What is the ruling on performing istinja' before every ablution?
Istinja' is not from the conditions for the validity of ablution. It is only obligatory for prayer when there is impurity from urine or stool on the private part, or if there is fear of the impurity spreading to the body or clothing. And Allah the Almighty knows best.
Does tooth extraction during the day in Ramadan break the fast?
Simply extracting a tooth during the day in Ramadan does not break the fast. However, if water or blood enters the body cavity, the fast becomes invalid.
Whoever's fast is invalidated in this way must refrain from eating and drinking for the rest of the day out of respect for the sacred month and make up for that day later.
It is preferable to postpone the extraction until nighttime or after Ramadan if possible.
What is the ruling on vomiting, and does it invalidate ablution?
Vomit is impure (najis). Its exit is not considered one of the nullifiers of ablution. However, the mouth must be washed and purified from it, and any that gets on clothing or the body must be washed for prayer, because prayer is not valid with impurity present on the body or clothing. And Allah the Almighty knows best.
Is it permissible for a wife to refuse to go to bed with her husband (for sexual intercourse)?
It isn`t permissible for her to do so unless for a sound reason.