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Oral Surgery

Wisdom Tooth Extraction Procedure

Removing wisdom teeth is often necessary to preserve the health of your mouth and remaining teeth. With modern dental techniques, it should be a comfortable and effective procedure.

 
The procedure
Before we start the extraction procedure, we may offer nitrous oxide to relax you, and we’ll numb the area with anesthetic to keep you comfortable. After several minutes, we check the area to make sure that it’s completely numb. During the procedure, you’ll feel pressure when the tooth is removed, but you shouldn’t feel any pain at all. If you do, we’ll stop and give you more anesthetic.
 
If your wisdom teeth haven’t yet come in through the gums, we’ll start by making a small incision. To remove the wisdom teeth, we’ll use an instrument called an elevator, which is placed next to each tooth and is used to gently loosen it. Then, we use forceps to carefully grip the tooth and remove it.
 
Sometimes, if your tooth’s roots are curved or are held tightly in the socket, it’s helpful to cut the tooth into sections before removing them. If an incision was necessary, we’ll close it with a couple of stitches once the tooth is removed.
 
Taking care of yourself after the extraction
To minimize problems after your tooth is removed, you’ll need to follow our postoperative
instructions carefully, especially for the first 24 hours. These instructions will explain how to control bleeding, how to relieve pain and minimize swelling, how to prevent dry socket, and what to eat and not eat.
 
The benefits of removing wisdom teeth
Having your wisdom teeth extracted can prevent many future dental problems, including increased risk for infection, tooth decay, periodontal disease, and cysts in the jawbone.

Ridge Preservation Procedure

Bone grafting techniques can sometimes be necessary to preserve the ridge of jawbone
 
The procedure
In many cases, a ridge preservation procedure takes place when a tooth is extracted. During
the procedure, we will make sure that the area is completely numb to keep you comfortable.
You shouldn’t feel any pain at all. If you do, we’ll stop and give you more anesthetic.
 
We prepare the bone grafting material, which may be your own bone or bone from another
source. After the tooth is extracted, we gently clean and disinfect the tooth’s socket and then
fill it with the grafting material.
 
In some cases, we may place a special membrane over the graft to make sure the bone and gum tissues heal properly. Last, we may close the socket with a few stitches.
 
The benefits of ridge preservation
A bone grafting procedure preserves the shape and strength of your jawbone. The procedure fills in the socket from which the tooth was removed and helps new bone to grow.
 
This helps slow the shrinkage of the jawbone that naturally occurs when teeth are missing. Jawbone shrinks when teeth are lost because the bone that supported the teeth is no longer stimulated by chewing.
 
Ridge preservation techniques help maintain your jaw’s healthy appearance and make some tooth replacement options possible and attractive.

Single Tooth Extraction Procedure

When tooth extraction is needed
Generally, we recommend treatments that will save teeth, but when a tooth is so damaged that it cannot be saved, extraction is the best choice. 
Extraction might be best for:
  • teeth that are fractured below the gumline.
  • severe tooth decay.
  • advanced periodontal disease.
  • primary teeth that are too crowded or not falling
  • out properly.
  • an impacted wisdom tooth.
The procedure
Before we start the extraction procedure, we may offer nitrous oxide to relax you, and we’ll numb the area with anesthetic to keep you comfortable. After several minutes, we check the area to make sure that it’s completely numb. During the procedure, you’ll feel pressure when the tooth is removed, but you shouldn’t feel any pain at all. If you do, we’ll stop and
give you more anesthetic.
 
If the tooth hasn’t yet come in through the gums, we’ll start by making a small incision. To remove the tooth, we’ll use an instrument called an elevator, which is placed next to your tooth and is used to gently loosen it. Then, we use forceps to grip the tooth carefully and remove it.
 
Sometimes, if your tooth’s roots are curved or are held tightly in the socket, it’s helpful to cut the tooth into sections before removing them. If an incision was necessary, we may close it with a couple of stitches once the tooth is removed.
 
Taking care of yourself after the extraction
To minimize problems after your tooth is removed, you’ll need to follow our postoperative
instructions carefully, especially for the first 24 hours. These instructions will explain how to control bleeding, how to relieve pain and minimize swelling, how to prevent dry socket, and what to eat and not eat.
 
The benefits of extracting teeth
An extraction is sometimes the best treatment choice for preventing many future dental problems. Depending on your situation, these problems might include the risk of infection, the spread of periodontal disease, cysts in the jawbone, or severely crowded or misaligned teeth.

Post-op Instructions for an Extraction

Follow these instructions carefully to ensure the successful healing of your tooth extraction.
 
When to call us
It is normal to experience some discomfort for several days after a tooth extraction, but call us right away if you have:
  • Heavy or increased bleeding
  • Pain or swelling that increases or continues
  • beyond two or three days
  • A bad taste or odor in your mouth
  • A reaction to the medication
During the first 24 hours
It is important that a blood clot forms on the extraction site to stop bleeding, reduce pain, and speed healing. To protect the clot and avoid the pain of dry socket:
  • Bite on a gauze pad firmly for 30-60minutes. Blood and saliva mix in the mouth and make it look like there is more bleeding than there really is. Some oozing is normal; however, after 1 hour, repeat with a clean gauze pad if oozing is profuse. The site could ooze for as long as 24 hours.
  • Don’t spit, and don’t suck on candies or through a straw.
  • Don’t rinse your mouth, and don’t brush or floss next to the site.
  • Don’t smoke or use tobacco. Avoid tobacco for at least 72 hours because it slows healing.
  • Don’t sneeze or cough, so have sinus or allergy medication on hand if necessary.
  • Limit yourself to calm activities, and elevate your head with pillows when you lie down to reduce bleeding.
  • Don’t drink hot, carbonated, or alcoholic drinks, and avoid hot or spicy foods.
 
To control discomfort, take pain medication before the anesthetic has worn off or as recommended.
 
To keep swelling to a minimum, use an ice bag over the area, 20 minutes on and 20 minutes off.
When the numbness has worn off completely, drink lots of fluids and eat only soft nutritious foods, chewing on the opposite side.
 
After the first 24 hours
Begin to eat normally as soon as it’s comfortable.
 
Resume brushing and flossing, but clean gently around the site for about a week.
 
If antibiotics were prescribed, continue to take them for the indicated length of time, even if all symptoms and signs of infection are gone.
 
Reduce soreness or swelling by applying moist heat. Swelling usually starts to go down after 48 hours.
 
Further reduce swelling by rinsing your mouth very gently with warm salt water. Use about one teaspoon of salt per class of warm water. Rinse two to three times a day for the week following the extraction.

Diagnosing a Dry Socket

Dry socket
 
Dry socket is an inflammation that occurs when the blood clot that forms in the socket after a tooth extraction becomes dislodged or does not form properly.
 
The clot is necessary to protect the socket, stop bleeding, promote the development of new bone and gum tissues, and prevent pain.
 
However, when the clot is lost prematurely, the inflamed socket and underlying nerves and bone are exposed.
 
Symptoms
The symptoms of dry socket are a severe throbbing pain that does not respond to normal pain
medications. It starts one to four days following an extraction, and the pain may radiate into your ear. You may also notice a foul odor or taste in your mouth.
 
Causes and prevention of dry socket
After your tooth has been extracted, we’ll give you complete instructions about caring for your mouth. Following them exactly will help you avoid dry socket. It’s especially important to avoid certain behaviors that can cause the premature loss of a blood clot, particularly within the first 24 hours after an extraction.
  • Do not touch the extraction site with your fingers or tongue.
  • Do not rinse the area during the first 24 hours after extraction. After that time, follow our instructions for when and how to rinse.
  • Do not smoke or use tobacco.
  • Do not suck through a straw.
  • Avoid sneezing or coughing when possible.
  • Avoid carbonated, hot, or alcoholic drinks.
Diagnosis and treatment
Call our office right away if you notice any symptoms of dry socket. To confirm the diagnosis, we’ll talk with you about your symptoms and perform a thorough examination. The exam may include an xray of the extraction site.
 
Treatment for dry socket often includes a gentle rinsing of the socket with a medicated solution. We may also pack the site with a gauze dressing that contains a soothing anesthetic. You’ll probably need to return to our office several times over the next week or two, so we can change the dressing and monitor the effectiveness of your pain medications.
 
Prompt diagnosis and treatment will allow the blood clot to fill back in, and the area will begin to heal normally once again.

Alternatives to Wisdom Tooth Extraction

Treatment alternatives
When we’re considering wisdom teeth, there are only two possibilities:
  • Keep them.
  • Remove them.
Keeping wisdom teeth
A few lucky people are able to keep their wisdom teeth and take proper care of them. In many cases, though, there isn’t enough room in the jaw for wisdom teeth to come in properly.
When a tooth cannot come in properly, we call it an impacted tooth.
 
Removing wisdom teeth
Removing wisdom teeth is sometimes the best choice for keeping your mouth healthy. If
you delay extracting a wisdom tooth that should come out, serious problems can result,
including: 
  • painful infection of the gums.
  • tooth decay.
  • periodontal disease.
  • destruction of the jawbone.
You should also know that it’s often better to remove wisdom teeth while their roots are
still small. Early removal can make the procedure easier and the healing process faster.
Sometimes this means that wisdom teeth should be removed even before they have come
in through the gums. If you wait too long before having wisdom teeth extracted, the roots
can grow around or close to a nerve in the jaw, which may then be damaged during extraction. This could leave your lip and chin permanently numb.
 
For all these reasons, we often recommend extracting wisdom teeth early to help you
keep your mouth and smile healthy.

Nitrous Oxide Procedure

Nitrous oxide relaxes you
Nitrous oxide, also called laughing gas, is a colorless gas that is often used for its calming effect.
 
After reviewing your health history, we determine if nitrous oxide is right for you. Nitrous oxide is safe, effective and helps you feel more relaxed during your dental appointment.
 
A typical visit with nitrous oxide
To use nitrous oxide, we place a small mask over your nose, and you simply breathe in normally. It takes just a few minutes for you to notice the effects. People most often describe the feeling as being relaxed, unconcerned, happy, slightly numb, and disconnected from what is happening around them.
 
Since nitrous oxide does not numb the teeth, we may also recommend anesthetic for some dental procedures.
 
Controlling the effects
During the procedure, let us know if you want us to adjust the dosage of the nitrous oxide gas to fit your needs. You can also control the dosage by your breathing. The more deeply you breathe through your nose, the more you feel nitrous oxide’s effect.
 
After a dental appointment with nitrous oxide, it is safe for you to drive because there are no longlasting effects.

IV Sedation Procedure

Is IV sedation for you?
If you put off needed dental treatment because you are afraid of the procedures, then IV sedation might be right for you. Intravenous sedation can help if you get extremely nervous at the dentist’s office, want to have several procedures in a single visit, don’t want to remember the dental procedures, or have a difficult time getting numb.
 
Prior to sedation
Before we use IV sedation, we’ll discuss all of your sedation options with you. We’ll take a
medical history and ask if you are allergic to any medications.
 
On the day of your appointment, you must bring a responsible adult who will stay with you for the entire day. We’ll take your blood pressure before we begin. Our staff is highly trained and will monitor you throughout the procedure. A simple device clipped onto your finger will give us a constant readout of your pulse and oxygen levels.
 
If you’re nervous about getting the intravenous sedative, we may offer you nitrous oxide first to help you relax. When the sedative begins, you will go into a deep state of relaxation almost immediately. You will be unaware of the procedure, but you will still be able to respond to conversation. We will begin the procedure when we are sure the area is numb.
 
The procedure
During the procedure, time will pass very quickly for you, and you won’t be distracted by the sights, sounds or aromas of the dental office. When we’re done and we remove the sedation, you’ll awaken with no memory of the procedure. We’ll take your blood pressure one more time. In about half an hour, you’ll be alert enough to go home. However, a responsible adult must drive you and stay with you for the rest of the day.
 
Once you leave our office, don’t operate a motor vehicle, don’t do any strenuous activity, plan to relax for the rest of the day; when you’re hungry, only eat a light meal, don’t drink alcohol, and only take medications as directed by your dentist.
 
IV sedation is a safe procedure that can help you get the dental care you need and back on the road to good oral health.