Treatments Surgical Treatment

Extractions involve removal of a tooth from the mouth. Reasons why a tooth needs to be extracted include gross decay that cannot be restored to normal health or teeth that are abnormally positioned causing crowding. In some cases, wisdom teeth or impacted teeth need to be removed. There are two types of extractions:

In this extraction, the dentist can grasp the tooth with an instrument. The Dentist will rock the tooth back and forth until the tooth becomes loose enough to be lifted out. These extractions usually only require local anaesthetic, since the tooth is visible to the dentist

In cases where a tooth is not visible or cannot be grasped with instruments, a surgical extraction may be necessary. In this type of extraction, the dentist will lift the gum over the tooth. He may also need to drill into the surrounding bone tissue or may need to remove the tooth piece by piece.

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Following extraction of a tooth, a blood clot forms in the socket, usually within an hour. Bleeding is common in this first hour, but its likelihood decreases quickly as time passes, and is unusual after 24 hours. The raw open wound overlying the dental socket takes about 1 week to heal. Thereafter, the socket will gradually fill in with soft gum tissue over a period of about one to two months. Final closure of the socket with bony remodeling can take six months or more.

It is advisable to wait for at least 4 weeks after the extraction of teeth before the dentist can initiate the process of denture construction. This gives sufficient time for the extraction wound to heal and for the underlying bone to remodel. A temporary set of dentures can be put in place immediately following the extraction of remaining teeth. If there are multiple extractions necessary, the procedure is typically done under general anesthesia. Once the teeth have all been removed, a set of temporary dentures is put into place immediately. The temporary dentures, also called immediate dentures, help to protect the gums, as well as numbing the pain. Immediate dentures allow the patient to have immediate use of a set of dentures, but these may need to be adjusted over time due to the potential of shrinking in the gums and changes in the bone structure of the jaw due to healing. Once the gum tissues and bones of the jaw have completely healed, which may take at least six to eight weeks, the patient can be fitted for a set of permanent dentures. This process requires additional measurements of both bone and gums in the mouth of the patient. It is important to ensure that the permanent denture fits the patient perfectly, to prevent sores or other problems that result from chafing.

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.

There is no set rule regarding a specific age by which a person "must" have their wisdom teeth removed. Third molar extractions can be performed successfully for patients in all age groups. From a standpoint of statistics however, research has shown that there are certain age-related factors that can place comparatively older patients at greater risk for complications. Related to these issues, dentists typically recommend that wisdom teeth should (most ideally) be removed between the ages of 18 and 24 years.

A dentist will typically want to delay a wisdom tooth extraction until that point in time when about two-thirds of the tooths root has formed. They wait for this stage because if the tooth is less developed it can be more difficult to manipulate during the surgical process. The age by which this degree of root development has been reached will vary with each individual (it can be sooner or later).

Choosing age 24 years for the upper end of the ideal age range for wisdom tooth removal is based on the fact that the dentist wants to remove the tooth within that time frame when their patients risk for complications is at a minimum. With age come more complete root formation and other physiologic factors that both potentially increase the difficulty of the extraction process and affect the patients post-surgical resiliency. In regards to these issues, studies have suggested that age 24 years is a good cutoff point.

Your teeth are held in place by roots that extend into your jawbone. Front teeth usually have one root. Other teeth, such as your premolars and molars, have two or more roots. The tip or end of each root is called the apex. Nerves and blood vessels enter the tooth through the apex. They travel through a canal inside the root, and into the pulp chamber. This chamber is inside the crown (Part of the tooth visible in the mouth). During root canal treatment, the canals are cleaned & inflamed or infected tissue is removed. An Apicoectomy may be needed when an infection develops or wont go away after root canal treatment or retreatment. Root canals are very complex, with many small branches off the main canal. Sometimes, even after root canal treatment, infected debris can remain in these branches. This can possibly prevent healing or cause re-infection later.

In an Apicoectomy, the root tip, or apex, is removed along with the infected tissue. A filling is then placed to seal the end of the root. If a root canal procedure has been done in the past and it becomes infected again, it is often because of a problem near the apex of the root. The dentist can do an Apicoectomy to fix the problem so the tooth does not need to be extracted. An Apicoectomy is done only after a tooth has had at least one root canal procedure and retreatment has not been successful or is not possible for e.g. retreatment is not a good option when a tooth has a crown or is part of a bridge. Retreatment of the root canal would require cutting through the crown or bridge. That might destroy or weaken the crown or bridge. An Apicoectomy is often considered in a situation like this. The gum is cut and lifted from the tooth to gain access to the root. The infected tissue is removed along with the last few millimeters of the root tip. The dentist takes an X-ray of the area before stitching the tissue back in place. Most Apicoectomies take 30 to 90 minutes. The length will depend on the location of the tooth and the complexity of the root structure. Procedures on front teeth are generally the shortest. Those on lower molars generally take the longest. Apply ice to the area for 10 to 12 hours after the surgery, and rest during that time. The area may bruise and swell. It may be more swollen the second day after the procedure than the first day. Any pain usually can be controlled with pain killers or a prescription medicine. To allow for healing, you should avoid brushing the area or rinsing vigorously. Also, don not smoke or eat crunchy or hard foods. Do not lift your lip to examine the area. This can loosen the stitches and disrupt formation of a blood clot that is needed for healing. Your stitches will be removed 7 days after the procedure. All soreness and swelling are usually gone within 14 days.

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