Dental FAQ's Surgical FAQ's

An Oral Surgeon is a dental specialist who specializes in surgery of the Oral and facial region involving the jaw bones etc.

Teeth Extractions are done for a variety of reasons:

  • Very large cavity/ caries that cannot be restored with cements.
  • Periodontal diseases or in simple words diseases of the gums.
  • Fractured or broken teeth
  • Teeth that are traumatized leading to infection and inflammation of the pulp
  • Teeth that fail to erupt or are unable to erupt into the mouth and are deep inside the bone. They are called impacted teeth and may have to be removed.
  • Abscessed teeth are teeth in which the infection has spread to the underlying bone.
  • Teeth that are abnormal in development i.e., structure, shape, size, etc.
  • Teeth that are involved in cysts or tumors.
  • Ectopic teeth that have erupted in a wrong place.
  • Sometimes the orthodontist may remove some teeth to correct crooked teeth.

There are two basic methods of tooth removal. The first method requires dental forceps and is suitable for the majority of teeth that have erupted. In this method the tooth is held at its neck by forceps and rocked gently to expand the surrounding bone socket. This action can be likened to removing a post set in the ground by rocking it sideward. So, much depends upon the elastic nature of the surrounding bone. In young patients the bone is elastic and thus expands easily. In older patients the bone is more mature and is resistant to expansion. The second method is reserved for those teeth whose roots either cannot be gripped using the forceps or the roots are of odd shape and defy all efforts to remove them by using forceps. In this method, the gums are cut open and the bone around the tooth is cut to allow removal of the teeth. Tooth extraction is a minor surgical procedure. Your dentist will apply local anesthesia causing numbness in mouth and also use antibiotics. Hence, you will not feel any pain. After the extraction, there could be some discomfort which is natural.

Dental Extractions are done after administration of local anesthesia that makes the tooth and the surrounding tissues numb. Thus Extractions need not be painful. But a feeling of pressure may be experience by the patient during the procedure. This is often coupled with fear and anxiety which makes the patient feel some sort of pain.

Soon after the dental Extraction the dentist will ask you to bite on a gauze pack for about 15 minutes. This helps in stopping the bleeding that occurs after Extraction and helps in forming a clot. During this period, the patient is asked not to open the mouth or talk.

It is usually advisable to avoid demanding physical work or exercise for the remainder of the day as such activities may restart the bleeding.

The following care should be taken after Extraction:

  • Bite on a gauze pack for 15-20 minutes.
  • Take rest and avoid physical activities.
  • Avoid eating till the numbness of the anesthesia persists.
  • Avoid warm food as it can result in bleeding. In addition soft food is advised.
  • The dentist may advise cold fomentation for some patients to reduce the inflammation and swelling.
  • After 24 hours warm saline mouthwash helps in keeping the wound clean.
  • Avoid biting the lips/cheeks.

Sutures are stitches which maybe given after an Extraction. These stitches help in approximating the gums close together and therefore restrict the size of the wound. Sutures also help in controlling the bleeding.

Sutures are of two types: absorbable and non-absorbable. The absorbable sutures are broken down by the enzymes in the human body. So they just dissolve in a few days and need not be removed. The non-absorbable sutures need to be removed after 7-10 days. Visit Surgical Treatment Section for further details

Once the tooth is extracted a wound is created and therefore bleeding occurs. The bleeding stops once a stable clot forms. But in some patients minor seeping of blood may be seen for a day or two after Extraction and their saliva may be tinged with blood. This need not be a cause for worry to the patient. However profuse bleeding must be brought to the notice of your dentist.

After a tooth is removed, it leaves behind a socket in the bone that was once occupied by the roots. This socket very soon gets filled with blood. The blood in the Extraction socket forms a clot. In a few weeks time the clot slowly reorganizes into bone and fills the socket. Thus the empty space in the bone left after the Extraction of the tooth heals completely by formation of new bone and the gum completely covers the area. This process may take a few months to complete.

The wisdom teeth are the third molars, which are the last teeth in the dental arch. The teeth usually erupt between 18 and 25 years of age. In many individuals, the wisdom teeth remain in the bone as they may not have adequate space in the dental arch to emerge out. This condition is called impaction. In addition the third molar may erupt in abnormal inclination thus affecting the health of the adjacent teeth. So the wisdom teeth need to be removed often.

The wisdom teeth are often inside the bone and therefore cannot be removed easily by using the forceps. In addition their position and angulations may be abnormal. They often require surgical Extraction by cutting open the overlying gums and cutting the bone around the teeth.

Some Extractions are followed by appearance of swelling. This is nothing to worry about, as it is a part of the normal healing process. In reaction to the Extraction, the tissues show an inflammatory reaction to heal the wound created by the removal of the tooth. Swelling is a part of the normal inflammatory process. However the dentist may advice you to have cold fomentation over the area to reduce the swelling.

Dry socket is a condition characterized by onset of pain and foul odor a few days after the Extraction. This occurs due to lysis or dislodgment of the clot that forms after the Extraction leaving behind the bony socket that is very sensitive and tender. The socket may also get infected. This is one of the rare complications of Extraction.

Teeth are embedded in bone. The principal behind Extraction is that the tooth is held by forceps and rocked from side to side to allow the bony socket to expand. In patients who are aged, the bone is very hard and mature and does not easily expand. In addition the teeth also become brittle with age or may have been weakened due to dental decay. The two factors, namely weakened teeth and brittle bone may result in breaking of the tooth during Extraction. The small piece of tooth left behind can be removed by appropriate root forceps or may require surgical opening of the gums and cutting of the bone to remove the broken fragment.

Those teeth that cannot be gripped by a forceps or are embedded inside the bone may require cutting of the gums and the overlying bone to remove the teeth. This is called surgical method of Extraction.

The dentist must be informed of any medical problems that you may have or had in the past. There are certain systemic problems, which may require certain precautions during the dental treatment so as to avoid complications. In some cases the dentist may require consent from your physician before he can extract.

Usually Extractions may not pose any problems for heart patients. However the dentist may require your physician consent. In addition prophylactic antibiotics may be prescribed prior to the Extraction as a precautionary measure. Some sedative may also be prescribed prior to the Extraction.

Patients who have their diabetes under control by diet and medication can undergo Extraction. However the dentist may give you a prophylactic antibiotic prior to the procedure. He would also advice you to have normal food and medicine before the appointment. Sedative may also be prescribed. Visit Surgical Treatment Section for further details

A cyst is a fluid filled cavity that can occur in the soft tissues or the bone. They are of different types and may be asymptomatic or maybe associated with swelling and pain.

Cysts are usually filled with a fluid and are lined by a layer of tissue. Cysts are treated by surgically removing the lining and draining the fluid that is found inside. The normal tissues grow into the cavity in due course of time. However, sometimes the cysts have a tendency to reform in the same area.

A tumor is uncontrolled duplication of certain cells in the body. Tumors are of 2 types - malignant and benign. Benign tumors are relatively harmless while the malignant tumors are serious and tend to spread to nearby and far tissues and pose a threat to life.

Oral cancers can occur due to a number of factors such as chewing of tobacco and betel, excessive alcohol intake, smoking, tissue irritation from sharp tooth or ill fitting denture etc. Lip cancer may occur due to excessive exposure to sunlight.

Most Oral cancers may appear as a swelling or painless ulcer. Sometimes a patch of whitish tissue or red tinged tissue may be seen. Pain is usually a feature in the late stages due to infection of the lesion. The cancer can spread to nearby and far tissues.

Oral cancer is treated by one or more of the following:

  • Chemotherapy: This means the tumors are treated by drugs or chemicals that kill the tumor cells. These drugs are usually very toxic to the body.
  • Radiation therapy: The tumor is exposed to radiation, which is found to cure certain tumors.
  • Surgical removal: The entire tumor is removed along with a border of normal tissue. In case the tumor has spread to nearby lymph glands, they may also be removed surgically.

Radiation therapy for treatment of Oral cancer is usually followed by reduced salivary quantity due to atrophy of the Oral glands. So the cleaning action of the saliva on the teeth is reduced resulting in increased dental decay. Thus patients who have had radiation therapy need to maintain good Oral hygiene and may also require professional fluoride application to offer resistance to caries.

Extraction and other minor Oral surgical procedures are usually completed prior to radiation therapy. Soon after the radiation therapy it has been found that the blood supply to the radiated zone is reduced. This predisposes the tissues to infection. So, surgical procedures and Extractions are avoided after radiation therapy.

Biopsy is surgical removal of a small sample of tissue from a lesion such as a tumor. This tissue is studied under the microscope to determine what type of lesion it is so that appropriate treatment can be planned.

They are certain lesions of the Oral tissue that show an increased risk of transforming into malignant Oral cancer. These lesions are called precancerous lesions. The dentist will try and determine what type of lesion it is and take treatment measures so as to prevent malignancy from developing.

Not all swellings in the mouth are tumors. Swellings can occur due to a number of other causes such as cysts, inflammation, infection of teeth etc. However it is advisable to consult your dentist on finding an Oral swelling.

Having regular dental checkups with x-rays allows you to learn about potential problems and have them corrected before they begin to bother you. There are a number of reasons for recommending removal of unerupted or impacted teeth. Your dentist may have seen that these teeth could cause problems for the adjacent teeth if left in place. There is also the possibility that you could develop such things as a cyst or abscess if left in place.

  • The Healing Process: It usually takes gum tissue about 3-4 weeks to heal. The bone can take up to 6 months to heal completely. However, pain should be lessening by the second day. You may feel the sharp edge of the socket with your tongue and sometimes, little bits of bone may make their way to the surface and work their way out. This is perfectly normal and harmless. If a small bit of bone is annoying you and you don not want to wait until it comes out by itself, you can ask your dentist to remove it for you. Pain that lasts for up to a week or so but is gradually getting better is normal. You could ask your dentist or pharmacist for stronger painkillers. Pain that starts to get worse after two days is considered abnormal and you may want to see your dentist. This could be a sign of "dry socket".

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  • Dry Socket: A dry socket occurs when the blood clot for healing becomes dislodged or does not form. In that case, the bone and fine nerve endings are not protected and exposed to air, food, and liquids. Dry socket delays the healing process and can be very painful. If you suspect dry socket, see your dentist. He will place a medicated dressing in the socket which will almost instantly relieve pain. If the area is infected, your dentist may also prescribe a course of antibiotics.

Local Anesthesia is temporary loss of sensation to pain and other sensations such as pressure, temperature and touch in a localized area of the tissue. This is done by injecting a local anesthetic drug around the tooth being extracted. The teeth, lips and tongue become numb so the patient does not feel the pain during the procedure. This numbness lasts for a few hours. Most Extractions are done under local anesthesia.

General anesthesia is reversible loss of consciousness along with loss of all sensation. General anesthetic drugs also help in controlling pain and relax the muscles of the body. General anesthetics are used in complicated surgical procedures that may take a long duration and when the surgery is done in multiple sites. They are also useful in unco-operative patients.

To make your dental visit as comfortable as possible, your dentist may suggest anaesthesia to reduce or eliminate any pain or anxiety that may be related to your dental treatment. The type of anaesthesia required for any dental procedure depends on the needs or preferences of the patient.

You and your dentist will decide what level of anaesthesia is right for you. Some patients prefer a higher level of anaesthesia than others. Children, people with special needs, such as mental retardation, and those with a condition, such as a dental phobia may require a higher level of anaesthesia. The type of anaesthesia administered by your dentist is more dependent on individual patient preferences than specific dental procedures.

Local anaesthesia is produced by the application or injection of a drug to eliminate pain in a specific area in the mouth. Topical anaesthetics are frequently used by your dentist to numb an area in preparation for administering an injectable local anaesthetic. Injectable local anaesthetics, such as Lidocaine, numb mouth tissues in a specific area of your mouth for a short period of time. Your dentist will probably inject a local anaesthetic before filling cavities, preparing your teeth for crowns, or for any surgical procedure. Local anaesthesia is the most commonly used form of anaesthesia in the dental office. Conscious sedation can be used to help you relax during a dental procedure. Your dentist may administer an anti-anxiety agent, such as nitrous oxide, or a sedative, in combination with a local anaesthetic for pain. During conscious sedation, you will remain calm during treatment, yet rational and responsive to speech and touch. Anti-anxiety agents and sedatives can be administered by mouth, inhalation or injection. Deep sedation and general anaesthesia is used for complex procedures and for patients who have trouble controlling their movements or need a deeper level of anaesthesia during treatment. During deep sedation you will be unable to respond appropriately to verbal commands. During general anaesthesia you will be unconscious.

Your dentist needs to know about all the medications that you are taking, any allergic reactions you have had to medicines in the past, and your past and present health conditions. It is important that you answer your dentist questions completely and ask about your concerns. This way your dentist will be sure to tell you everything you need to know before receiving treatment. For example, in some cases, your anaesthesia treatment may require that you suspend certain medications or abstain from eating or drinking for a period of time before the treatment.

Sedation (sleep) dentistry involves the use of sedative drugs so that patients who fear dental work can avoid the discomfort and anxiety associated with dental visits. With sedation dentistry, patients take a pill about an hour before their dental appointment. They arrive at our office relaxed and able to undergo treatment without feeling any pain or having any memory of the procedure. If you have avoided getting dental care because of anxiety or fear of discomfort, sedation dentistry may be the ideal solution to allow you to get essential treatment.

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