Oral Surgery

Extractions

A tooth that is severely damaged may need to be removed. Before removing your tooth, the dentist will give you a local anesthetic to numb the area where the tooth will be removed. During the extraction process, you will feel a lot of pressure. This is from the process of firmly rocking the tooth in order to widen the socket for removal. You feel the pressure without pain as the anesthetic has numbed the nerves stopping the transference of pain, yet the nerves that transmit pressure are not profoundly affected.

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.

Wisdom Teeth Removal
Wisdom teeth are the third and final set of molars that most people get in their late teens or early twenties. Sometimes these teeth can be a valuable asset to the mouth when healthy and properly aligned, but more often, they are misaligned and require removal.

Wisdom teeth present potential problems when they are misaligned – they can position themselves horizontally, be angled toward or away from the second molars or be angled inward or outward. Poor alignment of wisdom teeth can crowd or damage adjacent teeth, the jawbone, or nerves. Wisdom teeth that lean toward the second molars make those teeth more vulnerable to decay by entrapping plaque and debris. In addition, wisdom teeth can be entrapped completely within the soft tissue and/or the jawbone or only partially break through or erupt through the gum. Teeth that remain partially or completely entrapped within the soft tissue and /or the jawbone are termed “impacted.” Wisdom teeth that only partially erupt allows for an opening for bacteria to enter around the tooth and cause an infection, which results in pain, swelling, jaw stiffness, and general illness. Partially erupted teeth are also more prone to tooth decay and gum disease because their hard-to-reach location and awkward positioning makes brushing and flossing difficult.

The extraction of wisdom teeth is necessary when they are prevented from properly erupting within the mouth. They may grow sideways, partially emerge from the gum, and even remain trapped beneath the gum and bone. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to successfully erupt. Early removal is recommended to avoid such future problems and to decrease the surgical risk involved with the procedure.

Frequently a surgical procedure needs to be carried out to extract a molar that is recommended to be removed, especially if it is impacted. Almost routinely, x-rays are required to analyze tooth shape and configuration, prior to any treatment plan formulation or any surgical procedure being carried out. 
This includes sometimes the necessity to do a 3D cone beam CT analysis only of the area of interest (scan volume- 4cm X 5cm).

Biopsies: The procedure maybe carried out without any anesthesia with the WaterLase (Biolase) dental laser or sometimes under local anesthetic, that is, you will be awake and have an injection to numb up the tissue in question. You may need to have stitches at the biopsy site that dissolve over the next 10 – 14 days. You can expect some discomfort and possibly swelling afterwards. These will settle over the next few days. The whole process should take less than 30 minutes. 

Pre-prosthetic Surgery– Alveoplasty (also called an alveoloplasty) is a surgical procedure that smoothes or re-contour the jawbone. An alveoplasty is done in areas where teeth have been removed or lost (especially if a dental clearance has been done). 

Dry Socket, also known as dento-alveolar osteitis, alveolar osteitis, alveolitis, focal osteomyelitis without suppuration, alveolalgia, alveolitis sicca dolorosa and alveolar periostitis, is a well-recognized complication of tooth extraction. It is characterized by increasingly severe pain in and around the extraction site usually starting on the 2 – 4 post- operative day and can last for 10 – 40 days. The pain radiates typically to the ear. The normal post-extraction blood clot is absent from the tooth socket; the bony walls of the socket are bare and exquisitely sensitive to even gentle probing. Bad breath and an unpleasant taste in the mouth are invariably present. The condition probably arises as a result of a complex interaction between surgical trauma, local bacterial infection and various systemic factors. We have a number of treatment protocols to deal with this.