Surgery

Dental implant

Dental implants are a great way to replace missing teeth and also provide a fixed solution to having removable partial or complete dentures.  Implants provide excellent support and stability for these dental appliances.

Dental implants are artificial roots and teeth (usually titanium) that are surgically placed into the upper or lower jaw bone by a dentist or Periodontist - a specialist of the gums and supporting bone.  The teeth attached to implants are very natural looking and often enhance or restore a patient’s smile!

Dental implants are very strong, stable, and durable and will last many years, but on occasion, they will have to be re-tightened or replaced due to normal wear.

Reasons for dental implants:

  • Replace one or more missing teeth without affecting adjacent teeth.
  • Resolve joint pain or bite problems caused by teeth shifting into missing tooth space.
  • Restore a patient’s confident smile.
  • Restore chewing, speech, and digestion.
  • Restore or enhance facial tissues.
  • Support a bridge or denture, making them more secure and comfortable.

What does getting dental implants involve?

The process of getting implants requires a number of visits over several months.

X-rays and impressions (molds) are taken of the jaw and teeth to determine bone, gum tissue, and spacing available for an implant.  While the area is numb, the implant will be surgically placed into the bone and allowed to heal and integrate itself onto the bone for up to six months.  Depending on the type of implant, a second surgery may be required in order to place the “post” that will hold the artificial tooth in place.  With other implants the post and anchor are already attached and placed at the same time.

After several weeks of healing the artificial teeth are made and fitted to the post portion of the anchor.  Because several fittings may be required, this step may take one to two months to complete.  After a healing period, the artificial teeth are securely attached to the implant, providing excellent stability and comfort to the patient.

You will receive care instructions when your treatment is completed.  Good oral hygiene, eating habits, and regular dental visits will aid in the life of your new implant.

Tooth extraction

Sometimes, teeth need to be removed due to decay, disease or trauma. Having a tooth removed or “pulled” is called a tooth extraction.

When you have an extraction, it’s natural that changes will occur in your mouth afterward. Your dentist may give you instructions to follow after the extraction, and it's important to talk to your dentist if you have any questions or problems. Here are some general guidelines to help promote healing, prevent complications, and make you more comfortable.

Anesthetics

Before the extraction, you will be given an anesthetic to reduce your discomfort. Your mouth will remain numb for a few hours after the extraction. While your mouth is numb, you'll want to be careful not to bite your cheek, lip or tongue. After the extraction, do not eat any foods that require chewing while your mouth is numb. The numbness should go away within a few hours. If it doesn't, contact your dentist.

Bleeding

Your dentist may place a gauze pack on the extraction site to limit bleeding. This will also help a blood clot to form, which is necessary for normal healing. This gauze pack should be left in place for 30 to 45 minutes after you leave the dentist's office. Do not chew on the pack. There may be some bleeding or oozing after the pack is removed. If so, here’s what to do:

  • Fold a piece of clean gauze into a pad thick enough to bite on. Dampen the pad with clean, warm water and place it directly on the extraction site.
  • Apply pressure by closing the teeth firmly over the pad. Maintain this pressure for about 30 minutes. If the pad becomes soaked with blood, replace it with a clean one.
  • Do not suck on the extraction site or disturb it with your tongue.
  • A slight amount of blood may leak from the extraction site until a clot forms. However, if heavy bleeding continues, call your dentist. (Remember, though, that a little bit of blood mixed with saliva can look like a lot of bleeding.)

Do Not Disturb!

The blood clot that forms in the tooth socket is an important part of the normal healing process. You should avoid doing things that might disturb the clot. Here's how to protect it:

  • Do not rinse your mouth vigorously, or drink through a straw for 24 hours. These activities create suction in the mouth, which could loosen the clot and delay healing.
  • Avoid alcoholic beverages or mouthwash containing alcohol for 24 hours.
  • If you are a smoker, talk to your dentist before the surgery on ways to quit.  You should not smoke after surgery.
  • Limit strenuous activity for 24 hours after the extraction. This will reduce bleeding and help the blood clot to form.
  • Sometimes the blood clot does not form in the first day or two after the extraction, or it forms but breaks down. The result is called dry socket. This can be very painful and should be reported to your dentist. A dressing may be placed in the socket to protect it until the socket heals and to reduce any pain.

Cleaning Your Mouth

Do not clean the teeth next to the healing tooth socket for the rest of the day. You should, however, brush and floss your other teeth well and begin cleaning the teeth next to the healing tooth socket the next day. You can also brush your tongue. This will help get rid of the bad breath and unpleasant taste that are common after an extraction.

The day after the extraction, gently rinse your mouth with warm salt water (half a teaspoon salt in an 8 oz. glass of warm water) after meals to keep food particles out of the extraction site. Try not to rinse your mouth vigorously, as this may loosen the blood clot. If you have hypertension, discuss with your dentist whether you should rinse with salt water. Avoid using a mouthwash during this early healing period unless your dentist advises you to do so.

Medication

If your dentist has prescribed medicine to control pain and inflammation, or to prevent infection, use it only as directed. If the pain medication prescribed does not seem to work for you, do not take more pills or take them more often than directed—call your dentist.

Swelling and Pain

After a tooth is removed, you may have some discomfort and notice some swelling. This is normal. To help reduce swelling and pain, try applying an ice bag or cold, moist cloth to your face. Your dentist may give you specific instructions on how long and how often to use a cold compress.

When to Call the Dentist

If you have any of the following issues, call your dentist immediately. If you cannot reach your dentist, go to a hospital emergency room.

  • fever, nausea or vomiting
  • ongoing or severe pain, swelling, or bleeding
  • pain that gets worse with time instead of better

Eating and Drinking

Eating & Drinking After a Tooth Extraction After the extraction, drink lots of liquids and eat soft, nutritious foods. Avoid hot liquids and alcoholic beverages. Do not use a straw. Begin eating solid foods the next day or as soon as you can chew comfortably. For the first few days, try to chew food on the side opposite the extraction site. When it feels comfortable, you should resume chewing on both sides of your mouth.

Follow-Up

If you have sutures that require removal, your dentist will tell you when to return to the office

Wisdom teeth extraction

Third molars, commonly referred to as wisdom teeth, are usually the last four of 32 teeth to erupt (surface) in the mouth, generally making their appearance between the ages of 17 to 25. They are located at the back of the mouth (top and bottom), near the entrance to the throat. The term “wisdom” stems from the idea that the molars surface at a time typically associated with increased maturity or “wisdom”.

In most cases, inadequate space in the mouth does not allow the wisdom teeth to erupt properly and become fully functional. When this happens, the tooth can become impacted (stuck) in an undesirable or potentially harmful position. If left untreated, impacted wisdom teeth can contribute to infection, damage to other teeth, and possibly cysts or tumors.

There are several types, or degrees, of impaction based on the actual depth of the teeth within the jaw:

Soft Tissue Impaction: The upper portion of the tooth (the crown) has penetrated through the bone, but the gingiva (gum) is covering part or all of the tooth’s crown and has not positioned properly around the tooth. Because it is difficult to keep the area clean, food can become trapped below the gum and cause an infection and/or tooth decay, resulting in pain and swelling.

Partial Bony Impaction: The tooth has partially erupted, but a portion of the crown remains submerged below the gum and surrounding jawbone. Again, because it is difficult to keep the area clean, infection will commonly occur.

Complete Bony Impaction: The tooth is completely encased by jawbone. This will require more complex removal techniques.

Reasons to remove wisdom teeth

While not all wisdom teeth require removal, wisdom teeth extractions are most often performed because of an active problem such as pain, swelling, decay or infection, or as a preventive measure to avoid serious problems in the future. If impaction of one or more wisdom teeth is present, and left untreated, a number of potentially harmful outcomes can occur, including:

  • Damage to nearby teeth: Second molars (the teeth directly in front of the wisdom teeth) can be adversely affected by impacted wisdom teeth, resulting in tooth decay (cavities), periodontal disease (gum disease) and possible bone loss.
  • Disease: Although uncommon, cysts and tumors can occur in the areas surrounding impacted wisdom teeth.
  • Infection: Bacteria and food can become trapped under the gum tissue, resulting in an infection. The infection can cause considerable pain and danger.
  • Tooth Crowding: It has been theorized that impacted wisdom teeth can put pressure on other teeth and cause them to become misaligned (crowded or twisted). This theory isn’t universally accepted by all dental professionals, and it has never been validated by any scientific studies.

Wisdom teeth examination

As with any dental procedure, your dentist will want to initially conduct a thorough examination of the wisdom and surrounding teeth. Panoramic or digital x-rays will be taken in order for your dentist to evaluate the position of the wisdom teeth and determine if a current problem exists, or the likelihood of any potential future problems. The x-rays can also expose additional risk factors, such as deterioration or decay of nearby teeth. Early evaluation and treatment (typically in the mid-teen years) is recommended in order to identify potential problems and to improve the results for patients requiring wisdom teeth extractions. Only after a thorough examination can your dentist provide you with the best options for your particular case.

What does the removal of wisdom teeth involve?

Wisdom teeth removal is a common procedure, generally performed under local anesthesia, intravenous (IV) sedation, or general anesthesia by a specially trained dentist in an office surgery suite. The surgery does not require an overnight stay, and you will be released with post-operative instructions and medication (if necessary), to help manage any swelling or discomfort

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