Dentist in Brixton, SW2 5SP
Surgical Extraction
A surgical extraction involves teeth that cannot be seen easily in the mouth. They may have broken off at the gum line or they may not have come out yet. The tooth may also have an unusual root pattern and may need to be removed surgically To see and remove the tooth, the dentist or oral surgeon must cut and pull back the gums. Pulling back the gum "flap" provides access to remove bone and/or a piece of the tooth.
Surgical extractions commonly are done by oral surgeons. They are done with injections (local anesthesia), and you can also have conscious sedation. In a surgical extraction, the dentist will need to make a cut (incision) in your gum to reach the tooth. In some cases, the tooth will need to be cut into pieces to be removed.
Preparation
Your dentist or oral surgeon will ask about your medical and dental histories. He or she will take an X-ray of the area to help plan the best way to remove the tooth.
If you are having all of your wisdom teeth removed, you may have a panoramic X-ray. This X-ray takes a picture of all of your teeth at once. It can show several things that help to guide an extraction:
- The relationship of your wisdom teeth to your other teeth
- The upper teeth's relationship to your sinuses
- The lower teeth's relationship to a nerve in the jawbone that gives feeling to your lower jaw, lower teeth, lower lip and chin. This nerve is called the inferior alveolar nerve.
- Any infections, tumors or bone disease that may be present
Follow-Up
Most simple extractions do not cause much discomfort after the procedure. You may take an over-the-counter nonsteroidal antiinflammatory drug (NSAID) such as ibuprofen for several days. You may not need any pain medicine at all.
Because surgical extractions are more complicated, they generally cause more pain after the procedure. The level of discomfort and how long it lasts will depend on the difficulty of the extraction. Your dentist may prescribe pain medicine for a few days and then suggest an NSAID. Most pain disappears after a couple of days.
A cut in the mouth tends to bleed more than a cut on the skin because it cannot dry out and form a scab. After an extraction, you'll be asked to bite on a piece of gauze for about 20 to 30 minutes. This will put pressure on
the area and allow the blood to clot. It still may bleed a small amount for the next 24 hours or so and taper off after that. Don't disturb the clot that forms on the wound.
You can put ice packs on your face to reduce swelling after the operation. If your jaw is sore and stiff after the swelling goes away, try warm compresses. Eat soft and cool foods for a few days. Then try other food as you feel comfortable. A gentle rinse with warm salt water, started 24 hours after the surgery, can help to keep the area clean. Use one-half teaspoon of salt in a cup of water. Most swelling and bleeding end within a day or two after the surgery. Initial healing takes at least two weeks.
If you need stitches, they usually disappear (dissolve) on their own. They should disappear within one to two weeks. Rinsing with warm salt water will help the stitches to dissolve. Some stitches need to be removed by the dentist or surgeon.
You should not smoke, use a straw or spit after surgery. These actions can pull the blood clot out of the hole where the tooth was. That causes more bleeding and can lead to a dry socket, which occurs in about 3% to 4% of all extractions. Dry socket occurs 20% to 30% of the time when impacted teeth are removed. It happens more often in smokers and women who take birth control pills. It is also more likely after difficult extractions.
Risks
Infection can set in after an extraction, although you probably won't get an infection if you have a healthy immune system.
A common complication called a dry socket occurs when a blood clot doesn't form in the hole or the blood clot breaks off or breaks down too early.
In a dry socket, the underlying bone is exposed to air and food. This can be very painful and can cause a bad odor or taste. A dry socket needs to be treated with a medicated dressing to stop the pain and encourage the area to heal.
Other potential problems include:
- Accidental damage to teeth near the surgical site, such as fracture of fillings or teeth
- An incomplete extraction, in which a tooth root remains in the jaw – Your dentist usually removes the root to prevent infection, but occasionally it is less risky to leave a small root tip in place.
- A fractured jaw caused by the pressure put on the jaw during extraction –This occurs more often in older people with osteoporosis (thinning) of the jaw.
- A hole in the sinus during removal of an upper back tooth (molar) A small hole usually will close up by itself in a few weeks. If not, more surgery may be required.
- Soreness in the jaw muscles and/or jaw joint – It may be tough for you to open your mouth wide. This can happen because of the injections, keeping your mouth open and/or lots of pushing on your jaw.
- Long-lasting numbness in the lower lip and chin – This is caused by injury (trauma) to the inferior alveolar nerve during removal of the lower wisdom teeth. Complete healing of the nerve may take three to six months. In rare cases, the numbness may be permanent.
When To Call a Professional
Call your dentist or oral surgeon if the swelling gets worse instead of better. Also call if you have fever, chills, redness, trouble swallowing or uncontrolled bleeding in the area. If you have an infection, your dentist usually will prescribe antibiotics. If your tongue, chin or lip feels numb, tell your dentist or oral surgeon.
Also call your dentist or oral surgeon if the area of the extraction site becomes very painful. This is a sign that you may have a dry socket. If the area continues to bleed after the first 24 hours, notify your oral surgeon
