1.
About Oral Surgery
 Oral
surgery is an area of dental specialty involving the repair of bones
and soft tissues of the face, mouth, and neck for functional and
esthetic reasons. Patients with physical trauma to the face, mouth,
and neck, oral infection, and jaw disorders may explore surgical
treatment options.
The following are surgical procedures performed by an oral surgeon:
- Damaged or impacted tooth removal under a general anesthetic,
to prevent further damage to the adjacent teeth and jaw structure.
- Dental implant procedures, including reconstructive bone surgery
to ensure strong replacement teeth that look and feel natural.
- Reconstructive and cosmetic surgeries to correct soft tissue and
bone damage, or to change unwanted features. These procedures often
require grafting of skin, bone, tissue, and nerves from other parts
of the body.
- Facial surgery to the soft tissues, jaws, cheeks, nasal bones,
eye sockets, and forehead to repair cuts, fractured facial bones,
and for pain relief in extreme cases of temporomandibular joint
disorders.
- Corrective jaw surgery for treatment of bite deformities and birth
defects, including realignment of the upper and lower jaws, and
cleft palate corrective procedures to improve functionality and
appearance.
- Cyst and tumor treatments and removal, as well as procedures to
treat and manage severe infections within the oral cavity, jaws,
and neck.
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2.
Removal of Teeth
The
term extraction usually sends shivers up people’s spines along with
all sorts of thoughts of pain. The truth of the matter is that having
a tooth pulled, even an involved one such as a wisdom tooth is not
painful at all. An anesthetic such as Novocain is given. Some dentists
have the facilities to give you an IV Sedation, which will put you
into what is known as twilight sleep. If you do not like to hear
what is going on around you many dentists have headphone that you
can listen to during your visit so as to help make you more comfortable
and relaxed during the procedure.
After the tooth has been pulled there may be tenderness in the area
where the tooth was. This is normal, having a tooth pulled is a
form of surgery, and any area would be tender after such a procedure.
Your dentist will give you complete instructions on care after the
procedure has been performed and in a few days healing will be almost
complete. Please speak with your dentist, he or she can answer any
questions you may have and help make you more comfortable.
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3.
Dry Socket
A
dry socket can occur after a tooth has been extracted where the
blood clot fails to form or disintegrates without undergoing organization.
It can be accompanied by neuralgic pain but without suppuration
(infection / pus). A dry socket usually occurs as a result of too
much rinsing or "spitting" and thus the blood clot is
dislodged or never really forms. The blood clot acts as a bandage
over the recent extraction site. Symptoms can include a constant
throbbing over several days - "it doesn't seem to go away".
If you think that you have a dry socket, your dentist should be
contacted.
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4.
Root Resection
Root resection refers to an endodontic surgical procedure to remove
an untreatable, fractured, or dissolving root while retaining the
original tooth's structure. Root resection and other endodontic
surgical procedures are done in instances where conventional endodontic
(root canal) treatment is not sufficient in saving the affected
tooth. The duties of surgical endodontics include the removal of
infected or inflamed tissue in the bone, exploring for fractures
or canals in the roots that were not evident on x-rays, and cleaning
and sealing the tip of the root canal which due to some type of
obstruction was not possible during conventional endodontic treatment.
In the root resection procedure, the gum and tooth are anesthetized.
An incision is made in the gums and the untreatable, infected tissue
is removed at the tip of the root. A small filling is then placed
in the root tip and the gums are stitched back to its original position.
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5.
Post- Operative Instructions After Tooth Removal
Please
note: These instructions are for the benefit of the dental patients
treated by our office. Patients being treated by other dentists
may receive the same instructions or instructions that have been
modified based upon the individual care they have received. Should
you be experiencing either unusual pain or swelling or both, please
call your dentist immediately!
1. Bleeding is to be expected following extractions and other surgical
procedures. The gauze that has been placed in your mouth before
you left the office should remain in position for at least 45 minutes.
At the end of the 45 minutes, please take two or three pieces of
gauze, fold in half and if needed fold again and replace the gauze
that is in your mouth and continue biting very firm on the gauze
for another 45 minutes - total time biting on gauze is approximately
1 hours. Should the bleeding continue after this, repeat the process,
placing gauze for another 45 minutes. Should there continue to be
excessive bleeding do as follows: ¨ Wipe off excessively large blood
clots with sterile gauze. ¨ Place folded gauze over the bleeding
area. ¨ Bite firmly on pad and maintain gentle pressure for 45 minutes.
¨ Contact the office or call the emergency telephone number if bleeding
persists.
2. Pain. Some discomfort is normal following surgery. Please take
two aspirin or Tylenol™ or Advil™ or other over-the-counter
analgesic as soon as you arrive at home. Continue to take the analgesic
every three to four hours at least for the first day to minimize
any discomfort. If you have been given a prescription for pain medication,
please take as directed (Do not drive, work with machinery, or drink
alcoholic beverages for at least 6 hours after taking any prescribed
pain medication). Some pain medications may make you nauseous and
should be discontinued if this takes place. If you have a reaction
to the medication, stop the medication and call the office immediately.
3. Antibiotics. If antibiotics are prescribed, take as directed.
Be sure to take all the tablets prescribed. If any reactions occur,
such as a rash or itching, discontinue all medication immediately
and immediately call the office.
4. Rinsing. Do not rinse your mouth, do not spit and do not use
mouthwash, as any of these will lead to a possible loss of the blood
clot which protects the healing extraction site and will then lead
to pain.
5. Swelling. Following surgery some swelling is expected. It will
reach its peak on the second day following surgery and it will begin
to resolve on the fourth day. To minimize swelling, apply a covered
(with towel) ice bag to your face for 20-minute intervals, removing
the bag for 10 minutes in between intervals. Continue ice packs
for 4-6 hours after surgery.
6.
Temperature. Following surgery it is quite common to have a slight
elevation in temperature. Rest, 2 aspirin or Tylenol™ or other
over-the-counter analgesic every 4-hour, and plenty of fluids will
return temperature to normal. If you are taking pain medication,
they will also aid in controlling fever and additional aspirin or
Tylenol™ or other over-the-counter analgesic will not have to be
taken.
7. Eating. A well balanced diet is important for proper healing.
A soft, bland diet is suggested for the first few days. Drink plenty
of fluids as soon as possible, especially if you have been given
antibiotics. Avoid hot foods, hot liquid and avoid smoking for at
least 48 to 60 hours after surgery. (Smoking will delay the healing
process.)
8. Impacted teeth. The removal of impacted teeth is quite different
from the extraction of erupted teeth. The following conditions may
occur, all of which are considered normal: ¨ Swelling and bruising
can be expected. Minimize by using ice packs. ¨ Moderate to severe
pain can be expected. Do not wait until the pain is severe to take
medication. Have the prescription filled and take the first dose
at once. ¨ Trismus (tightness) of the muscles may cause difficulty
in opening the mouth. Should this happen, moist heat applied to
the area should help. A sore throat may also develop. ¨ The corners
of your mouth may dry and crack. Keep moist with ointment or petroleum
jelly.
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6.
Wisdom teeth
Many
people require removal of their third molars also known as wisdom
teeth. As with any surgical procedure, there are some possible risks
and complications. The decision on third morlar removal should be
decided by a patient and their dentist.
Is it necessary to remove wisdom teeth?
Wisdom teeth are a valuable asset to the mouth when they are healthy
and properly positioned. Often, however, problems develop that require
their removal. When the jaw isn't large enough to accommodate wisdom
teeth, they can become impacted (unable to come in or misaligned)
Wisdom teeth may grow sideways, emerge only part way through the
gum or remain trapped beneath the gum and bone.
Extraction of third molars is generally recommended:
• When wisdom teeth only partially erupt;
• When there is a chance that poorly aligned wisdom teeth will damage
adjacent teeth;
When
a cyst (fluid-filled sac) forms, destroying surrounding structures
such as bone tooth roots.
The most common reason people choose to remove their wisdom teeth
is that their mouth is t too small for these teeth to normally erupt
behind the second molare into a good position. This can result in
one of the following situations:
1.
Complete Bony Impaction when the wisdom teeth are completely covered
in bone. When the tooth is completly covered with bone it will remain
completly covered with its "developmental sack" in which
all teeth develop. Later in life, this sack may undergo changes
and enlarge and develop ionto a cyst. This cyst will enlarge at
the expense of the bone of the jaw. These cysts should be removed
and and examined by a pathologist.
2. Partial Bony Impaction whenThe teeth begin to erupt but are not
able to erupt completely. In this situation, the upper third molars
usually are poisitoned towards the cheek while the lower third molars
usually lean forward with only part of the crown sticking through
the gum. This situation can to decay and gum disease around the
second molar directly in front of it.
The most common complication of the partial bony impaction, is that
the flap of gum tissue which partially covers the erupting third
molar, creates a pocket where bacteria that are present in the mouth
can grow and and cause an infection known as pericoronitis. The
swelling and infection can become very serious. The treatment for
pericoronitis is extraction of the third molar tooth.
Some
dentists believe that wisdom teeth may push the other teeth in the
mouth forward and cause crowding and misalignment of the lower front
teeth. Not all dentists believe that this actually happens.
The risks and complications involved in the removal of third molars
are:
PAIN
Surgical removal of the third molars can lead to some discomfort
and pain. This is usually treated with pain medication.
INFECTION
Because of the large number of bacteria present in the mouth post
surgical infection is always possible. Patients are usually placed
on prophylactic antibiotics to prevent infections from developing.
SWELLING
Following surgery patients may experience swelling and bruising.
These symptome vary between patients.
BLEEDING
Some post surgical bleeding is considered normal. This is usually
minimal and is easily controlled with the pressure of biting on
gauze.
Most wisdom teeth can be removed with local anesthesia alone but
many people prefer I.V. sedation during surgery.
Finally there are some risks/complications that are unique to the
removal of third molars.
The upper third molars have roots which often are separated from
the maxillary sinuses by only a very thin layer of bone. Occasionally,
a small communication is established between the sinus and the oral
cavity when one of the upper third molars is removed. If this is
the case, the normal procedure is for the area to be sutured closed,
the patient to be informed of the finding, appropriate antibiotics
and decongestants to be prescribed, the patient to be instructed
to avoid Valsalva maneuvers (tasks which build up pressure in the
sinus like nose blowing and bearing down forcefully) and the patient
reappointed for followup. Most often this results in an uneventful
healing period with no further treatment being required. Occasionally,
the area will heal open rather than closed in which case an additional
small surgical procedure will be required to close the communication.
The lower third molars often have roots that lie very near or even
wrapped around the inferior alveolar nerve. This is the nerve that
supplies feeling to the lip, teeth and tongue on each side of the
mouth. Occasionaly, when a lower third molar is removed, that nerve
will be bumped or bruised and if so a change in sensation may be
noted on that side. It is important to understand that this is a
sensory nerve and does not affect the ability to move the parts
of the oral cavity to which it gives sensation (feeling). In most
cases, the nerve heals itself but, because nerves heal slowly, it
may take six months to one year before return of normal sensation.
Very rarely, the damage to the nerve is permanent.
Finally, the normal precautions, risks and benefits of extraction
of any tooth (which are beyond the scope of this discussion) also
apply here and should be discussed with the dentist prior to beginning
any procedure.
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7.
Dental Trauma
Dental
trauma is any injury to any part of the mouth, such as the teeth,
lips, gums, tongue, and jawbones. Sports, car accidents, physical
fights, hard foods, and too-hot liquids are all potential causes
of dental traumas. Broken or knocked-out teeth are the most common
mouth injury.
The symptoms of dental trauma depend on the type of injury. Soft
tissue injuries, such as cuts, burns or bruises to the lips, inner
cheeks or tongue can result in pain, redness, swelling and possible
bleeding. Broken teeth result in sharp edges that can potentially
cut the soft tissue. Depending on the type of fracture, broken teeth
may also result in toothache. A tooth that has been knocked out,
or evulsed, will leave a swollen, painful and bloody socket. A broken
jawbone can lead to malocclusion (improper fit of the upper and
lower teeth), jaw pain and limited movement in the temporomandibular
joint, the joint that opens and closes the mouth.
A dentist can easily recognize signs of trauma in the mouth. He
or she may x-ray the mouth to detemine the extent of the damage.
The sensitivity of the oral tissues means that mouth traumas tend
to be painful, so prompt treatment of suspected traumas is recommended.
The type of treatment, too, depends on the type of injury.
For soft tissue injuries:
• Reduce swelling with cold compresses
• Controll bleeding by putting pressure with a clean gauze
• Stitches can help deep punctures or lacerations
• Painkillers such as aspirin or ibuprofen can reduce pain
For broken teeth:
Immediately rinse the injured tooth and surrounding gums with warm
water to remove dirt
Cover the area with a cold compress to lessen swelling and pain
Save any pieces of the broken tooth. If an entire tooth has been
knocked out, hold it by the crown (outer area), not the root.
Keep the tooth moist. Place it in milk, cool water, or saliva.
See a dentist as soon as possible, preferably within thirty minutes.
The sooner your dentist treats the problem, the better the chances
of salvaging the tooth.
If
the pulp, or inner core, of a chipped tooth is still intact, the
dentist can smooth out the chipped area and replace the missing
section with a resin filling.
If you have saved the missing piece of tooth, it may be possible
to bond it back into place.
If the pulp is in tact but a large part of the outer tooth structure
is missing, the dentist can protect the remaining parts of the tooth
by covering it with a gold or porcelain crown.
If the pulp has been damaged, your tooth may need root canal treatment
followed by a protective crown.
Dentists
try to save teeth whenever possible; however, if the tooth structure
is damaged beyond repair, it may be necessary to extract the tooth
and consider other options, like dental implants. If a baby tooth
is knocked out, your dentist will likely not try to salvage it,
as the body will often reject it. He or she will instead treat the
socket as a soft tissue injury. He or she may recommend using a
space maintainer, a device to prevent the remaining teeth to shift
into the gap left by the missing one, potentially causing crowding
when the permanent teeth begin to erupt.
For broken jaws:
See your dentist immediately. He or she must set it back to its
proper position, and will likely supply wires to hold it into place.
Healing can take up to six weeks or more, depending on your age
and the degree of your injury.
With immediate care, most dental traumas will eventually result
in full recovery.
Like all traumas, mouth injuries can result in infection; if this
occurs, your doctor can prescribe antibiotics.
Dental trauma is highly preventable. To reduce the risk, do the
following:
Wear seat belts in cars, and ensure young children are secured in
car seats
Child-proof areas of your homes such as stairs, table edges, and
loose electircal wires
Eliminate tripping hazards from your home and office
Wear mouthguards during sports, especially contact sports or any
activity involving speed, potential falls, and potential contact
with a hard surface or piece of equipment (such as skateboarding,
in-line skating, and bicycling).
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