Oral Surgery & Extractions

• Tooth decay – If the decay is severely advanced and the nerves and blood vessels in the tooth have been infected, and are unsuitable for root canal treatment.
• Impacted wisdom teeth – Sometimes our mouths are simply not big enough to accommodate these teeth. The teeth become impacted (stuck), this can cause infection and pain.
• Orthodontics (braces) – Teeth can erupt in many different positions, if this happens you may have to have teeth extracted so your other teeth can be brought into line.
• Periodontal disease - Bacterial infection under the gum damages the tissue which connects the tooth to the gum; as the disease progresses, the bone anchoring the tooth to the jaw begins to dissolve, resulting in the tooth becoming loose.
• Teeth that have been damaged by trauma.
• Certain medical conditions may require teeth to be extracted.

Your dentist will examine your tooth and explain the reasons why your tooth needs to be extracted. An x-ray will be taken to help plan the best way to remove the tooth.

If an abscess is present your dentist might give you a course of antibiotics before your tooth is extracted.

Your dentist will ask you about your medical history. You must list every medication you are taking even if you have purchased it from over the counter, as some medications can complicate an extraction

Tell your dentist if you are anxious about the procedure as sedation might be a possibility.

Make sure you had something to eat before the extraction.

There are two types of extraction - simple extractions and surgical extractions.

A simple extraction is performed when the tooth can easily be seen in the mouth. The dentist will give you a local anaesthetic to numb the area around the tooth. When the anaesthetic has taken effect and the area around the tooth is numb, the dentist will hold the tooth using a pair of forceps, you will feel pressure but NO pain. The dentist will move the forceps back and forth to loosen the tooth in order to extract the tooth.

A surgical extraction is carried out on teeth which

• Cannot be seen in the mouth but are present below the gum.
• Partially showing through the gum
• Broken off at gum level.

A local anaesthetic will be administered to numb the area before a small incision is made in the gum. The gum is pulled back to expose the whole of the tooth or the root. The dentist then uses the same procedure as a simple extraction to remove the tooth. In some cases, the tooth or root may have to be divided into pieces to be removed.

When the tooth has been removed, a cotton roll will be placed at the extraction site and you will be asked to bite on this until the bleeding has stopped and a blood clot has formed.

DO NOT: Rinse out the mouth, take alcohol, or hot drinks or food for the first 3 hours.

Avoid: Sucking or interfering with the wound.

Take: Normal cold or warm drinks and soft food.

Pain Relief: Take pain relief tablets as prescribed.

Bleeding: A slight ooze of blood can be expected. If there is more bleeding, apply pressure by placing a cotton roll over the bleeding point and close jaw firmly for 30 minutes. If the bleeding hasn't stopped, repeat with a new cotton roll and apply pressure for 40 minutes. If still bleeding, please seek help.

Begin mouth baths using ½ teaspoon salt in a glass of lukewarm water. Hold in the mouth without rinsing. Do this every 4 hours or as often as possible over 24 hours. Repeat over next few days, starting to rinse gently, becoming more vigorous.

Do NOT use Hydrogen Peroxide.

Other points to note:

• Teeth can be brushed carefully.
• Following a general anaesthetic – rest for a few days and take no vigorous exercise.
• Expect mild pain, if there is excessive bleeding or other symptoms like pain – Contact your dentist promptly.

Adults have up to 32 teeth, of which four are wisdom teeth and these are the last to come through the gum. They are the one's right at the back of the mouth and usually appear between the ages of 17 and 25 although sometimes they can appear in later years.

If there is enough room in the mouth the wisdom teeth will come through (erupt) in a useful position and there will only be minor discomfort as they erupt. However, wisdom teeth can cause problems if there is not enough room in the mouth, as the wisdom tooth erupts at an angle and gets stuck against the tooth in front; the dentist will describe this as 'Impacted'.

The dentist will be able to assess whether there is sufficient room for the teeth to come through by taking an x- ray which will show the position of the root. Once the x-rays have been taken, the dentist will be able to tell how easy or difficult it will be to remove the tooth. The dentist will then determine whether the tooth should be taken out at the Dental Practice or by a Specialist Oral Surgeon.

You may have wondered why we have to have wisdom teeth removed in the first place. The main reason has to do with a lack of space for these teeth. By the time wisdom teeth develop and erupt, most adults already have a full complement of teeth and there isn't much room left in the dental arch to allow for 4 more large teeth to grow into a healthy position and alignment.

The wisdom teeth begin to erupt and are blocked by the back molars, or the jaw, or both. When the erupting wisdom teeth encounter these blocks or barriers, the wisdom teeth get trapped in an awkward position, sometimes referred to as impacted teeth. This situation often leads to all kinds of problems ultimately resulting in pain and infection.

The lack of space often results in areas that you cannot reach to maintain optimal hygiene. These unreachable areas become havens for toxic bacteria to breed, which can turn into a chronic infection causing tooth decay and gum disease. These chronic infections put you at higher risk for systemic diseases like cardiovascular disease, diabetes, inflammatory diseases, and more

If there is not enough room in the mouth for the wisdom teeth to be completely healthy then they should be removed. When we have a shortage of space, often the wisdom teeth roots can grow into or around the large nerve, that supplies the Jaw, Teeth and Gum on the affected side.

It is essential to evaluate the shape and position of the roots at an early stage in wisdom tooth development, to plan and avoid risk to the large nerve should the tooth need to be removed later in life.

We often have to use CBCT Xrays (3D Xrays) to confirm the position of the nerve and roots.

• The teeth are not able to fully erupt through the gum and are causing an infection in the surrounding tissue; this is known as Pericoronitis, or
• The large nerve supplying the jaw is going to be jeopardised in the future.
• There is decay present - wisdom teeth will often decay as it is very difficult to clean them as thoroughly as your other teeth.

Following the removal of wisdom teeth, there is likely to be some discomfort. However, this will vary depending on how difficult it was to remove the tooth. It is not uncommon to experience some swelling and/or bruising for a few days.

The dentist will advise on how best to reduce this discomfort and may recommend pain killers such as Paracetamol or Ibuprofen. A further dental appointment will be necessary for the dentist to check the healing process and remove any stitches.

Ice packs on the outside of the surgery areas on the cheeks will prevent swelling.

After the extraction a blood clot will form in the socket were the tooth used to be, this is NOT to be disturbed by vigorous rinsing or poking the site with your tongue or finger as it is a very important part of the healing process.

If the socket does start to bleed after you have left the dental practice, place the supplied cotton roll over the extraction site and apply pressure by biting down, the bleeding will normally stop within a few minutes. Again do NOT disturb the blood clot. If the bleeding does persist please contact your dentist for further advice.

Your mouth will still be numb for an hour or so after the local anaesthetic, please take care not to bite your cheek or tongue or burn your mouth when drinking hot liquids.

Avoid Smoking and Alcohol for 24 hours as these can have an effect on the healing process

You may be in discomfort after the anaesthetic has worn off, taking a pain reliever following the manufactures instructions. Do NOT take Aspirin as this may cause the socket to bleed.