Oral Surgery Q & A
Everyone’s teeth cannot support dental implants due to lack of healthy natural bone. Naturally insufficient bone can be caused by:
- Gum disease
- Tooth development defects
- Wearing dentures long term
- An injury to the face or trauma
- Spaces left empty in the mouth after teeth are removed
- Dental procedures where efforts were not made to restore natural bone
There are various techniques to rebuild bone, restore smile and natural jawline and create a strong foundation for implant –supported teeth. After undergoing these procedures, majority of patients are able to continue with everyday life and work often by the next day. Consult a dental implant expert if you need bone augmentation.
Some of the common techniques for bone augmentation are as follows:
Bone grafts is the process of building up or adding to the bone of the jaw with the use of one’s natural bone from another location or through use of donor, processed or synthetic bone material. Majority of the time, the new bone to be used can be found inside your mouth. Bone grafting is a safe as well as highly successful procedure. Make an informed decision by asking your dentist about the advantages of different bone grafting methods and materials.
Bone grafts are usually performed with local anesthesia in order to numb the area involved, and sometimes may use intravenous sedation to remove anxiety.
Patients will be provided with antibiotics and, pain medication if needed and an antibacterial mouthwash along with instructions to avoid eating certain foods and putting pressure on the bone graft. The patient will be able to return home in between the appointments when the bone graft heals and should be able to work and go about their daily lives.
Implants will be placed after the grafted bone has fused with the existing bone and become a strong integrated part of it. The time taken for integration depends on the location of the graft as well as the density of the bone, ranging from three or more months.
Sinus Lift (Sinus Augmentation or Sinus Elevation).
The back teeth in the upper jaw, which are among the most difficult to restore, if they are missing cause the sinus cavity to become larger as natural bone deteriorates over time. Sinus augmentation, sinus lift or sinus elevation is the procedure of bone-augmentation for patients with insufficient natural bone in this area for dental implant placement. This involved adding bone below sinus for placement of one or more implants. This procedure does not affect speech, intonation or cause sinus problems.
Dental implants can be placed after the bone has been given time to develop which is usually around four to twelve months. Sinus augmentation ensure long lasting implants with sufficient strong and sturdy bone allowing new teeth to fit and function like health, natural teeth with only minimal discomfort.
Ridge Expansion (Ridge Modification).
In the case of the jaw not being wide enough to support dental implants, bone grafting material can be used to add small ridge or space created along the top of the jaw. Implants are placed right after a ridge expansion in some cases, while some cases require four to twelve month wait period to ensure that ridge has fully healed. This procedure helps to create a strong foundation and long lifespan for your new teeth, but can also be used to correct a difficult to clean and unattractive indentation occurring in the jawline near missing teeth.
The potentially serious sleep disorder where breathing repeatedly stops and starts is called sleep apnea. You might suffer from sleep apnea if you feel tired even after a full night’s sleep or if you snore loudly.
The main types of sleep apnea are:
- Obstructive sleep apnea, the more common form that occurs when throat muscles relax.
- Central sleep apnea, which occurs when your brain doesn’t send proper signals to the muscles that control breathing.
- Complex sleep apnea syndrome, also known as treatment-emergent central sleep apnea, occurs when someone has both obstructive sleep apnea and central sleep apnea.
Visit your doctor if you think you might have any form of sleep apnea as the treatment can ease symptoms and also prevent heart problems and other complications.
Wisdom Tooth Extraction
During the procedure
Your dentist or oral surgeon may use one of three types of anesthesia, depending on the expected complexity of the wisdom tooth extraction and your comfort level. Options include:
- Local anesthesia: Local anesthesia can be administered through one or more injection near extraction site by your dentist or oral surgeon. A substance is applied to your gums to numb them before receiving injection. You will be awake during the extraction and feel some pressure and movement, but should not experience pain.
- Sedation anesthesia: Sedation anesthesia can be given by the dentist or oral surgeon through intravenous (IV) line in your arm. Under sedation anesthesia your consciousness is suppressed and no pain is felt, however you will have limited memory of the procedure. Local anesthesia to numb the gums is also provided.
- General anesthesia: General anesthesia may be offered under special circumstances. Medication can be inhaled through nose, IV line in your arm or both. Consciousness is then lost, and the surgical team closely monitors medication, breathing, temperature, fluids and blood pressure. No pain will be experienced along with no memory of the procedure. In order to help with postoperative discomfort, local anesthesia may also be given.
During wisdom tooth extraction, your dentist or oral surgeon:
- Makes an incision in the gum tissue to expose the tooth and bone
- Removes bone that blocks access to the tooth root
- Divides the tooth into sections if it’s easier to remove in pieces
- Removes the tooth
- Cleans the site of the removed tooth of any debris from the tooth or bone
- Stitches the wound closed to promote healing, though this isn’t always necessary
- Places gauze over the extraction site to control bleeding and to help a blood clot form
After the procedure
If sedation anesthesia or general anesthesia is administered, you are taken to a recovery room after the procedure, whereas if only local anesthesia is administered, only brief recovery time is required in dental chair.
Healing from surgery, follow dentist’s advice for recovery such as:
Bleeding. While some blood oozing may occur the first day after wisdom teeth removal, avoid excessive spitting so that blood clot from the socket is not dislodged and replace gauze over extraction site as directed by dentist or oral surgeon.
Pain management. Pain can be managed through over-the-counter pain relievers such as acetaminophen (Tylenol, others) or through pain medicine prescribed from you dentist or oral surgeon. Prescribed pain medication are helpful especially in the case of bone removal during procedure. A cold pack held against your jaw can also relieve pain.
Swelling and bruising. Any swelling of cheeks is improved usually in two to three days, while bruising may take several more day. Use an ice pack as directed by your dentist to control swelling and bruising.
Activity. Rest needs to be taken for the rest of the day after the surgery. Normal activities can be resume the next day, however strenuous activity resulting in losing blood clot from socket should be avoided for at least a week.
Beverages. Drink lots of water after the surgery. Alcoholic, caffeinated, carbonated and hot beverages should be avoided in the first twenty four hours, and drinking with a straw should be avoided for at least a week as the sucking action can cause the blood clot to be dislodged from socket.
Food. Eat only soft foods, such as yogurt or applesauce, for the first twenty four hours. Start eating semisoft foods when you can tolerate them. Avoid hard, chewy, hot or spicy foods that might get stuck in the socket or irritate the wound.
Cleaning your mouth. Don’t brush your teeth, rinse your mouth, spit or use mouthwash during the first 24 hours after surgery. Typically you’ll be told to resume brushing your teeth after the first 24 hours. Be particularly gentle near the surgical wound when brushing and gently rinse your mouth with warm salt water every two hours and after meals for a week.
Tobacco use. If you smoke, don’t do so for at least 72 hours after surgery — and wait longer than that if possible. If you chew tobacco, don’t use it for at least a week. Using tobacco products after oral surgery can delay healing and increase the risk of complications.
Stitches. You may have stitches that dissolve within a few weeks or no stitches at all. If your stitches need to be removed, schedule an appointment to have them taken out.