You can have a tooth infection for a long time before you know it. When the infection gets bad enough to put pressure on the gums and the roots of the teeth, you will start feeling pain. That means that the area around the roots is filled with a deep infection. When you go to the dentist complaining of tooth pain, it is important to have an X-ray made to see how far the infection has spread so it can be treated properly. The infection always has to be treated before the tooth can be extracted or it can lead to complications once the tooth is pulled.
Sometimes an infected tooth can have other teeth impacted around it. Impacted teeth never make their way above the gum line and can put pressure on the roots of other teeth, which lead to infection. It is important to have X-rays before your extraction to make sure that there are not other teeth below the gum line that need to be removed. Some impacted teeth can be fused to the jaw or can be fused to the roots of the tooth that needs extraction. When impacted teeth are involved in an extraction, you will need dental surgery.
Tooth roots can be much longer than you think. Some even grow so long that they reach into the sinus cavities. This is fine as long as the tooth is healthy, but when a tooth is infected, the infection can travel through the roots and into your sinuses. This is very dangerous because your sinuses are so close to your brain and infections can spread rapidly. Also, tooth root perforation means that you may need stitches to close the opening between your mouth and sinuses after extraction. This has to be done by an oral surgeon and is a good idea even if the tooth removed is not infected.
The dentist may need to take multiple x-rays to determine what needs to be done. They may also take more after the procedure to check that everything is healing properly