A man died after extracting 23 teeth at once! Can you only extract one tooth at a time?

When it comes to tooth extraction, everyone is familiar with it. After all, even if you have not experienced it yourself, there are always relatives and friends around you who have had their wisdom teeth extracted. But recently, a piece of news has refreshed our understanding of tooth extraction.

A netizen from Jinhua, Zhejiang Province recently said that his father had 23 teeth extracted and 12 implants placed in one day, and died 13 days later. Was the patient's unfortunate death related to the extraction of so many teeth? How many teeth can be extracted at one time?

As for the first question, there are many possible factors, and no one can judge the cause of death of the patient based on the information on the Internet. We can only wait for the investigation results of the relevant departments. But as a dentist, I can answer one or two questions for you. Let's talk briefly about how many teeth can be extracted at one time.

How to decide how many teeth to extract at one time?

When we remove wisdom teeth from patients, one of the most common questions we get is, “Can I remove them all at once?”

This feeling is certainly understandable. In many cases, there is more than one wisdom tooth with problems. It is not easy to take leave to see a dentist, so why not solve the problem at once if possible.

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However, most of the time, our answer is "No!" But in some cases, it is indeed possible to extract more than one tooth at a time. Generally speaking, when we judge whether to extract multiple teeth, we can never rigidly follow the rules to extract as many teeth as we want (in fact, there is no such rule). After all, there are many different people, and many different people have many different teeth. The situation is too complicated.

So how do you decide how many to pull?

The tooth condition is complicated, so when making a judgment, we mainly base it on one principle, that is, the trauma should be small and not affect recovery. As long as the trauma is small enough, it is feasible to extract more teeth at one time, not to mention one or two teeth.

So the question is, how small is the “small” in “small trauma”?

There is no accurate standard for this, and the dentist needs to judge based on the specific "tooth condition". Generally speaking, if the tooth is already loose, then extracting such a loose tooth root will cause little trauma , and even extracting several teeth may not even take ten minutes.

However, if you extract a horizontally impacted tooth, the trauma may be very serious . It may take more than half an hour to extract one tooth, which will exhaust the doctor's energy and the patient may be too tired to open his mouth.

Therefore, if it is to extract wisdom teeth, we sometimes choose to extract both teeth on one side at the same time in the outpatient clinic, because mandibular wisdom teeth are usually easily impacted, while maxillary wisdom teeth are often relatively simple, and the trauma added up is moderate. At the same time, the doctor does not spend much time on extraction and the efficiency is relatively high, saving the patient from repeated visits to the doctor.

The teeth in front of the wisdom teeth have developed cavities, also known as caries, and an impacted tooth can be seen in the picture. Image source: author

But if we encounter a mouth full of rotten roots and broken crowns, we sometimes extract a few more teeth, because these teeth are usually somewhat "loose", that is, they are not so firm, so it is not difficult to extract them.

However, we must also take into account the convenience of the patient's daily life . In actual operations, we usually choose to extract the residual roots on the same side or in the same quadrant (meaning both the same side and the upper or lower teeth).

The advantage of doing this is that after the tooth is extracted, only one side is injured and unable to bite anything, while the other side is relatively uninjured, allowing the patient to chew when eating, rather than forcing the patient to only drink liquid food.

How many to pull at a time depends on the crowd

We have emphasized the need to reduce trauma as much as possible, but we attach so much importance to "trauma" mainly because we hope that the trauma can recover quickly. Therefore , in addition to reducing trauma, we also need to consider the patient's own resilience.

Because even traumas of similar severity cannot be compared to different groups of people. For example, even if it is a similar tooth extraction injury, the teeth extracted are equally difficult to extract, the time taken is similar, and the size of the wound is similar. But one patient is a frail elderly person, and the other is a young and energetic young person. Their reactions and recovery speeds to the same trauma are also completely different.

Another factor that must be considered is the underlying disease. Young people are usually in better physical condition and have fewer underlying diseases. The elderly often suffer from various underlying diseases , such as diabetes, hypertension, heart disease, immune diseases, etc. For this group of people, even the smallest trauma may become the last straw that breaks the camel's back. Therefore, when evaluating the surgical trauma that these patients can tolerate, we must be more cautious and err on the side of being conservative.

In addition, when extracting multiple teeth at one time, the specific circumstances at the time of extraction must also be considered. The process of extracting multiple teeth at the same time should be controlled in a shorter time, such as within half an hour or an hour; the bleeding situation should be evaluated after the operation, and sutures should be performed to stop bleeding when appropriate; in addition, the possibility of postoperative infection should be evaluated based on the depth of the trauma during the operation and the patient's basic physical condition.

Extracting multiple difficult teeth at one time often brings more challenges to post-operative medication, infection prevention, and swelling and pain relief.

Teeth cleaning. Copyright image. Reproduction may cause copyright disputes.

Regarding how many teeth to extract at a time , although it is impossible to give a specific and universal number for the sake of rigor , as a dentist I can share some practical experience.

As far as I can remember, the most teeth extracted in a single operation was six residual roots for an elderly person. The reason why this operation was possible was that although the patient was nearly 70 years old, his overall health was good. In addition to high blood pressure (which was well controlled by taking medicine), he did not have any other systemic diseases such as diabetes, cardiovascular and cerebrovascular diseases.

According to the principle mentioned above of combining the patient's own condition, minimizing trauma and facilitating recovery, elderly people who are not in such good health may need to be more cautious when extracting multiple teeth.

Back to this incident, although the causal relationship between the tooth extraction operation and the patient's eventual death remains to be investigated, it must be said that processing so many teeth at one time is indeed a very rare operation.

Elderly people need to pay attention to these points when extracting teeth

It should be emphasized here that although "tooth extraction" sounds ordinary and common, it is also a surgery after all, and it also needs to be standardized and taken seriously. Especially for some high-risk groups, more attention should be paid. Here we focus on the precautions for elderly friends when having their teeth extracted.

First of all, the patient should inform the dentist of his/her general condition as detailed as possible , including various underlying diseases, such as the most common hypertension and diabetes, etc. In addition, diseases of the respiratory system, digestive system, and urinary system should also be told to the doctor before tooth extraction, so that the doctor can have a certain assessment of your overall ability to tolerate the surgery.

Secondly, if the patient is taking long-term medications, especially anticoagulants such as aspirin , they should also tell the doctor. Because of the bleeding after tooth extraction, the doctor also needs to check the patient's coagulation function.

Finally, it is best for the elderly to have their teeth extracted with the company of their family members , especially those over 80 years old. On the one hand, having family members with them will make everything much more convenient, and any problems can be communicated and handled in a timely manner. And when the doctor conveys some precautions after the tooth extraction, having an extra pair of ears to listen will make it less likely that the key points will be missed.

Let me emphasize again that on the one hand, we should pay attention to the health care of teeth in daily life, eat less sugar, drink less soft drinks, especially carbonated drinks, brush teeth frequently, use dental floss and water floss. Avoid tossing good teeth to the point where they have to be extracted. On the other hand, we don’t need to be afraid of seeing a doctor for wisdom teeth that are causing trouble. We should extract them when they are necessary. It will be easier after extraction. As for how many teeth can be extracted at one time, it depends on the judgment of the dentist.

Finally, I hope that everyone does not need to see a dentist on a regular basis except for regular dental check-ups and periodontal cleanings.

Planning and production

Author: He Jianliang, Chief Physician of General Dentistry, Second Affiliated Hospital, Zhejiang University School of Medicine

Reviewer: Tang Qin, Director and Researcher of the Science Popularization Department of the Chinese Medical Association

Planning丨Ding Zong

Editor: Ding Zong

Proofread by Xu Lailinlin

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