There are many mouth conditions that may require oral surgery. Gum disease is a harmful infection that can loosen teeth or cause serious damage to the supporting tissues. It is necessary to surgically remove a tooth when decay or an abscess is so severe that no other course of action will cure the infection. Advanced stage gum disease is the leading cause of tooth loss in adults. Your dentist or an oral surgeon can remove an infected tooth.
When wisdom teeth fail to erupt in proper alignment or if they don’t emerge completely through the gum line these third molars become impacted between the jawbone and the gum. If this problem occurs, surgical intervention is needed. If left untreated, impacted teeth can cause an infection of the surrounding gum tissue. This can lead to permanent damage to teeth, gums, and bone. In addition, cysts or tumors can form and destroy parts of the jaw.
Tooth removal surgery is typically performed under local anesthesia. General anesthesia may be used for other types of oral surgery, or if multiple or all teeth will be extracted. Stitches or sutures may be used to close an incision or after tooth removal.
Other reasons for oral surgery include:
- Improve jaw-related problems
- Repair facial injury
- Remove lesions and biopsy
- Repair cleft lip and cleft palate
- Treat facial infections
- Sleep apnea or snoring correction
After Extraction Care
The recovery period after tooth extraction usually lasts only a few days. The following steps will help manage pain and ensure a speedy recovery:
- Use pain medication as prescribed by your oral surgeon or dentist. To aid discomfort, swelling, and pain, apply an ice pack to your cheek for 10-20 minute intervals. Please a thin face cloth between the cold compress and your skin.
- After the initial 24 hours, has passed, begin rinsing your mouth gently with warm water and salt. This will ease pain and help to reduce any swelling. Do not rinse aggressively, this can release the blood clot and hinder healing.
- Replace gauze with refresh pads before they become saturated with blood and pus
- Relax and refrain from physical activity after oral surgery to avoid bleeding
- Do not smoke
- Stick will soft foods like thin soup, gelatin or pudding. Reintroduce solid foods gradually, as your healing progresses.
- Sleep with your head propped up. Lying down flat can prolong the bleeding.
- Avoid rubbing your tongue over the affected area
- Do not use a straw or make any sucking movements
- Gently brush your teeth and tongue
Stitches or sutures are often used to close an open area after oral surgery. Some stitches will dissolve over a short period, others will need to be removed. Your dentist or oral surgeon will inform you of which type of suture was used during surgery.
It is standard practice for medical providers to supply their patients with postoperative guidelines. If a problem develops or persists, contact your physician immediately.
Most patients experience some degree of pain or discomfort after the anesthesia wears off. It can be helpful to take a pain reliever, after eating, before the numbness subsides. Do not exceed the recommended maximum daily dosage and don’t mix different pain medications. To avoid nausea or vomiting, it Is important to take Ibuprofen or aspirin with food in your stomach.
Do not irritate the surgery location. The initial healing stages progress well when raw tissues are placed at rest. Avoid disturbing the area with excessive spitting, rinsing or vigorous chewing. These actions can lead to delayed healing, prolonged bleeding or infection.
Oozing and minor bleeding is normal and may continue for up to two days. Gauze is placed immediately after surgery. Biting on the gauze for the first hour creates enough pressure to start to control bleeding. If the seeping persists, pressure will continue for up to an hour. Stubborn bleeding can be managing by biting a moistened gauze-wrapped tea bag. Specific ingredients in tea help encourage clotting. Uncontrollable bleeding or oozing requires medical attention.
Additional points to remember:
- Limit or avoid excessive physical activity for the first 1-2 days following oral surgery.
- Minimize swelling by applying an ice pack to the affected side of your face.
- Increase your fluid intake
- Do not use a straw to drink
- Eat soft foods at a cool temperature
- Take antibiotics and pain medications as directed
- Do not smoke, drink alcohol or operate a vehicle for 24 hours after surgery
Periodontal Bone Graft
Dentists often refer patients who suffer from advanced periodontal disease (periodontitis) to a specialist (periodontist) who may suggest a periodontal bone graft. This procedure can help replace bone destroyed by periodontitis.
Periodontitis breaks down the structures that hold teeth in place. Symptoms and signs of the disease include:
- Bad breath all the time
- Swollen or bleeding gums
- Loose teeth
- Sensitive teeth
- Mouth pain when chewing
If left untreated, periodontitis can lead to tooth loss. Bone grafting can repair the damage caused by advanced gum disease and improve the likelihood of saving the affected teeth.
A periodontal bone graft is performed by folding back the gum and disinfecting the bacteria-riddled area. The periodontist then inserts bone grafts that help the body generate new bone. Guided tissue regeneration may also be an option if the supporting bone has been destroyed by periodontitis.
After cleaning out the damaging oral bacteria beneath the gum, the physician inserts a piece of mesh between the bone and the gum. This acts as a shield, keeping the gum from expanding into the area intended for bone. This process helps the bone to grow back properly to preserve the teeth.
Bone grafting and tissue regeneration are just a couple of the innovative procedures periodontists use to treat severe gum disease. New advances are being discovered all the time to help fight the war against tooth loss.
Periodontal Bone Regeneration
Bone regeneration is used to correct periodontal defects, for ridge augmentation following a tooth extraction, and to prepare a patient with insufficient bone mass to support dental implants. Periodontal bone regeneration is a very valuable procedure that has produced great results for patients who lack efficient bone composition. The process makes use barrier membranes to promote new bone and tissue growth.
The procedure is performed with local anesthesia administered in the treatment area. The surgeon will then make an incision in the gum overlying the deteriorated bone. The open flap is lifted to expose the bone and grafting begins with bone grafts that have been extracted from other areas in the mouth, or from artificial sources. The grafted pieces are placed directly on the affected areas to act as a platform for which the new bone can develop. The graft will be cloaked with a thin membrane to hold it in place before the gum is repositioned and the site stitched or sutured shut.
Bone regeneration using synthetic grafts may take some time to complete. New bone will start to grow in the first few months, but it takes quite a while for the new tissues to thrive and fuse completely with the original bone. Grafts with the patient’s natural bone tend to take a shorter amount of time to regenerate and healing is believed to come faster.
Crown lengthening is performed to correct the appearance of teeth or fix a problem. Sometimes teeth appear to be too short. They may be the proper lengths but are covered with too much gum tissue. Not enough tooth is accessible to support a crown or a filling. This condition occurs when a tooth breaks at the gum line. It can also happen if decay is present beneath a tooth or if a filling or crown falls out. To replace a crown or filling, a dentist needs to bring more of the embedded tooth to the surface. This procedure involves removing a portion of bone or gum tissue.
Some people have excessive amounts of gum tissue surrounding their upper teeth. This is referred to as a “gummy smile.” This can also be corrected with crown lengthening.
During the crown lengthening procedure gum and bone tissue is contoured or reshaped to expose more of the tooth. This can be performed on one tooth or several.
Also, your periodontist or dentist may suggest crown lengthening to make it possible to do restorative work or a cosmetic procedure. If a patient has a badly decayed tooth, one the has broken below the gum or not enough tooth structure, functional crown lengthening is an effective solution.
Flap surgery may be used for patients with severe periodontitis that can’t be cured with scaling or root planing and won’t respond to antibiotics. This procedure involves cleaning the tooth root and repairing damage to the bone.
This plastic and reconstructive surgery technique require that any tissue that is lifted from a donor site and transferred to a recipient site must have an intact blood supply. This procedure is like a bone graft, which doesn’t require an intact blood supply, but relies on the regeneration of new blood vessels.
After applying a local anesthesia, the oral surgeon will pull back part of the gum to clean out the root and treat the damaged bone. The flap is then sewn back in place and blanketed with gauze to control bleeding.
The procedure may involve:
- Reshaping and smoothing out gaps so there are fewer areas for plaque to thrive
- Grafting with bone from other body parts or with synthetic material. A lining may be placed on the graft to encourage bone growth. Eventually, it may be removed.
Flap surgery is often necessary when diseased, damaged bone can no longer support teeth. By following aftercare instructions and practicing good oral hygiene post-surgery, flap surgery should allow patients to clean their teeth and gums more efficiently.
A frenectomy is a surgical removal or loosening of connecting muscle to the cheek, lip or base of the mouth. This procedure is usually performed under local anesthesia.
This procedure is typically used on patients with abnormally large frenums which prevent their tongues from moving freely (ankyloglossia or tongue tie). This condition can also interfere with speech. A lingual frenectomy involves removal of the tissue fold beneath the tongue. During childhood, there are several phases where symptoms of ankyloglossia are the most noticeable:
- In infancy, a large frenum may interfere with feeding
- By 12 to 18 months if a child is having difficulty forming words
- In older children and adolescents, they may find their frenum often gets caught between their teeth
- Some children can’t stick their tongues out as far as their peers
- A dentist may notice the fold is pulling the gum tissue out and away from the lower front teeth, causing a periodontal concern.
Sometimes a frenum is attached between the two top teeth in the front. A labial frenectomy will remove these upper folds. This type of abnormality usually occurs in children with erupted adult upper front teeth., but it may show up earlier. Sometimes the condition is present in infants,
Denture-wearing adults may require a frenectomy if the frenum makes it impossible for the appliance to fit properly.
Functional Crown Lengthening
There are times when extensive decay destroys a significant amount of tooth structure, leaving only a minimal foundation for a filling, bridge, or a crown. More exposed tooth may be needed to apply a new, lasting crown. Your dental provider may suggest functional crown lengthening for the following conditions:
- Severe tooth decay
- Tooth broke beneath the gum line
- Insufficient amount of tooth structure to support a crown or a bridge
More of the tooth is exposed after the gum and bone get surgically trimmed and reshaped. Once the desired look is achieved, sutures are put in place to secure the gum tissue in the set position and surgical dressing is applied. After about two weeks the sutures are removed and healing is evaluated.
Normal brushing and flossing can resume with a soft-bristled toothbrush, gently around the surgical site. Complete healing will take about 4 to 6 weeks’ post-surgery.
There are many reasons why gums are reshaped. Some patients have gums that did not recede after their permanent teeth erupted, others show a lot of gum when they smile. In some instances, the gums recede over time and eventually expose too much of the tooth surface.
To lengthen teeth that appear to be too small or to straighten an uneven gum line, a laser gum lift or gum reduction may be the solution. Sometimes gum grows over the surface of front teeth, covering the crowns and making teeth appear stubby. A gum lift will remove gum overgrowth to reveal the underlying teeth. This procedure also works well to correct uneven or jagged gum lines. Gum lifts are usually only performed on the front teeth as these are the most visible.
Gum reduction is done with either a soft or hard tissue laser. This allows for a fast, safe and precise gum surgery. Laser dentistry allows for minimal trauma to the gums eliminating the need for stitches or sutures. This means a faster healing time and no inconvenient downtime, like with traditional surgical methods. There is little to no pain or bleeding for most patients who have a gum lift.
Extraction is often performed after a trauma or severe decay has caused irreparable tooth damage. Additional reasons are loosened teeth due to periodontal disease, overcrowding of teeth, or to prepare for orthodontia where the goal is to properly align and straighten teeth. This can’t be achieved if the patient’s mouth doesn’t have room for the amount or size of the teeth. Also, if teeth can’t erupt due to a lack of mouth space, extraction may be recommended.
If extensive tooth damage or decay reaches the pulp, (tooth center which houses blood vessels and nerves), mouth bacteria can get inside and lead to infection. This condition can usually be repaired with root canal therapy. However, if the infection does not respond to antibiotics or root canal, tooth extraction is necessary to avoid the spread of infection.
Both oral surgeons and dentists remove teeth. Extraction is typically performed after a local anesthetic is injected into the treatment area. A stronger general anesthetic may be used if more than one tooth is getting pulled or if any are impacted. Removal of an impacted tooth requires cutting away of bone and gum tissue.
Wisdom Tooth Development
Wisdom teeth are the third molars, and the last set of teeth to form and erupt. These four back teeth emerge behind the second molars on the upper and lower jaws, on both sides. They appear anytime from mid-puberty through early adulthood. Wisdom teeth come in a wide variety of shapes, sizes, and formations. Most people develop four of these late teeth, but a small population doesn’t have them at all, others grow more. The extra molars are called supernumerary teeth A full-mouth x-ray can determine the presence or absence of wisdom teeth.
There are many potential problems that can arise due to the movement and position of these teeth. If there is enough room and no barriers in the way, wisdom teeth may erupt straight and well-aligned with surrounding teeth. But if there is a path blockage or if the jaw is too small, the tooth can become locked in place, or impacted. Bone, gums, teeth and other jaw tissues can block wisdom teeth.
Wisdom Tooth Positions
Under the best circumstances, wisdom teeth emerge through the gum line straight, just like any other tooth. However, in many cases, this last set of teeth becomes blocked and impacted beneath the gums or inside the jaw. In these situations, tooth extractions are needed.
Common types of impaction resulting in improper tooth alignment include angular, horizontal, vertical and soft tissue impaction. This condition prohibits wisdom teeth from pushing through the gums correctly. The more widely seen problematic positions are angular and mesioangular impaction, where the tooth is angled towards the front of the mouth, and distoangular impaction where the tooth angles towards the back.
Vertical impaction occurs when the tooth does not emerge fully through the gum line. Horizontal impaction is the least common problem position where the wisdom tooth is at a full 90-degree sideways angle that can grow into the root of the second molar. Soft tissue impaction takes place when the tooth lies stuck beneath the gum line.
Impacted wisdom teeth can cause a host of complications if left untreated. Symptoms may include the development of cysts, bacterial infection due to difficulty cleaning the affected area, pain, swelling, jaw stiffness and tooth decay.
Wisdom Tooth Problems
When blocked, misaligned wisdom teeth are not removed, problems may occur such as infection due to do the inability to clean the affected area properly, which can result in pain, swelling, and jaw discomfort. Decay in the tooth and gum can also be caused by impacted wisdom teeth. The misalignment makes it hard to clean teeth which can lead to infections and decay. In addition, a cyst can develop around impacted teeth.
Healthy wisdom teeth in the proper alignment are not likely to cause problems. If any of these conditions are present, problems are on the horizon:
- Partial eruption due to a lack of available space. This issue causes a tissue flap to develop over the teeth creating a pocket for food and bacteria to get trapped.
- Teeth grow in crooked or facing in the wrong direction
- The jaw is too small. There is insufficient room for the wisdom to emerge
- Wisdom teeth are too far back in the mouth or will cause overcrowding
- The formation of a cyst that can damage the tooth root or underlying bone
Wisdom Tooth Removal
A maxillofacial or oral surgeon or a dentist can extract an impacted wisdom tooth. The surgical procedure is usually performed in the office. If a patient is at a high risk for complications or if all four wisdom teeth are getting removed at once, the surgery may take place in a hospital.
Before the extraction, a local anesthetic is administered to numb the treatment area. The surgeon may use a sleep-inducing general anesthesia if more than one tooth will be extracted at once. Patients are usually instructed not to eat or drink after midnight prior to the surgery.
Wisdom tooth removal requires that the gum is opened over the impacted tooth and that all bone covering the tooth be removed. The surgeon will separate the tissue that connects the tooth to the bone, making it easier to extract the tooth. If necessary, the impacted wisdom tooth will be broken into smaller pieces.
Once the extraction is completed, stitches may be used to closed the area. Some varieties will dissolve over a period, others will need to be manually removed by a surgeon or dentist.