Before any oral surgical procedure you should:
- Eat a light and easily digestible meal the night before your appointment
- If you are going to be sedated, DO NOT eat or drink anything on the day of your appointment
- Wear short sleeves and loose-fitting clothing
- Arrange for a relative or friend to stay in the office with you and be ready to drive you home
- You may NOT drive a car on the day of the surgery if you are to be sedated!
Bone grafting is commonly performed by an oral and maxillofacial surgeon to replace or augment bone in areas of tooth loss. Bone grafting to the jaws and facial structures may be necessary in a wide variety of scenarios. The most common bone grafts are facial skeleton and jaw procedures. Other common procedures include tooth extraction site graft, bone graft reconstruction and for a sinus lift. Shrinkage of bone often occurs when a tooth is lost due to trauma, severe caries, or periodontal disease. Additionally, bone loss may have already occurred due to infection or pathology around a tooth. There are many artificial biocompatible bone substitutes available; however, 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. Most bone grafts use a person's own bone, possibly in combination with other materials.
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 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 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.
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 after wards. 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 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:
- Infection to the gums
- A crowded tooth displacing neighboring teeth
- A decayed wisdom tooth
- Poorly positioned wisdom tooth
- A cyst that destroys bone
Wisdom Tooth Removal
Wisdom teeth also known as third molars are the last teeth to erupt into the mouth. Wisdom teeth typically appear around a person's mid-twenties but can erupt much later. If the wisdom tooth doesn't have enough space symptoms can occur. The wisdom teeth may only partially erupt or might not come through at all. Dentists designate wisdom teeth 'impacted' if they are wholly or partly blocked from eruption into the mouth. The tooth may lie at an angle and remain tipped against an adjacent tooth. Impacted wisdom teeth can cause problems like pain and swelling; The mouth could ache when stretched open wide or it may be difficult to open your mouth. Tenderness when chewing and biting may occur. Earaches may develop from the spread of pain in the mouth. Symptoms may be intermittent but can begin anytime without warning. If you are experiencing symptoms, it is best to get treatment 'usually removal' as soon as you can to avoid potentially expensive and painful complications.
When the extraction of a tooth is required:
- An incision in the gums is made
- The tooth is removed
- 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
- DO NOT RINSE MOUTH TODAY
Tomorrow rinse mouth gently every 3 to 4 hours (especially after meals) using one quarter teaspoon of salt to a glass of warm water. Continue rinses for several days.
Following extractions, some bleeding is to be expected. If persistent bleeding occurs, place gauze pads over bleeding area and bite down firmly for one-half hour. Repeat if necessary.
Ice bag or chopped ice wrapped in a towel should be applied to the operated area; one-half hour on, and one-half hour off for 4-5 hours.
For mild to average pain, use any non-aspirin type of medication you like. If the doctor prescribes a specific pain medication, follow the instructions and do not mix with other medications unless approved by your doctor.
Light diet is advisable during the first 24 hours.
- BONY EDGES
Small sharp bone fragments may work up through the gums during healing. These are not roots; if annoying, return to our office for their simple removal.
- If any unusual symptoms occur, call the office at once.
- The proper care following oral surgical procedures will hasten recovery and prevent complications.
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. You should therefore avoid activities that might disturb the clot.
Here's how to protect it:
- Do not smoke, rinse your mouth vigorously or drink through a straw for 24 hours.
- 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. Gently rinse your mouth afterwards.
- Limit strenuous activity for 24 hours after the extraction. This will reduce bleeding and help the blood clot to form. Get plenty of rest.
- 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 tomorrow if needed. Be sure to follow your doctor's instructions.
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.
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!
Post-Surgery Instructions for Children
Anesthesia - The feeling of numbness will begin to wear off in 30 minutes to 4 hours. Until that time, avoid all hot foods or liquids, and do not chew. This is to prevent accidentally burning or biting the lips, cheeks, inside of your mouth or tongue until the feeling has returned
Gauze Pack - Fold the gauze into a small pack and place over the extraction site and apply firm pressure for one to two hours. Change the gauze pack every 15-30 minutes.
Bleeding - It is normal for the extraction site to bleed slightly or ooze blood for 12 to 24 hours following surgery.
Ice Pack - For the first 2 to 8 hours after surgery, ice packs should be applied to the outside of the face over the area of the extraction site. The ice pack should be held in place for 15 minutes on, and then removed for 15 minutes. Doing this throughout the day will help reduce discomfort and swelling.
Medications - DO NOT TAKE ASPIRIN PRODUCTS due to the possible increase in bleeding potential. If prescription medications were prescribed please follow label instructions carefully. For most extractions, a non-aspirin over the counter pain medication will provide good pain relief. Do not take more than the recommended dosage!
Diet - A liquid or soft diet should be adhered to for the first 12 to 24 hours after surgery. It is important to drink plenty of liquids for the first day or two. Avoid the use of a straw as it may dislodge the blood clot that is forming in the extraction site.
Oral Hygiene - Clean the rest of your mouth as usual, however avoid bumping or brushing the extraction site. DO NOT RINSE OR SWISH YOUR MOUTH for the first 24 hours following surgery.
Dry Socket - This is sometimes a problem after surgery. The symptoms associated with dry socket are constant moderate to severe pain, bad taste, putrid odor, and poor clot formation at the surgical site. If you think you have ANY of these symptoms call our office as soon as possible.
Fever - Monitor your temperature for the first 24 to 48 hours. Any elevated temperature should be reported to our office.
Swelling - Some swelling during the first 24 to 48 hours can be expected.