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Extractions

Here at McMillan Dentistry our dentists are well trained in tooth extractions. Common indications for extractions include: unrestorable teeth, infected teeth, fractures or cracked teeth, orthodontic treatment, and impacted teeth. Our dentists work hard to make sure the extraction is as comfortable as possible. We will keep you informed durning every step of the process.

 

Often young adults between the ages of 17-25 will require extraction of wisdom teeth. They grow in the back of the mouth, and often become impacted, meaning there is not adequate room in the rear of the mouth to function properly. Symptoms of impacted wisdom teeth can include pain, swelling and infection. The process for removal of wisdom teeth include a consult with a panoramic radiograph and discussion regarding sedation options. The patient is booked back at a later date for the extraction(s).

 

After the extraction, it is very important that your wounds begin to clot and heal. To allow the wounds to heal, you must be very careful around the affected area. Try not to rinse vigorously, smoke, consume alcohol or use a drinking straw. Make certain that you take your pain medication as directed and drink plenty of fluids.

 

Do not wait until you experience pain-contact us for an assessment.

  • Q:  Are there any complications or risks?

    Any operation caries some degree of risk. The most commonly encountered complications are discussed below.

     

    Excessive Bleeding and/or bruising

    Post-operative bleeding is uncommon and usually is encountered when the patient has not placed the gauze pack DIRECTLY over the surgical site. Pressure over the site for 45-60 minutes will control most post-operative bleeding. If you are still concerned call the office.

     

    Infections

    Infections after the removal of teeth are not common. The most common infection is under the gum tissue that was pushed back in order to get at the tooth. This is called “subperiostaeal abscess”. If after the first three days of healing, redness, increased swelling, pain, foul-tasting discharge into the mouth, fever, chills, and enlarged glands exist, these are all signs of infection. If these appear, call the office. This is usually treated with antibiotics. Occasionally a hole in the gum tissue must be made to allow the infection to drain. In some circumstances the infection tends to recur, and if this is the case the dentist may have to clean the area.

    Upper molars lie against the sinus. Occasionally the thin bony wall of the sinus cracks and fluid seeps into the sinus resulting in an infection (sinusitis). This is extremely rare and is usually treated with antibiotics. Occasionally a communication between the sinus and the mouth may be formed. This is rare, but if the communication does not close liquids in your mouth can go up into the sinus, then out the nose, and there can be recurrence of sinusitis. The closure of this hole would require additional surgery during which the gum tissue is stretched across the opening in order to close it.

     

    Nerve Damage

    The roots of the lower teeth very often rest on and around the main nerve of the lower jaw which provides feeling to the lower lip and chin. Very rarely, during removal of molars this nerve is bruised or cut. The result will be numbness of the lower lip, chin, gum tissue, tongue and teeth on the involved side. This effect does not last longer than a few weeks, in most cases. It improves as the nerve repairs and regenerates itself. Occasionally the numbness may last as long as several months. Also in the region of the lower molars is the nerve which supplies sensation to the side of the tongue. It may also be damaged with a resultant numb tongue. This problem usually resolves within several weeks or months. The incidence of permanent numbness of both these nerves is less than 1.0%. In some situations a nerve may be hurt and in the process of healing more of the feeling comes back but it is an uncomfortable or painful feeling, present all the time or only if you stimulate the area. This is called a neurapraxic response. Fortunately it occurs so rarely that the incidence is not known.

     

    Damage to adjacent teeth, fillings or crowns

    Occasionally large fillings in, or a crown of, an adjacent tooth may be loosened, cracked or dislodged during the removal of the teeth, in spite of diligent care and skill used.

     

    Fractured Roots

    On removing any tooth, a portion of its root may fracture off. If this occurs, a decision by the dentist will be made as whether it will be necessary to remove it. In some circumstances it may be prudent to leave it. The body will usually heal over it and it seldom causes a problem.

     

    Others

    Another very rare complication is a cracked or fractured lower jaw.

  • Post-operative instructions

    You can expect some discomfort/bleeding/bruising/swelling/stiffness of your jaw/sensitivity of adjacent teeth and numbness for a period of time after having a tooth removed.

     

    DISCOMFORT

    You should take pain medication as prescribed. If you experience stomach upset, as can happen with pain medication, you can try taking Gravol (can get at pharmacy without prescription) or drink flat ginger ale. If the discomfort persists, please call to obtain advice.

     

    BLEEDING

    A small amount of bleeding is normal. Most of the bleeding should be stopped by the time you leave the building. Often however the clot can be washed away and this will cause minor bleeding the day of surgery. This should be minimal but looks like a lot as it becomes mixed with your saliva. If you are concerned about the amount of bleeding which is occurring then:

     

    Bite on a piece of gauze, a clean rolled up cloth moistened with lukewarm water or used moist tea bags

    Place the provided gauze, cloth or tea bags over the wound and keep your mouth firmly closed for 20-30 minutes, the bleeding should stop. If bleeding continues, and appears to be a lot then you should call to obtain advice.

     

    This kind of bleeding can be avoided:

    • Do not rinse for 24 hours after the extraction
    • Do not spit
    • Do not drink fluids through a straw
    • Avoid smoking and alcohol in any form

     

    SWELLING

    This may occur after the removal of a tooth and is common if the operation has been difficult and most commonly if the gum tissue has been pushed back in order to remove the tooth. The swelling is often accompanied by stiffness of the jaws and you may be unable to open normally. The swelling is at its maximum at about the second or third day and then slowly goes down. If you have access to ice, the swelling may be lessened by placing ice in a plastic bag on the face and applying it for 20 minutes. Remove the ice pack for 20 minutes and repeat for up to 6 hours, after which the ice packs will have no effect. If ice is not available, a bag of frozen vegetables is equally effective.

     

    DIET

    Eating may be difficult during the first week following the procedure and eating of hard food will only injure the area. You should keep to a soft diet until you can eat comfortably (liquids and soft foods are initially advised). It is important that you drink at least 8 cups of fluid a day. Drinking should begin on the same day as your surgery. Drink soups such as chicken or beef broth, water, fruit and vegetable juices, and powdered food supplements such as Ensure or Instant Breakfast. Drink as much as you are able. Small amounts should be taken frequently. A vitamin supplement may be taken. Harder foods should be added to the diet as soon as they can be comfortably managed. Avoid hot drinks until local anaesthesia is worn off.

     

    ACTIVITY

    Too much physical activity may cause you pain and also may cause the socket to bleed. Normal activity can usually be resumed the following day. If you intend to play sports, you should consult with your surgeon. On the day of operation, when you return home, we advise that you relax quietly in a chair.

     

    ORAL HYGIENE

    After surgery, it is important to keep your teeth as clean as possible. Initially, this may be more difficult as you may not be able to use your toothbrush in the area where your tooth was removed. You should avoid rinsing your mouth until the following day. Then you may rinse gently with a glass of warm water with salt (1/2 teaspoon salt in a glass of warm water), or 1 teaspoon of baking soda in warm water. You should, however, use a toothbrush and tooth paste to clean the teeth that are not near the operative site.

     

    LIMITED MOUTH OPENING (stiffness of your jaw)

    This normal protective mechanism is due to the accumulation of fluid in the jaw muscles to help healing. Opening will usually return to normal within 2 weeks.

     

    TEMPERATURE ELEVATION

    A temperature increase to 102 degrees Fahrenheit or 39 degrees Celsius is normal after surgery. If your temperature goes higher than this, please call the office.

     

    STITCHES

    Dissolving stitches are used to control bleeding and hold the tissues in the proper place in the area of the surgery. These stitches come out on their own anywhere from 3 days to one week. If dissolving stitches are not used, the patient must return to the office for suture removal within 7-10 days.

     

  • Post-Operative Instructions For Sinus Exposure

    An opening into the sinus occasionally occurs after extraction of an upper tooth. The following instructions help speed the healing of this opening.

    For the next 10 days:

     

    • No nose blowing
    • If you must sneeze, prevent backpressure into the nose and sinus by keeping your mouth open and allowing air to come out of the mouth and nose.
    • When drinking, a small amount of fluid coming out of the nose is expected.
    • Avoid smoking for as long as possible.
    • Do not use a straw when drinking. This will cause back pressure in the sinus passages.
    • It is not unusual for a nosebleed to occur. If this happens, tilt your head back and apply ice to the bridge of the nose for 15 minutes.
    • Maintain antibiotic and decongestant therapy as directed.
  • General Information for the Patient Having their Wisdom Teeth Removed

    WHAT IS AN IMPACTED TOOTH?

    An impacted tooth is one which has been prevented from erupting into the mouth. The tooth may be blocked by another tooth, dense bone or a pathological condition. Any tooth can be impacted, but more often than not, impacted teeth are third molars or “wisdom teeth”. Some people have enough room in the back of their mouth for their wisdom teeth which can function for a lifetime. However, many people do not have enough room and their wisdom teeth become crowded and fail to come through the gum tissue properly.

     

    WHAT HARM CAN IMPACTED TEETH DO?

    Impacted teeth may grow in any direction; however they often grow forward and push against the adjacent second molar. This can result in pain in the second molars and possibly damage its roots or crown. The second molar can also be pushed out of its position.

    All teeth develop in a sac deep in the bone. If the tooth erupts normally, the sac generally disappears. If the tooth is impacted, the sac can fill with fluid and enlarge to form a cyst. The cyst can cause destruction of surrounding bone and damage to other teeth in the area.

    Whenever saliva reaches the tooth, decay may occur, and since such cavities cannot be filled, severe pain may result. This may be followed by the formation of an abscess.

    Bacteria in the saliva may cause an infection around the crown of the wisdom tooth and under the flap of gum tissue which may be covering part of the tooth. The infection may spread to the cheek, throat or neck and result in severe pain, stiffness of the jaw, fever and severe generalized illness.

    Pressure from wisdom teeth may contribute to crowding of the front teeth. This is why some orthodontists do not consider orthodontic treatment complete until third molars have been removed.

     

    WHEN IS THE BEST TIME TO HAVE WISDOM TEETH REMOVED?

    Usually it is possible to determine if wisdom teeth will be impacted by the teen years. At this stage roots are not fully formed and often bone is less dense. As a result, wisdom teeth are less complicated to remove, the healing is generally faster and fewer complications arise during this time period.

     

    WHAT IS IT LIKE TO HAVE AN IMPACTED TOOTH REMOVED?

    The impacted tooth is usually completely beneath the surface of the gum and often encased in bone. Local freezing will be used in conjunction with sedation or general anaesthesia. Depending on the degree of difficulty of the case, the procedure can last from 15 minutes to 60 minutes. If sedation or general anaesthesia is used there will be a recovery period from 30 to 90 minutes.

     

    WHAT SHOULD I EXPECT AFTER SURGERY?

    Swelling, increasing up to 36-48 hours after surgery and then slowly dissipating.

    Bleeding – majority stopped by the time you leave the office, but may have blood oozing from the site throughout the day of surgery. Bleeding may occur after this and is associated with brushing of your teeth. This is nothing to be alarmed about.

    Bruising – can occur in the corner of lower lip and chin and may extend into neck and chest.

    Stiffness of the jaw – one should start to exercise the jaw on the 2nd or 3rd post-operative day to allow the jaw to return to its normal function.

    Sensitivity – of teeth in front of the wisdom teeth and may last up to a week.

    Numbness- it is not unusual for a patient to experience numbness of their lower lip and chin and /or the tongue on one or both sides, when lower wisdom teeth are removed. This occurs from pressure being placed on the nerve either from swelling or the manipulation of the tooth, it most often temporary, lasting a few days/weeks/months.

    Difficulty eating – for first 24 hours food and beverages should be warm or cool not HOT. Soft food is recommended. Fluid intake should be approximately 2 L or 8 juice glasses per day for the average adult.

     

    ARE THERE ANY COMPLICATIONS OR RISKS?

    Any operation carries some degree of risk. The most commonly encountered complications are discussed below.

     

    Excessive Bleeding and/or bruising

    Post-operative bleeding is uncommon and usually is encountered when the patient has not placed the gauze pack DIRECTLY over the surgical site. Pressure over the site for 45-60 minutes will control most post-operative bleeding. If you are still concerned call the office.

     

    Dry Socket

    A condition known as “dry socket” occurs in approximately 5-10% of patients. It is more common in smokers and in female patients taking oral contraceptives. It is manifested by a dull throbbing pain which starts within 3-5 days after the operation and is accompanied by a bad taste and odour in the mouth. The treatment is simple and consists of cleaning and packing the area with medication that will relieve the pain. Healing is slightly slower than normal and a depression or hole may exist, where things will get caught. If this occurs you will be given a special irrigating syringe to use on a daily basis to keep this area clean until the hole fills in.

     

    Infections

    Infections after the removal of wisdom teeth are not common. The most common one is under the gum tissue that was pushed back in order to get at the tooth. This is called “subperiostaeal abscess”, and occurs in 1.5-3% of patients. If after the first three days of healing, redness, increased swelling, pain, foul-tasting discharge into the mouth, fever, chills, and enlarged glands exist, these are all signs of infection. If these appear, call the office. This is usually treated with antibiotics. Occasionally a hole in the gum tissue must be made to allow the infection to drain. In some circumstances the infection tends to recur, and if this is the case the surgeon may have to clean the area. Upper impacted third molars lie against this structure. Occasionally the thin bony wall of the sinus cracks and fluid seeps into the sinus resulting in an infection (sinusitis). This is extremely rare and is usually treated with antibiotics. Occasionally a communication between the sinus and the mouth may be formed. This is rare, but if the communication does not close liquids in your mouth can go up into the sinus, then out the nose, and there can be recurrence of sinusitis. The closure of this hole would require additional surgery during which the gum tissue is stretched across the opening in order to close it.

     

    Nerve Damage

    The roots of the lower impacted teeth very often rest on and around the main nerve of the lower jaw which provides feeling to the lower lip and chin. Very rarely, during removal of third molars this nerve is bruised or cut. The result will be numbness of the lower lip, chin, gum tissue, tongue and teeth on the involved side. This effect does not last longer than a few weeks, in most cases. It improves as the nerve repairs and regenerates itself. Occasionally the numbness may last as long as several months. Also in the region of the lower third molar is the nerve which supplies sensation to the side of the tongue. It may also be damaged with a resultant numb tongue. This problem usually resolves within several weeks or months. The incidence of permanent numbness of both these nerves is in the order of 0.5-1.0%. In some situations a nerve may be hurt and in the process of healing more of the feeling comes back but it is an uncomfortable or painful feeling, there all the time or only if you stimulate the area. This is called a neurapraxic response. Fortunately it occurs so rarely that the incidence is not known.

     

    Damage to adjacent teeth, fillings or crowns

    Occasionally large fillings in, or a crown of, an adjacent tooth may be loosened, cracked or dislodged during the removal of the wisdom teeth, in spite of diligent care and skill used.

     

    Fractured Roots

    On removing any tooth, a portion of its root may fracture off. If this occurs, a decision by the dentist will be made as whether it will be necessary to remove it. It some circumstances it may be prudent to leave it. The body will usually heal over it and it seldom causes a problem.

     

    Others

    Another very rare complication is a cracked or fractured lower jaw.

Connect With Us

35 Colter Ct.

Fredericton, NB

 

(506) 454-6593

 

jmcmillandentalclinic@hotmail.com

Clinic Hours

Monday  8:00am - 7:00pm

Tuesday-Friday  8:00am - 4:30pm

Saturday by appointment only.

 

 

 

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