Oral Surgery

Impacted Teeth

oralsurgeryWisdom teeth, otherwise known as third molars, are the last set of teeth to develop. Sometimes these teeth emerge from the gum line and the jaw is large enough to allow room for them, but most of the time, this is not the case. More often, one or more of these third molars fails to emerge in proper alignment or fails to fully emerge through the gum line and becomes entrapped or “impacted” between the jawbone and the gum tissue. Impacted wisdom teeth can result in swelling, pain, and infection of the gum tissue surrounding the wisdom teeth. In addition, impacted wisdom teeth can cause permanent damage to nearby teeth, gums, and bone and can sometimes lead to the formation of cysts or tumors that can destroy sections of the jaw. Therefore, dentists recommend people with impacted wisdom teeth have them surgically removed.

It’s not just wisdom teeth that sometimes become impacted and need to be removed. Other teeth, such as the cuspids and the bicuspids can become impacted and can cause the same types of problems described with impacted wisdom teeth.

Tooth Loss

Dental implants are an option for tooth loss due to an accident or infection or as an alternative to bridges and dentures. The implants are tooth root substitutes that are surgically anchored in place in the jawbone and act to stabilize the artificial teeth to which they are attached. Suitable candidates for dental implants need to have an adequate bone level and density, must not be prone to infection, and must be willing to maintain good oral hygiene practices.

Jaw-Related Problems

Unequal jaw growth. In some individuals, the upper and lower jaws fail to grow properly. This can cause difficulty in speaking, eating, swallowing, and breathing. While some of these problems — like improper teeth alignment — can be corrected with braces and other orthodontic appliances, more serious problems require oral surgery to move all or part of the upper jaw, lower jaw, or both, into a new position that is more balanced, functional, and healthy.

Improve fit of dentures. For first-time denture wearers, oral surgery can be done to correct any irregularities of the jaws prior to creating the dentures to ensure a better fit. Oral surgery can also help long-term denture wearers. Supporting bone often deteriorates over time, resulting in dentures that no longer fit properly. In severe cases, an oral surgeon can add a bone graft to areas where little bone remains.

Extraction

Gum disease can loosen or severely damage a tooth. A tooth that is severely damaged may need to be removed. Your dentist or a surgeon who specializes in surgeries of the mouth (oral and maxillofacial surgeon) can remove a tooth.

Before removing your tooth, your dentist will give you a local anesthetic to numb the area where the tooth will be removed. A stronger, general anesthetic may be used, especially if several or all of your teeth need to be removed. General anesthetic prevents pain in the whole body and will make you sleep through the procedure.

After the tooth is removed, you may need stitches. You can gently bite down on a cotton gauze pad placed over the wound to help stop the bleeding. The removed tooth can be replaced with an implant, a denture, or a bridge. A bridge is a replacement for one or more (but not all) of the teeth and may be permanent or removable.

What To Expect After Surgery

In most cases, the recovery period lasts only a few days. The following will help speed recovery:

Take painkillers as prescribed by your dentist or oral surgeon. Apply an ice or cold pack to the outside of your mouth to help relieve pain and swelling.

After 24 hours, rinse your mouth gently with warm salt water several times a day to reduce swelling and relieve pain. Make your own salt water by mixing 1 tsp (5 g) of salt in a medium-sized glass [8 fl oz (240 mL)] of warm water.

Change gauze pads before they become soaked with blood.

Relax after surgery. Physical activity may increase bleeding.

Avoid smoking.

Eat soft foods, such as gelatin, pudding, or a thin soup. Gradually add solid foods to your diet as healing progresses.

Do not lie flat. This may prolong bleeding. Prop up your head with pillows.

Avoid rubbing the area with your tongue.

Do not use sucking motions, such as when using a straw to drink.

Continue to carefully brush your teeth and tongue.

After the tooth is removed, you may need stitches. Some stitches dissolve over time, and some have to be removed after a few days. Your dentist will tell you whether your stitches need to be removed.

Why It Is Done

Removing a tooth is necessary when decay or an abscessed tooth is so severe that no other treatment will cure the infection.

How Well It Works

Removing the tooth can help keep infection from spreading to other areas of your mouth.

Risks

Some dental work can cause bacteria in the mouth to enter the bloodstream and cause infections in other parts of the body. People who have a hard time fighting off infections may need to take antibiotics before and after dental surgery.

You may need to take antibiotics if you:

Have certain heart problems that make it dangerous for you to get a heart infection called endocarditis.

Have an impaired immune system.

Had recent major surgeries or have man-made body parts, such as an artificial hip or heart valve.

After an extraction, a blood clot forms in the tooth socket. The clot protects the bone while the healing process takes place. If that blood clot is loosened or dislodged, you may have a dry socket, in which the bone is exposed. Dry sockets may last for several days and may cause severe pain that sometimes includes ear pain.

What To Think About

A tooth extraction should be done as soon as possible to avoid the spread of infection and more serious problems. In cases in which a root canal treatment might not save the tooth, your dentist may recommend that the tooth be removed and a bridge or implant installed.

Smoking or using spit tobacco delays healing and reduces your ability to fight infection in your gums. So to heal well after your surgery, it’s best to stop all use of tobacco. If you do smoke, the sucking motion of inhaling may loosen or dislodge the blood clot that is important for healing.

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