When tooth becomes severely decayed, infected or fractured, a dental extraction may be necessary. Other common reasons for extraction would be for the removal of wisdom teeth, or during the process of wearing braces when teeth is removed to provide room in order for other teeth to align. Please remember to disclose all medical history to your dentist to assess the risks of your extraction. Patients who have high blood pressure or heart disease will be at higher risk of increased blood pressure, patients who are taking blood-thinners will have increased risk of prolong bleeding, patients who have diabetes, HIV, or are smokers will be at risk of delayed wound healing.
Extraction is usually an outpatient procedure with local anaesthesia or under IV sedation. For simple extraction, local anesthetic is applied, numbing the area around the tooth so you will not feel any pain. However, you can still feel pressure when the tooth is extracted. For surgical extraction, local anaesthesia and optional IV sedation could be used depending on how extensive the surgery will be. After the procedure, your dentist will advise you on diet recommendations, medications, and/or review visits. You will be asked to bite on a gauze for at least 30 min after the extraction to promote blood clotting.
It is normal to feel some pain after the anaesthesia wears off. For 24 hours after a tooth extraction, you should also expect some swelling and residual bleeding. However, if either bleeding or pain is still severe more than four hours after your tooth is extracted even on painkillers, you should call your dentist. You should also call your dentist if you experience any of the following:
The initial healing period usually takes about two weeks. New gum tissue will grow into the gap. It takes approximately six months for bone to grow in, prior to which you may feel a dent in your gums. Over time, however, having a tooth (or teeth) missing can cause the remaining teeth to shift, affecting your bite and making it difficult to chew. For that reason, your dentist may advise replacing the missing tooth or teeth with an implant, fixed bridge, or denture.
Wisdom teeth are the last teeth to emerge in our mouths and usually attempt to grow out of the gums between 17-21 years of age. As most of our jaws do not have enough space for it, they often do not come fully through and are not functional, potentially causing pain and infection. The term used to describe this situation is that the teeth are impacted and the resultant infection is termed pericoronitis. Most wisdom teeth pain are due to the gum above the impacted wisdom tooth becoming infected. In most cases, surgery is required as the tooth is usually partly covered by the overlying gum and partially buried within the jawbone.
The procedure takes around an hour and is performed under local anaesthesia though many patients prefer the comfort of being under IV sedation or to be completely asleep under general anaesthesia. A surgical procedure is usually required and the gums covering the buried tooth pushed back to expose the tooth. As the angle of the tooth is usually unfavourable, it cannot be easily removed. A dental bur is used to divide the tooth to enable it to be removed in 2 or 3 sections. The gums are then stitched back into position. After the operation, you may feel uncomfortable but this can be controlled with the prescribed painkillers. Expect some oozing from the surgical site which can be controlled by applying direct pressure with a clean gauze. Some swelling and bruising are also to be expected for a few days after the surgery and you will be given up to 5 days of Medical Certificate. You can resume normal activity within a day but should avoid exercise and swimming. A soft diet is advised and can commence after the numbness from the local anaesthesia wears off, usually after 2-3 hours to avoid biting your lip or tongue accidentally.
It is not always necessary to remove wisdom teeth if they are in a functional position, are well cleaned, and not causing any pain or infection. However, as most patients have jaws that are too small to accommodate all their teeth, wisdom teeth often emerge in an awkward position and are difficult to keep clean. This results in food residue being trapped below the overlying gum, leading to infection of the surrounding gums as well as decay of the molar tooth in front of the wisdom tooth. In this case, it should be removed.
You may feel some minor discomfort during the procedure as even though the local anaesthetic that is given blocks pain pathways, you will still be able to feel some pressure and hear the sound of the drilling and the instruments. You will also need to keep your mouth open during the duration of the surgery. In most patients, the lower wisdom teeth may take longer to remove and require more manipulation. You will usually be given painkillers to take before the procedure so that you will be comfortable after the surgery.
The surgery is safe as there are no major blood vessels in the oral cavity. However, your dentist will still exercise the utmost care during the surgery. The only major complication is possible damage to the nerves which supply the lips, cheek, teeth and tongue. Most other problems are temporary and reversible. It is also safe to undergo IV sedation and general anaesthesia for comfort, as it is always carried out and supervised by experienced specialist medical anaesthetists and trained nurses.
A bone graft is a procedure where bone is transferred to an area which is deficient in order to create the bulk necessary to place an implant. Bone graft material can either be harvested from near the implant site, or processed from synthetic or other calcified sources (for example, specially processed cow bone to remove all proteins and only leaving the calcium minerals). They serve as the supporting framework in areas of missing bone. Whatever the source, even if it is your own bone, the body would then initiate its healing process and remodel the graft material into fully functional bone.
When teeth are missing or extracted, the jawbone in which it is anchored is lost as well, reducing the amount of support for face and lips, resulting in a sunken and aged appearance. The overlying gum also recedes, creating unsightly gaps and spaces between teeth. As bone is required in order to place implants, there is a need to “grow back the bone”. Thankfully, even if teeth have been lost for a long time, implants can still be placed after regenerating the jaw bone using a combination of bone grafts and special membranes.
In general, it takes around 4 months for bone to grow back and regain strength. When powdered bone from a synthetic or alternative source is used, it might take a few additional months for the body to replace it with its own new bone. There is no upper age limit and as long as you are suitable for surgery, it can be performed as the process of bone regeneration will occur even in older individuals. The same principles of healing after a fracture apply, that is the area should be stabilised and left undisturbed, and is free from infection.
Bone grafts have a success rate in excess of 90%, though it also depends on the experience of the dentist, the size and shape of the defect, and also the general health of the patient. Success is lower in areas where it is difficult to create and maintain the space for the bone to grow into. Success may also be affected if the patient is a smoker, or in patients with diabetes.
Nitrous oxide/oxygen is a safe, effective technique to calm a normal amount of fear of the dental visit. Nitrous oxide/oxygen is perhaps the safest sedative in dentistry. It is non-addictive. It is mild, easily taken, and then quickly eliminated by the body. You will remain fully conscious and keeps all natural reflexes when breathing nitrous oxide/oxygen. However, any respiratory condition that makes breathing through the nose difficult may limit the effectiveness of nitrous oxide/oxygen. It is also not effective for patients with severe anxiety, nasal congestion, extensive treatment needs, or discomfort wearing nasal masks.
Our dentists recognize that there exists a patient population for whom routine dental care using nonpharmacologic behavior management techniques or nitrous oxide alone are inadequate due to their need for extensive treatment, acute situational anxiety, uncooperative age-appropriate behavior, immature cognitive functioning, disabilities or medical conditions. In these situations, our dentists and staff will discuss with you the option of sedation dentistry. Intravenous (IV) sedation refers to the administering of an anti-anxiety drug through the blood during your dental treatment. An IV sedation dentistry is sometimes referred to as ‘twilight’ or ‘sleep’ dentistry. However, rather than putting you to sleep, the sedative helps you to relax and feel at peace. While you will be in a position to respond to the dentist’s questions, your treatment procedure will be vague once the sedative wears off. Some patients even describe it as “the best sleep” they’ve had!
For some patients with complex medical conditions, extensive dental needs or failed IV sedation, it may be necessary that their treatment would best be completed in a hospital setting under general anesthesia. In this case, our dentists would refer you to the appropriate facility.
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