Oral Surgery
Tooth Extraction
When the extraction of a tooth is required:
1) An incision in the gums is made
2) The tooth is removed
3) The area is stitched up and is allowed to heal
During this time, it is important to think about a tooth replacement option. An extracted tooth leaves an open area in the jaw which, in time, allows the neighboring teeth to drift into the area where the tooth was extracted. This in turn, causes a chain reaction to all the surrounding teeth. Also, if you are considering placing an implant in the future, you should consider asking your dentist to place a bone graft at the time of surgery to preserve the bone width and height.
After Extraction Care
After tooth extraction, it’s important for a blood clot to form to stop the bleeding and begin the healing process. We ask you to bite on a gauze pad in the tooth extraction area for 30 minutes after the appointment. If the bleeding or oozing persists, repeat the process. After the blood clot forms, it is important not to dislodge the clot. Do not rinse vigorously, suck on straws, smoke, drink alcohol or brush teeth next to the extraction site for 72 hours. These activities will dislodge the clot. Limit vigorous exercise for the next 24 hours as this will increase blood pressure and may cause more bleeding from the extraction site.
After the tooth is extracted you may feel some pain and experience some swelling. An ice pack applied to the area 20 minutes on, 20 minutes off, will keep swelling to a minimum. Take pain medications as prescribed by Irwin Dentistry. The swelling will usually subside in about 48 hours.
Use the pain medication as directed. Call the office if the medication doesn't seem to be working. If antibiotics are prescribed, continue to take them for the indicated length of time, even if signs and symptoms of infection are gone. Drink lots of fluid and eat nutritious soft food on the day of the extraction. You can eat normally as soon as you are comfortable.
It's important to resume your normal dental routine after 24 hours. This should include brushing and flossing your teeth at least twice a day. This will speed healing and help keep your mouth fresh and clean.
After a few days you will feel fine and can resume your normal activities. If you have heavy bleeding, severe pain, continued swelling after 2-3 days, or a reaction to the medication, call our office immediately at (714) 674-0555.
After the Removal of Multiple Teeth
BLEEDING. A small amount of bleeding is to be expected following the operation. If bleeding occurs, place a gauze pad directly over the bleeding socket and apply biting pressure for 30 minutes. If bleeding continues, a moist tea bag can be used for 30 minutes. If bleeding occurs, avoid hot liquids, exercise, and elevate the head. If bleeding persists, call our office immediately. Do not remove immediate denture unless the bleeding is severe. Expect some oozing around the side of the denture.
SWELLING. Use ice packs on the same side of the face of the surgical area. Apply ice 20 minutes on, 20 minutes off, during your waking hours for a maximum of 36 hours only. Ice does not have an effect after 36 hours. Call the office for further assistance.
DISCOMFORT. For mild discomfort use aspirin, Tylenol or any similar medication; two tablets every 3-4 hours. Ibuprofen (Advil, Motrin) 200mg can be taken 2-3 tablets every 3-4 hours. For severe pain use the prescription given to you. If the pain does not begin to subside in 2 days, or increases after 2 days, please call our office. If an antibiotic has been prescribed, finish your prescription regardless of your symptoms.
DIET. Drink plenty of fluids. If many teeth have been extracted, the blood lost at this time needs to be replaced. Drink at least six glasses of liquid the first day. Restrict your diet to liquids and soft foods, which are comfortable for you to eat. As the wounds heal, you will be able to advance your diet.
HOME HYGIENE CARE. Do not rinse your mouth for the first post-operative day, or while there is bleeding. After the first day, use a warm salt water rinse every 4 hours and following meals to flush out particles of food and debris that may lodge in the operated area. (One half teaspoon of salt in a glass of lukewarm water.). After you have seen your dentist for denture adjustment, take out denture and rinse 3 to 4 times a day.
WEARING DENTURES. The removal of many teeth at one time is quite different than the extraction of one or two teeth. Because the bone must be shaped and smoothed prior to the insertion of a denture, the following conditions may occur, all of which are considered normal:
- The area operated on will swell reaching a maximum in two days. Swelling and discoloration around the eye may occur. The application of a moist warm towel will help eliminate the discoloration quicker. The towel should be applied continuously for as long as tolerable beginning 36 hours after surgery (remember ice packs are used for the first 36 hours only).
- A sore throat may develop. The muscles of the throat are near the extraction sites. Swelling into the throat muscles can cause pain. This is normal and should subside in 2-3 days.
- If the corners of the mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment like Vaseline. There may be a slight elevation of temperature for 24-48 hours. If temperature continues, notify our office.
If immediate dentures have been inserted, sore spots may develop. In most cases, Irwin Dentistry will see you within 24-48 hours after surgery and make the necessary adjustments to relieve those sore spots. Failure to do so may result in severe denture sores, which may prolong the healing process.
Wisdom Tooth Development
Wisdom teeth generally begin to form in your pre-teen years. By late teen years, the crown of the wisdom teeth will begin to erupt through the gums if there is adequate room. By mid twenties, your wisdom teeth will either be able to fully erupt or will have become impacted. Early removal of wisdom teeth makes the procedure easier for the patient to tolerate and promotes faster healing afterwards. By your early forties, the wisdom teeth roots have become fully anchored to the jawbone and if required to be extracted, will be much harder and will need more time to heal.
Wisdom Tooth Positions
Wisdom teeth under ideal circumstances should grow in straight like any other tooth. However, it is common for wisdom teeth to become impacted inside the jaw or just under the gums. If this occurs, your wisdom teeth should be removed.
Common Impactions:
1) Horizontal Impaction
2) Angular Impaction
3) Vertical Impaction
4) Soft Tissue Impaction
Wisdom Tooth Problems
The problems involving your wisdom teeth may be caused by the size of your jaw and/or by how crowded your teeth are. Common warning symptoms that there is an un-natural problem in the development of your wisdom teeth could be pain and swelling.
Symptoms can be caused by:
1) Infection to the gums
2) A crowded tooth displacing neighboring teeth
3) A decayed wisdom tooth
4) Poorly positioned wisdom tooth
5) A cyst that destroys bone
Wisdom Tooth Removal
Removal of wisdom teeth could be done while you are sedated and being carefully monitored.
1) An incision is made in the gums.
2) The overlaying bone is removed to
expose the crown of the tooth.
3) The tooth is then extracted as a whole or under certain circumstances, it may be necessary to be removed in pieces. This is generally done for severely impacted wisdom teeth.
4) The area is stitched closed and allowed to heal.
Periodontal Bone Graft
The best material for a bone graft is your own bone, which most likely will come from your chin, the back part of your lower jaw or your hip bone. The hip is considered to be a better source because the hip bone has a lot of marrow, which contains bone-forming cells. There are also synthetic materials that can be used for bone grafting. To place the removed bone in the recipient site, little holes are drilled in the existing bone to cause bleeding. This is done because blood provides cells that help the bone heal. The block of bone that was removed will be anchored in place with titanium screws. A mixture of the patient's bone marrow and some other bone-graft material will then be placed around the edges of the bone block. Finally, a membrane is placed over the area and the incision closed. The bone graft will take about 6 to 12 months to heal before dental implants can be placed. At that time, the titanium screws used to anchor the bone block in place will be removed before the implant is placed.
Crown Lengthening
Crown lengthening is a surgical procedure that re-contours the gum tissue and often the underlying bone of a tooth. Crown lengthening is often for a tooth to be fitted with a crown. It provides necessary space between the supporting bone and crown, which prevents the new crown from damaging bone and gum tissue.
Facial Trauma
Dr. Irwin is an Oral and Maxillofacial Surgeon, who is trained, skilled and uniquely qualified to manage and treat facial trauma. Injuries to the face, by their very nature, impart a high degree of emotional, as well as physical trauma to patients. Dr. Irwin may also be on staff at local hospitals to deliver emergency room coverage for facial injuries, which include the following conditions:
- Facial lacerations
- Intra oral lacerations
- Avulsed (knocked out) teeth
- Fractured facial bones (cheek, nose or eye socket)
- Fractured jaws (upper and lower jaw)
The Nature of Maxillofacial Trauma
There are a number of possible causes of facial trauma; e.g. Motor vehicle accidents, accidental falls, sports injuries, interpersonal violence and work related injuries. Maxillofacial facial injuries can range from injuries of the teeth to severe injuries of the skin and bones of the face. Typically, facial injuries are classified as either soft tissue injuries (skin and gums), bone injuries (fractures), or injuries to special regions (such as the eyes, facial nerves or the salivary glands).
Soft Tissue Injuries of the Maxillofacial Region
When soft tissue injuries such as lacerations occur on the face, they are repaired by suturing. In addition to the obvious concern of providing a repair that yields the best cosmetic result possible, care is taken to inspect for and treat injuries to structures such as facial nerves, salivary glands and salivary ducts (outflow channels). Dr. Irwin is proficient at diagnosing and treating all types of facial lacerations.
Bone Injuries of the Maxillofacial Region
Fractures of the bones of the face are treated in a manner similar to the fractures in other parts of the body. The specific form of treatment is determined by various factors, which include the location of the fracture, the severity of the fracture, and the patients age and overall health. When an arm or a leg is fractured, a cast is often applied to stabilize the bone to allow for proper healing. Since a cast cannot be placed on the face, other means have been developed to stabilize facial fractures.
One of these options involves wiring the jaws together for certain fractures of the upper and/or lower jaw. Certain other types of fractures of the jaw are best treated and stabilized by the surgical placement of small plates and screws at the involved site. This technique called "rigid fixation" of a fracture profoundly improved the recovery period for many patients, allowing them to return to normal function more quickly. The treatment of facial fractures is accomplished in a thorough and predictable manner so the patient's facial appearance to be minimally affected.
Injuries to the Teeth and Surrounding Dental Structures
Isolated injuries to teeth are quite common and may require the expertise of various dental specialists. Oral surgeons usually are involved in treating fractures in the supporting bone or in replanting teeth that have been displaced or knocked out. These types of injuries are treated by one of a number of forms of splinting (stabilizing by wiring or bonding teeth together). If a tooth is knocked out, it should be placed in salt water or milk. The sooner the tooth is re-inserted into the dental socket, the better chance it will survive. Therefore, the patient should see a dentist or oral surgeon as soon as possible. Never attempt to wipe the tooth off, since remnants of the ligament that hold the tooth in the jaw are attached and are vital to the success of replanting the tooth. Other dental specialists may be called upon such as endodontists, who may be asked to perform root canal therapy, and/or restorative dentists who may need to repair or rebuild fractured teeth. In the event that injured teeth cannot be saved or repaired, dental implants are often now utilized as replacements for missing teeth.
Impacted Canine
Canine teeth are also commonly referred to as cusped or "eye teeth" since the teeth align under your eyes?. You should have two canines in both your upper and lower jaw. They are the strongest teeth you have, used for tearing into your most meaty meals. Because of this need for strength, your canines have the longest roots of all your teeth. They are an essential part of your bite and balanced smile for two main reasons:
- Your Bite – due to their length, the canines guide your other teeth together when chewing and biting. Canines are essential for maintaining a proper bite.
- Your Appearance – without canines, large gaps appear in your smile. This can lead to your other front teeth becoming twisted or crooked.
Your canine teeth are generally some of the last teeth to erupt. Occasionally they do not erupt. The two most common reasons are:
- Overcrowding in your mouth – extra teeth or a small jaw can cause the space where your canines are supposed to come in to be very small, resulting in impaction, or failure to erupt.
- Abnormal growths – tissue may have developed in your jaw that prevented your canines from reaching the surface.
The fact that teeth don’t always come in like they’re supposed to highlights the need for regular dental visits when young teeth are developing. If you suspect your child has impacted canines, don’t hesitate to make an appointment with Irwin Dentistry. With regular dental visits, X-rays and examinations, the problem of impacted canines can be found out early when treatment is easier. If you are an adult and your canines have not erupted Irwin Dentistry can help. Set an appoint today for an x-ray and consultation. Your smile is up there waiting for you.
Treatment for Impacted Canines
After assessing your situation, Irwin Dentistry will devise a plan to make room for your canines. Will a typical oral surgery and the assistance of an orthodontist your canine will find their way into their proper place over time.
Jaw Surgery
Orthognathic surgery is needed when jaws don't meet correctly and/or teeth don't seem to fit with jaws. Teeth are straightened with orthodontics and corrective jaw surgery repositions misaligned jaws. This not only improves facial appearance, but also ensures that teeth meet correctly and function properly. People who can benefit from orthognathic surgery include those with an improper bite or jaws that are positioned incorrectly. Jaw growth is a gradual process and in some instances, the upper and lower jaws may grow at different rates. The result can be a host of problems that can affect chewing function, speech, long-term oral health and appearance. Injury to the jaw and birth defects can also affect jaw alignment. Orthodontics alone can correct bite problems when only the teeth are involved. Orthognathic surgery may be required for the jaws when needing repositioning.
Difficulty in the following areas should be evaluated:
- difficulty in chewing, biting or swallowing
- speech problems
- chronic jaw or TMJ pain
- open bite
- protruding jaw
- breathing problems
Any of these can exist at birth or may be acquired after birth as a result of hereditary or environmental influences or the result of trauma to the face. Before any treatment begins, a consultation will be held to perform a complete examination with x-rays. Feel free to ask any questions that you have regarding your treatment. When you are fully informed about the aspects of your care, you and your dental team will make the decision to proceed with treatment together.
Orthognathic Surgery Technology
Irwin Dentistry uses comprehensive facial X-rays and computer video imaging, to show you how your bite will be improved and even give you an idea of how you will look after surgery. Irwin Dentistry wants you understand the surgical process and the extent of the treatment prescribed and to see the benefits of orthognathic surgery.
If you are a candidate for Corrective Jaw Surgery, Irwin Dentistry will work closely with your dentist and orthodontist during your treatment. The actual surgery can move your teeth and jaws into a new position that results in a more attractive, functional and healthy dental-facial relationship.
Oral Pathology
The inside of the mouth is normally lined with a special type of skin (mucosa) that is smooth and coral pink in color. Any alteration in this appearance could be a warning sign for a pathological process. The most serious of these is oral cancer. The following can be signs at the beginning of a pathologic process or cancerous growth:
- Reddish patches (erythroplasia) or whitish patches (leukoplakia) in the mouth
- A sore that fails to heal and bleeds easily
- A lump or thickening on the skin lining the inside of the mouth
- Chronic sore throat or hoarseness
- Difficulty in chewing or swallowing
These changes can be detected on the lips, cheeks, palate and gum tissue around the teeth, tongue, face and/or neck. Pain does not always occur with pathology, and curiously, is not often associated with oral cancer. However, any patient with facial and/or oral pain without an obvious cause or reason may also be at risk for oral cancer.
Post-Surgery Instructions
Fold a piece of clean gauze into a pad thick enough to bite on and place directly on the extraction site. Apply moderate pressure by closing the teeth firmly over the pad. Maintain this pressure for about 30 minutes. If the pad becomes soaked, replace it with a clean one as necessary. Do not suck on the extraction site (as with a straw). A slight amount of blood may leak at the extraction site until a clot forms. However, if heavy bleeding continues, call your dentist. (Remember, though, that a lot of saliva and a little blood can look like a lot of bleeding).
The Blood Clot
After an extraction, a blood clot forms in the tooth socket. This clot is an important part of the normal healing process and therefore activities that might disturb the clot should be avoided. Here's how to protect it:
1. Do not smoke, rinse your mouth vigorously or drink through a straw for 24 hours. These activities create suction in the mouth, which could dislodge the clot and delay healing.
2. Do not clean the teeth next to the healing tooth socket for the rest of the day. You should, however, brush and floss your other teeth thoroughly and gently rinse your mouth afterwards.
3. Limit strenuous activity for 24 hours after the extraction. This will reduce bleeding and help the blood clot to form. Get plenty of rest.
4.If you have sutures, your dentist will instruct you when to return to have them removed.
Your dentist may prescribe medication to control pain and prevent infection. Use it only as directed. If the medication prescribed does not seem to work for you, do not increase the dosage. Please call your dentist immediately if you have prolonged or severe pain, swelling, bleeding, or fever.
Swelling Pain
After a tooth is removed, you may have some discomfort and notice some swelling. You can help reduce swelling and pain by applying cold compresses to the face. An ice bag or cold, moist cloth can be used periodically. Ice should be used only for the first day. Apply heat the following day if needed. Be sure to follow your doctor's instructions.
Diet
After the extraction, drink lots of liquids and eat soft, nutritious foods. Avoid alcoholic beverages and hot liquids. Begin eating solid foods the next day or as soon as you can chew comfortably. For about two days, try to chew food on the side opposite the extraction site. If you are troubled by nausea and vomiting call your dentist for advice.
Rinsing
The day after the extraction, gently rinse your mouth with warm salt water (teaspoon of salt in an 8 oz. glass of warm water). Rinsing after meals is important to keep food particles away from the extraction site. Do not rinse vigorously!
