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Commentary

Pulling Out, Extraction or Avulsion?

Ehrenfest, David M. Dohan DDS, MS, PhD*; Vazquez, Lydia MD, DDS, PhD

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doi: 10.1097/ID.0b013e31816760b4
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Commonly used words may not always be appropriate scientific terms. Among all the words used in dentistry and oral surgery, no word is more representative than the term “extraction.” However, surgeons from other medical disciplines, who are “extracting” a lot of elements from the human body, clearly state that extraction is used for fluid or bone marrow harvesting, for instance. For the elimination of a solid body—such as a tooth—the correct medical word should be “avulsion.”

Extraction comes from the Latin verb “extraho, extrahere, extractum,” which means “to pull out”: the word is put together from “ex” (“outside”) and “trahere” (“to pull”). In chemistry and biochemistry, this word is used for the chemical or physical separation of a component from a mixture. In the surgical literal sense, it means to pull out a specific component (such as a foreign body or some poison) from the body. Teeth clearly do not fit in this category.

Avulsion comes from the Latin word “avulsus”: “a” privative (means “without” or “the end of something”) and “vulsio” (to remove something useless or sick). Avulsion means the forcible separation (not only surgical removal) of a sick (or useless) part of an organism. Traditionally, the Latin word was used both for the pulling out of the teeth and the excommunication of a blasphemer, considered as a corrupted part of the social body, for example. In medicine, this term is often used in traumatology, when an element of the body is removed unintentionally, such as a ligament avulsion injury, a traumatic nerve root avulsion, or a traumatic tooth avulsion. In such cases, the traumatism has to be literally considered both as the “pathology” that makes the organ sick, and the removal “procedure”.

In reality, most of us know these concepts as we have often heard: “we pull out carrots or weeds, we extract minerals, coal, and oil from the ground, but we avulse teeth.” This vocabulary problem exists both in French and in English as well as in other languages. “Tooth pulling” or “tooth extraction” is so often used by our patients, that even dictionaries consider these words scientifically acceptable. As health professionals and specialists should we also use these common expressions? Should we write “devitalization” or “endodontic treatment,” “short bridge” or “fixed partial denture,” “prosthetic crown” or “tooth cap,” “periapical radiograph” or “photo” (as in pediatric odontology), “dental surgeon” or “tooth puller”?

In the Medline database, publications always use the expression “tooth extraction,” or “immediate postextraction implantation”. However, as we are not extracting any fluids or gold nuggets from the mouths of our patients, we should be using the appropriate scientific terms in our publications. As specialists in oral surgery, we are called upon to avulse teeth tomorrow and perhaps manage immediate postavulsion implantation. As researchers, we investigate the healing processes within tooth avulsion sockets and try to find out better ways to control postavulsion alveolar bone resorption. Ultimately, broader use of the correct term “avulsion” will open a new chapter of keywords in the Medline database …

© 2008 Lippincott Williams & Wilkins, Inc.