they migrate to a better spot where we can now remove them. If it's still close to the nose, we'll check it again maybe a year or two later to see if a cavitation is developing around it, meaning necrotic bone and maybe potentially some bacteria that is left behind, which actually causes chronic inflammation. And we don't like to have it in the jawbone. Okay. Do I need antibiotics after an extraction? Well, it all depends. If you had a major infection and the infection's up into the sinus, yes, an antibiotic is necessary. Why? Because the Maxillary sinus is connected to the brain, the ethmoid sinus. So we don't want that infection from the mouth to escalate definitely to the brain or other parts of the body. So antibiotics sometimes are necessary, but most of the times are not. The reason being, especially when we use prf has actually the immune cells in there. So the immune cells are actually protective. And ozone gas also helps me to detoxify. So I typically do not prescribe antibiotics for a tooth removal because we have better tools today. And antibiotics really only work on bacteria. It doesn't work on fungus, it doesn't work on parasites that sometimes are also causing infections. So in a nutshell, this is my recommendation for extractions. Just make sure it's done carefully. We want to really save all the bone that we can. We no longer have to remove bone to remove a tooth because we can actually remove the tooth gently using a piezo device, sterilizing it with ozone, using PRF in the site. And just make sure the gums are sutured, closed at the top. And oftentimes when we have a molar, even though we try to stretch the gum over the top, it's not always possible to fully close it. Can cavitation still happen if the extraction is done? Absolutely correct, yes. For the reason that I was mentioning before is the biofilm in the mouth. The biofilm in the mouth can actually affect the area and get under the gum, especially during the healing period. And you know, bacteria is not something that we see with the naked eye. Follow up treatment with ozone injections is recommended. But even that doesn't fully ensure, and especially if you have a difficult extraction because of the inflammation, infection, the roots that are in the area, it might still require a second cleanup to ensure that the bone is healing properly. Can implants be placed and what are the benefits of placing an implant at the time of the extraction? Well, yes, implants can be placed at the time of doing an extraction. However, if you have a lot of infection in the site that basically we have to clean up a whole lot of bone in order to make sure that the bone heals in a proper manner, then implants are not possible. We want to make sure that the bone grows properly before implants are placed. However, for the front teeth, anything from the eye tooth forward, it's possible definitely to place implants at the same time. And some advantages of placing implants at the same time is because we actually can preserve the bone, preserve the gum, so it doesn't collapse with the healing in terms of are bone grafts necessary after an extraction? Most of the times they're not. There was a study done, however, in the front aesthetic zone where the bone is thinner, to show that when we place implants with bone graft, we actually can maintain the bone profile a lot better. So that would be my recommendation today to actually place the implant at the time of extraction, if at all possible, in the front part of the mouth. And what kind of bone grafts would we place in that instance? It would be actually your own bone is always preferred because you have nice live cells that are associated with it. And the last question here, how can I accelerate my healing? Well, in our next episode I will address this topic. I will be going over nutrition supplements, homeopathics, and also my book Heal up, which is available on Amazon, has seven different ways for optimum healing. Thank you so much for joining me this week. Please make sure you check out the show notes for any links mentioned in the show. If you like today's show, please invite your friends to listen as well. That would mean a lot to me. Do you have a question you'd like me to answer? Message me on Instagram. DoctorsAnda. This is Dr. Sandha. And remember, your mouth is the gateway to your health, so take care of it in the most natural and best way possible.