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Oral Surgery
 

Tooth Extraction

Many teeth can be saved with modern dental techniques, some must be removed. There are a number of reasons why you may need to have a tooth removed (a tooth extraction). A surgeon who specializes in surgeries of the mouth (oral and maxillofacial surgeon) or your dentist can remove a tooth.

Many patients like to have sedation dentistry for tooth extraction appointments. Whether or not this is recommended depends on the patient. If you have no anxiety about the dental appointment at all, this isn’t necessary.
The extraction of teeth is a commonly performed and generally safe procedure. For most people, the benefits - treatment of pain, decay and infection - are greater than any disadvantages. However, in order to make a well-informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

There are several reasons why your dentist may recommend that you have a tooth taken out.

  • Tooth has decay or is infected. This can be very painful and an abscess may form.
  • Break or fracture a tooth by accident.
  • Having severe gum disease which may affect the supporting tissues and bone structures of teeth.
  • In preparation for orthodontic treatment (braces)
  • Teeth are crooked because there is not enough space in mouth. One or more teeth can be extracted to make room for the rest. This can help to straighten children’s teeth as the teeth have more room to grow.
  • Not having enough space for wisdom teeth at the back of your mouth (impacted wisdom teeth).

Before you have your tooth extraction procedure it’s important to consult with your dentist how it might be replaced.

Procedure for Tooth Extraction

1. First Evaluation and diagnosis

  • An oral examination to determine if a tooth extraction is really warranted
  • X-ray(s) may be taken of the tooth to evaluate both the internal aspects of the tooth, the tooth root and bone
  • Relevant medical histories are recorded. Do ensure that you report to your dentist any problems with any previous tooth extractions, bleeding problems, medical conditions or allergies to medications and supplements

2. Site tooth preparation

  • Local anesthetize is given to "numb up" the tooth, jawbone and surrounding gums

3. Tooth removal

Recovery Expectations

Most people have teeth removed under local anaesthesia by a general dentist or oral surgeon. This means that they are awake, but the area around the tooth is completely numb. Sedative drugs can be given with local anaesthesia to help you relax during the procedure.

It will be necessary to rest for a while after general anaesthesia or sedation. After any method of extraction using local or general anaesthetic the jaw may feel stiff and sore, but painkillers will help to relieve discomfort.
For simple normal tooth extraction, the patient is simply sent home and the tooth site left to heal. Bleeding should stop after the first few hours. You may follow your regular daily activities, avoiding excessive exertion typed of activities such as exercising or sunbathing. 

Postoperative care Instructions after Tooth Extractions

  • Bite the gauze firmly for a full 1-2 hour to stop bleeding. If bleeding persists, change to new gauze and continue biting firmly until the bleeding stops
  • Do not use mouthwash for 24 hours after oral surgery
  • If mild bleeding occurs, hold cold salt water in the mouth until it warms to body temperature
  • Do not rinse for 12 hours
  • After 12 hours you may rinse with a solution of tea spoonful of salt in a glass of warm water
  • Brush your teeth as usual, but do not brush the wound
  • Take only soft, non-spicy and cold foods, if possible, for 2- 3 days
  • Avoid smoking and alcohol
  • Mild pain can be controlled with pain relieve medications as directed by your dentist

Effects of Missing Teeth

During an examination of your teeth and mouth it is possible that your dentist will present to you various alternative treatments instead of a tooth extraction.
While having a tooth extracted may be less expensive than the other options proposed, it may not be the least expensive in the long run.

When a tooth is missing its neighboring teeth will tend to shift, sometimes significantly, which in turn can have a major impact on your dental health.
Even the removal of a single tooth can lead to problems related to your chewing ability, problems with your jaw joint, and predispose the teeth that have shifted to problems also.

To avoid these complications, in most cases, your dentist will probably recommend to you to replace the tooth that has been extracted.
Replacing a tooth that has been extracted with an artificial one can easily
cost more than the alternative of not having a tooth extraction and instead rebuilding the tooth

 

Wisdom Teeth Removal

Wisdom teeth are third molars. Normally people have three permanent molars that develop in each quadrant of the mouth. The third molars usually will try to grow in at around age 18 to 20 years.

Wisdom teeth are actually no different than any other tooth except that they are the last teeth to erupt. They are just as useful as any other tooth if they grow in properly, have a proper bite relationship, and have healthy gum tissue around them. Unfortunately, this does not always happen.

When wisdom teeth are not erupting into the mouth properly, they are referred to as impacted teeth. A dentist must examine a patient's mouth and corresponding x-rays to determine if the teeth are impacted or will not erupt properly. Impacted teeth may cause problems. Here are several common problems that occur when the impacted wisdom teeth are not removed:

  • bacteria and plaque build-up
  • decay of adjacent teeth
  • formation of cysts (a fluid- filled sac) or tumors from follicle
  • tumor development
  • infection
  • jaw and gum disease

Erupted wisdom teeth may need to be removed. The dentist may recommend wisdom tooth removal if wisdom tooth:

  • interferes with the bite
  • non-functional
  • badly decayed
  • involved with or at risk for periodontal disease
  • interferes with restoration of an adjacent tooth

Every case is different and only your dentist can determine if there is a reason for you to have a tooth removed.  

Symptoms of Wisdom Tooth Removal
The following symptoms may indicate that the wisdom teeth have erupted and surfaced. However, each individual may experience symptoms differently. Symptoms may include:

  • pain
  • infection in the mouth
  • facial swelling
  • swelling of the gum line in the back of the mouth

Many oral health specialists will recommend removal of the wisdom teeth, (when the roots are approximately formed, or three-fourths developed, usually in the adolescent years), as early removal will help to eliminate problems, such as an impacted tooth that destroys the second molar. Third molar impaction is the most prevalent medical developmental disorder.

Procedure for Wisdom Tooth Removal
1. First Evaluation and diagnosis

  • An oral examination to determine if a tooth extraction is really warranted
  • X-ray(s) may be taken of the tooth to evaluate both the internal aspects of the tooth, the tooth root and bone
  • Relevant medical histories are recorded. Do ensure that you report to your dentist any problems with any previous tooth extractions, bleeding problems, medical conditions or allergies to medications and supplements

2. Site tooth preparation

  • Local anesthetize is given to "numb up" the tooth, jawbone and surrounding gums
  • Wisdom tooth removal
  • Connective tissue between the tooth and the bone are removed

3. Wisdom Tooth is removed

  • Stitch up to close surgical site

Recovery after Wisdom Tooth Removal
Most people have teeth removed under local anaesthesia by a general dentist or oral surgeon. This means that they are awake, but the area around the tooth is completely numb. Sedative drugs can be given with local anaesthesia to help you relax during the procedure.
It will be necessary to rest for a while after general anaesthesia or sedation. After any method of extraction using local or general anaesthetic the jaw may feel stiff and sore, but painkillers will help to relieve discomfort.

First 24 hours
Controlling bleeding from the extraction site
Some bleeding may occur for some time after your tooth extraction. This bleeding can usually be controlled by placing a piece of moist clean gauze over the empty tooth socket and then biting firmly on this gauze for 45 minutes to an hour. Make sure that it is positioned so when you bite down the gauze in turn applies pressure directly to the extraction site. If you bite down and your teeth come together fully you may not be placing much pressure on the gauze.

keep changing the gauze
If a small amount of bleeding persists after 45 minutes then repeat these instructions. If heavy bleeding is still present then contact your dentist.

About the blood clot that forms in the empty tooth socket
Avoid vigorous rinsing or spitting during the first 24 hours after your tooth extraction. Also, creating suction, such as using straws or smoking, may dislodge the blood clot. Hot liquids will tend to dissolve blood clots so stay away from hot coffee or soup.

Swelling
Trauma from a tooth extraction can cause swelling. The swelling might present itself as just a slight fullness that you can feel but is not readily obvious to others or at the other extreme a clear enlargement of facial tissue. In general, the more difficult the extraction has been the more likely swelling will occur.

Any swelling that does occur can be kept to a minimum by placing ice on your face in the area where the extraction took place. Position the ice on your face for 10 minutes on and then leave it off for the next 20 minutes. Repeat this cycle as you feel is necessary for up to 24 hours after the extraction.

Smoking
Persons who smoke tend to have more complications with extraction site healing than those people who don't (including the development of “dry socket"). If you can avoid smoking for the first 48 hours after your tooth extraction it will be to your benefit.

Pain and pain medications
You may not experience much pain after your tooth extraction.  If you do, for minor pain you might use non-prescription drugs such as acetaminophen (Tylenol) or ibuprofen (Motrin or Advil). Follow the directions and warnings that accompany these products.

The pain reliever your dentist prescribes may contain a narcotic (such as codeine). If so, most narcotic pain medications will have a tendency to upset your stomach so it is usually best to take them with food. Narcotics can also make you drowsy or even act strangely.

Antibiotics
Your dentist may have placed you on antibiotics some days before your tooth extraction. If any of this medication remains, even after your tooth has been extracted, continue to take the antibiotic as initially directed. Failure to do so can lead to the development of bacterial resistance to the antibiotic.

Activities
So to reduce the amount of bleeding which occurs and to promote the formation of a blood clot in the tooth socket, avoid strenuous activities or exercise for 24 hours after your tooth has been extracted. If you lie down use an extra pillow so to elevate your head.

Foods and Eating
After difficult extractions a soft or liquid diet may be indicated for 24 hours after your dental surgery. For simpler extractions just making sure you do your chewing with those teeth which are away from the extraction site will be sufficient. Hot liquids will tend to dissolve the blood clot that has formed in the extraction socket so avoid them for the first 24 hours. Also, you should avoid alcoholic beverages for at least 24 hours.

Brushing and cleaning your teeth

It is important to maintain good oral hygiene during the healing process. On the day of the extraction it might be best to avoid brushing the teeth directly neighbouring the extraction site. The next day you can resume cleaning these teeth in a gentle manner. On the day of the extraction you may want to gently roll some water through your mouth as a part of cleaning so to dislodge food particles. Just don't rinse the water around vigorously so it dislodges the newly formed blood clot.

Post extraction instructions/dry sockets

Beginning 24 hours after your tooth extraction
Swelling
Any swelling that is related to the trauma of the tooth extraction process should reach its maximum after 24 hours. So to bring this swelling down more quickly apply a warm moist towel to the swollen area for 20 minutes followed by 20 minutes of no heat application. Repeat this cycle, as you find necessary.

Keeping the extraction site clean
The quicker it will heal. Beginning 24 hours after your tooth extraction you can gently rinse the socket with warm salt water (1/2 teaspoon of salt in a cup of water) after meals and before bed. Do not use commercial mouth rinses, they may have a tendency to irritate the extraction site.

Stitches (resorbable and non-resorbable)
Your dentist may have found it necessary to place sutures ("stitches") in the extraction site after removing the tooth. Some types of stitches are resorbable and therefore will dissolve away on their own; others will not and will need to be removed by your dentist. If stitches were placed make sure you know which type have been used. Usually a dentist will want to remove stitches that don't resorb in about a week or so after the extraction. The process of removing stitches is usually very easy and quite painless.


Dry Sockets

One of the more common complications people experience after a tooth extraction is that of developing a "dry socket." It is thought that dry sockets occur when either a blood clot has failed to form in the socket (the hole found in the bone) where a tooth has been extracted, or else the blood clot that did form has been dislodged and lost. Since the formation of a blood clot is an important part of the healing process, the healing of the extraction site is significantly delayed.

Dry sockets are most frequently associated with difficult tooth extractions or those extractions that have been traumatic in nature. Extractions involving the removal of bone from around a tooth so the dentist can access it, which is often the case when lower impacted wisdom teeth are removed, would be considered to be more traumatic in nature than extractions where the tooth is already through the gums and easily accessed. 

 Typically dry sockets manifest themselves as a dull throbbing pain which doesn't appear until three or four days after the tooth extraction. The pain can be moderate to severe in intensity and often seems to radiate from the area of the extraction site to the ear. Dry sockets are usually associated with a foul odor or bad taste. Visually, if you can see down into the socket, the extraction site appears "dry", in the sense that you just see exposed bone, there is no formation of pus.

Dry sockets need to be treated by your dentist, and don't be hesitant to let them know that you need help. Your dentist knows that there is no predictability regarding who will develop a dry socket and who will not, and when one occurs they will be eager to assist you.

Typically a dentist will place a medicated dressing into the dry socket. This will help to soothe and moderate the pain. The dressing is usually removed and replaced every 24 hours until the dry socket's symptoms subside, which can in some cases take some number of days.

Postoperative care Instructions after Tooth Wisdom Extractions

  • Use cold compress for 12-24 hours right after the surgery
  • Bite the gauze firmly for a full 1-2 hour to stop bleeding. If bleeding persists, change to new gauze and continue biting firmly until the bleeding stops
  • Do not use mouthwash for 24 hours after oral surgery
  • If mild bleeding occurs, hold cold salt water in the mouth until it warms to body temperature
  • Do not rinse for 12 hours
  • After 12 hours you may rinse with a solution of tea spoonful of salt in a glass of warm water
  • Brush your teeth as usual, but do not brush the wound
  • Take only soft, non-spicy and cold foods, if possible, for 2- 3 days
  • Avoid smoking and alcohol
  • Mild pain can be controlled with pain relieve medications as directed by your dentist
 
 
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