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.

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.

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.

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.

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.

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.

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).