Oral surgery involves all minor surgical procedures to remove teeth that cannot be saved. These are usually carried out in the dental rooms under local anaesthetic, but we can provide conscious sedation for highly anxious patients. We also do removal of impacted wisdom teeth; we prefer to remove impacted teeth in hospital under general anaesthesia.
As with all other dental procedures, oral surgery treatment starts with a thorough dental examination. A patient’s medical history and current medication are extremely important in surgical cases, as surgery is invasive and can lead to severe complications if the patient suffers from a disease, or uses medication that we are not aware of.
This procedure starts with a good local anaesthetic to anaesthetise the affected tooth and the surrounding tissues. Our aim is to remove the tooth as calmly as possible and preserve the maximum amount of bone. Maintaining the integrity of the surrounding bone is essential if we are planning dental implant in the future. If the tooth fractures during the procedure, we will remove the remaining roots using surgical techniques that will be explained later.
Post-operative oral surgery instructions are very important after extractions:
• Bite on the cotton roll placed in the socket for 60 minutes
• Do not eat or drink anything for 2 hours after the procedure
• Try to chew on the other side of the mouth
• If you are a smoker, please do not smoke for 3 days after the extraction
• If bleeding occurs, take a wet tea bag, press out all the water, and bite on it for 60 minutes
• If the bleeding does not stop, please contact your dentist
• Please do not scratch in the socket
Surgical Removal of a Tooth or Residual Roots
In cases where the affected tooth cannot be removed by a conventional extraction, we need to make use of surgical techniques to remove the tooth or residual root rests. Residual rests are a source of infection and need to be removed as soon as possible to prevent complications. If left untreated, the roots will become infected and the infection can spread through the bone into the surrounding tissues, causing abscess formation and severe swelling. In some cases the infection can spread to the facial spaces in the mouth; in severe cases, this can lead to a very serious condition called Ludwig’s angina. In Ludwig’s angina, the infection spreads into the sublingual and submandibular spaces and from there into the neck. The pressure from the swelling can cause airway obstruction and this can be fatal for the patient.
Oral Surgery Procedure
Oral surgery starts with a proper local anaesthetic. The aim is to remove the roots, causing as little damage to the surrounding tissues as possible. We will raise a mucoperiosteal flap to improve access to the surgical site. If necessary, we will remove bone around the root with a surgical drill. The root is removed from the socket using an elevator, and once removed, the surgical site is closed with an absorbable suture material. We will provide you with a prescription for an antibiotic and an antiseptic mouth wash. Please follow the same instructions described under extractions.
Surgical Removal of Impacted Wisdom Teeth
Impacted wisdom teeth can cause serious complications for a patient if left untreated. These include headaches, earache and jaw pain. The common cause is a condition called pericoronitis, where the gum surrounding the impacted tooth becomes infected due to plaque and bacterial accumulation between the gum covering the tooth and the crown of the tooth. This presents with severe pain and discomfort.
The roots of the wisdom teeth of all children are evaluated at the age of 16 by taking a panoramic x-ray. Once the root has developed to at least two thirds of its final length, it can be removed. We advise that all wisdom teeth be removed by age 18; the younger the patient, the softer the bone surrounding the wisdom tooth. It is much easier to remove and these patients tend to have less swelling and discomfort post-operatively. We prefer to remove all wisdom teeth under general anaesthetic in hospital, but if a patient prefers taking them out in the dental chair, we are more than happy to do that.
The procedure starts by anaesthetising the area with a local anaesthetic. This helps with post-operative pain and bleeding during the procedure. We lift a mucoperiosteal flap to gain access to the impacted wisdom tooth, while a surgical drill is used to remove the buccal bone surrounding the tooth. If the tooth needs to be removed in sections, the drill is used to cut the crown and roots of the tooth. The pieces of tooth and root structure are removed using an elevator. Once removed, the mucoperiosteal flap can be closed using an absorbable suture material.
After the Procedure
Patients can expect post-operative pain, swelling and bruising. We advise these patients to stay at home and recover for at least 5 days after the procedure. We will prescribe antibiotics, analgesics like Myprodol or Mypaid, and an antiseptic mouth wash. Please follow a soft diet for the first seven days and place ice packs over the cheeks to help with swelling.
For more information about oral surgery, please get in touch.