Procedures & Patient Information

A natural tooth has a root and a crown, and an implant-supported replacement tooth has the same two parts. Both have a crown — the visible part you chew with — and both have a root anchored into the jaw beneath the gum. The difference is that the root is replaced by a small titanium post, the same time-tested material surgeons use for artificial joints.

Once the implant is placed, time is allowed for bone to heal and grow around it. The bone bonds with the titanium and creates a strong foundation for the replacement tooth. A support post (abutment) is then fitted to the implant and a new crown is placed on top of the abutment. In many cases a temporary replacement tooth can be attached immediately after the implant is placed. If all of your teeth are missing, a number of options are available to support a full set of replacement teeth.

A fully digital workflow

Implant treatment here is planned digitally from start to finish. An intraoral scanner replaces conventional impression material, planning software positions each implant before surgery, and a patient-specific surgical guide is printed so that the implant is placed in the position that was planned. We do not regard non-guided implant placement as the standard of care.

Implant treatment is a team effort between the oral and maxillofacial surgeon and your restorative dentist. We carry out the implant surgery, any initial extractions, and bone grafting where it is needed. Your dentist fits and makes the permanent prosthesis, along with any temporary one you need during the process.

• Overview of implant placement
• Replacing missing teeth
• Bone grafting for implants
• Implant-supported overdenture
• Missing all upper or lower teeth
• After implant placement
• Cost of dental implants

Third molars are commonly referred to as wisdom teeth. They are usually the last teeth to develop and are located at the back of the mouth, behind the second molars. Their development is normally complete between the middle teenage years and the early twenties.

Most people grow 32 permanent adult teeth, but many jaws are simply too small to accommodate all four wisdom teeth. When there is not enough space for them to erupt they are described as impacted, which means they cannot reach a position where they can be used for chewing or kept properly clean.

A consultation with a panoramic x-ray of the mouth and jaws will show whether your wisdom teeth are impacted, whether there is room for them to erupt, and how straightforward removal would be. Impactions are usually described in three broad types:

• Soft tissue impaction — there is not enough room for the gum tissue to retract far enough for the tooth to be cleaned adequately.
• Partial bony impaction — there is enough space for the tooth to erupt part of the way, but it cannot take a proper part in chewing and it is difficult to keep clean.
• Complete bony impaction — there is no space for the tooth to erupt and it remains embedded in the jaw bone. Removal calls for more complex surgical technique, particularly where the tooth sits in an unusual position.

• Impacted wisdom teeth
• Wisdom teeth removal
• After extraction of wisdom teeth

Missing teeth left in place over a period of time cause the jaw bone to atrophy, or resorb. This often leaves bone of poor quality and quantity — not enough to support a dental implant — and over the longer term it allows the remaining teeth to shift and changes the structure of the face. In that situation many patients are told they are not candidates for implants.

Fortunately, bone can now be grown where it is needed. That not only makes it possible to place implants of the proper length and width, it also restores function and facial appearance.

Minor and major bone grafting

Grafting can repair implant sites with inadequate bone caused by previous extractions, gum disease, or injury. The bone is either obtained from a tissue bank or taken from your own body. Sinus bone grafts are performed to replace bone in the back of the upper jaw. Special membranes that dissolve under the gum may also be used to protect the graft and encourage new bone to form — a technique known as guided bone regeneration, or guided tissue regeneration.

Major bone grafts are performed to repair larger defects of the jaws, which may follow traumatic injury, tumor surgery, or a congenital defect. Large defects are repaired using the patient's own bone, harvested from a donor site chosen according to the volume needed. Procedures on that scale are carried out in an operating room and involve a hospital stay.

• About bone grafting
• Jaw bone health
• Jaw bone loss and deterioration
• Khoury grafting
• Ridge augmentation
• Sinus lift
• Socket preservation

There are a number of reasons a tooth may need to come out. Some teeth are severely decayed; others have advanced periodontal disease, or have broken in a way that cannot be repaired. A tooth may also need removing because it is poorly positioned in the mouth — an impacted tooth, for example — or in preparation for orthodontic treatment.

Losing even a single tooth can affect your ability to chew, put strain on the jaw joint, and allow the neighboring teeth to shift, all of which has a real effect on your dental health. For that reason we will always discuss the alternatives to extraction with you, and how the tooth would be replaced afterwards, before anything is removed.

The extraction process

The tooth, jaw bone, and surrounding gum are numbed with a local anesthetic. During the extraction itself you will feel a good deal of pressure — this comes from firmly rocking the tooth to widen the socket so it can be removed. You feel the pressure without pain, because the anesthetic blocks the nerves that carry pain while the nerves that sense pressure are far less affected. If you do feel pain at any point, tell us straight away.

Sectioning a tooth

Some teeth need to be sectioned. This is a common step, used when a tooth is very firmly anchored in its socket, or the root is curved and the socket cannot expand enough to release it. The tooth is simply divided into sections and each section is removed one at a time.

Home care afterwards is set out under After Extractions in the Surgical Instructions section on this page.

An impacted tooth is simply one that is stuck and cannot erupt into function. Wisdom teeth are the most common example. After those, the maxillary cuspid — the upper eyetooth — is the tooth most likely to become impacted. The cuspid matters: these are strong biting teeth with the longest roots of any human tooth, and they are designed to be the first teeth to meet when the jaws close, guiding the rest of the teeth into the proper bite.

The upper cuspids are normally the last of the front teeth to arrive, usually around age 13, closing any remaining space between the upper front teeth as they come in. If a cuspid becomes impacted, every effort is made to bring it into its proper position rather than remove it. Around sixty percent of impacted eyeteeth sit on the palatal side of the dental arch; the rest are in the middle of the supporting bone, stuck above the roots of the adjacent teeth, or out towards the facial side of the arch. The same techniques can be applied to an impacted tooth anywhere in either jaw.

Early recognition is the key

The older the patient, the less likely it is that an impacted eyetooth will erupt on its own, even when there is space for it. A panoramic x-ray alongside a dental examination will show whether all the adult teeth are present. Treatment may involve removing over-retained baby teeth, selected adult teeth, or extra (supernumerary) teeth and growths that are blocking eruption.

• At 11 to 12 years old, with space opened for eruption, there is a good chance of success.
• At 13 to 14, the impacted eyetooth will not erupt by itself even once the space is cleared.
• Over 40, there is a much higher chance the tooth has fused in position, and the remaining option is to remove it and replace it with a crown on an implant or a fixed bridge.

Exposing and bracketing the tooth

Where an eyetooth will not erupt on its own, the orthodontist and the oral surgeon work together. The surgeon exposes the impacted tooth and bonds a bracket to it, and the orthodontist then guides it into place. Every case is assessed individually. The goal throughout is to erupt the tooth, not to extract it. Once it has reached its final position the gum around it is reviewed, and occasionally a small amount of gum surgery is needed.

Exposing and bracketing an impacted tooth is a straightforward procedure carried out in the office. For most patients it is done with nitrous oxide and local anesthesia; IV sedation is available if you would rather be asleep, though it is generally not necessary for this procedure. If the tooth only needs exposing, with no bracket, the appointment is roughly half as long. All of this is discussed in detail at your preoperative consultation.

Orthognathic surgery is needed when the upper and lower jaws do not meet correctly, or the teeth do not fit adequately within the jaw. Orthodontics straightens the teeth; corrective jaw surgery repositions a misaligned jaw. Together they improve facial appearance and, just as importantly, make sure the teeth meet correctly and function properly.

Who benefits from jaw surgery?

Jaw growth is a gradual process, and the upper and lower jaws sometimes grow at different rates. The result can affect chewing, speech, long-term oral health, and appearance. Injury to the jaw and congenital differences can also affect alignment. Where only the teeth are involved, orthodontics alone can correct the bite; where the jaws themselves need repositioning, surgery may be required. Difficulty in any of the following areas is worth having evaluated:

• Difficulty chewing, biting, or swallowing
• Speech problems
• Chronic jaw or TMJ pain
• Open bite
• Protruding jaw
• Breathing problems

Any of these can be present from birth, develop later through hereditary or environmental influences, or follow trauma to the face. Before treatment begins there is a full consultation and examination with x-rays, and the plan is talked through in detail so that you and your dental team make the decision to proceed together.

Planning with 3D imaging

Computer-aided planning and three-dimensional models are used to show you exactly how the surgery will be approached. Using comprehensive facial imaging, we can show how the bite will be improved and give you an idea of how you will look afterwards, which makes the extent of the proposed treatment much easier to understand. If you are a candidate, we work closely with your dentist and orthodontist throughout.

What to expect

• Corrective jaw surgery is a significant intervention that requires many months of preparation.
• The surgery is performed in hospital and takes between one and four hours.
• A hospital stay of one to three days is normal.
• Braces are kept on through surgery and may be removed six to twelve months afterwards.
• The recovery phase has the greatest impact. Patients are typically off work or school for two weeks to a month.
• Normal chewing function may take around two months to return, and full function up to a year.
• Weekly appointments are needed for up to two months after surgery.

An oral and maxillofacial surgeon is trained to repair facial injuries across the whole span of care — emergency treatment, acute management, and long-term reconstruction and rehabilitation. Injuries to the face carry a high degree of emotional as well as physical trauma, and treating them well requires an understanding of how the treatment given will influence a patient's function and appearance years later. The conditions treated include:

• Facial lacerations
• Intraoral lacerations
• Avulsed (knocked out) teeth
• Fractured facial bones — cheek, nose, or eye socket
• Fractured jaws, upper and lower

The nature of maxillofacial trauma

Facial trauma has many causes: motor vehicle accidents, falls, sports injuries, interpersonal violence, and work-related injuries. Injuries range from damage to a single tooth through to severe injury of the skin and bones of the face. They are usually classified as soft tissue injuries (skin and gums), bone injuries (fractures), or injuries to special regions such as the eyes, the facial nerves, or the salivary glands.

Soft tissue injuries

Lacerations of the face are repaired by suturing. Alongside the obvious concern of achieving the best possible cosmetic result, care is taken to inspect for and treat injury to underlying structures such as the facial nerves, the salivary glands, and the salivary ducts.

Bone injuries

Fractures of the facial bones are treated much as fractures elsewhere in the body, with the approach determined by the location and severity of the fracture and the age and general health of the patient. A cast cannot be applied to the face, so other means of stabilization are used. One option is wiring the jaws together for certain fractures of the upper or lower jaw. Other fractures are better treated by placing small plates and screws at the fracture site — a technique known as rigid fixation, which often allows healing without the jaws being wired together and has significantly shortened the recovery period.

Facial fractures should be treated thoroughly and predictably, with as little effect on facial appearance as possible. The facial bones are accessed through the fewest incisions necessary, and any incision that is needed is kept small and, wherever possible, placed so that the resulting scar is hidden.

Injuries to the teeth and surrounding structures

Isolated injuries to teeth are common and may involve several dental specialists. Oral surgeons are usually the ones treating fractures in the supporting bone, or replanting teeth that have been displaced or knocked out, stabilizing them by wiring or bonding the teeth together.

If a tooth is knocked out, place it in salt water or milk. The sooner it is re-inserted into the socket the better its chance of surviving, so see a dentist or oral surgeon as quickly as you can. Never wipe the tooth off — remnants of the ligament that holds the tooth in the jaw remain attached to the root and are vital to the success of replanting it. An endodontist may then be needed for root canal treatment, or a restorative dentist to repair or rebuild a fractured tooth. Where an injured tooth cannot be saved, a dental implant is often used as the replacement.

The inside of the mouth is normally lined with a special type of skin (mucosa) that is smooth and coral pink in color. Any change in that appearance can be a warning sign of a pathological process — the most serious of which is oral cancer. The following can be early signs:

• Reddish patches (erythroplasia) or whitish patches (leukoplakia) in the mouth
• A sore that fails to heal and bleeds easily
• A lump or thickening in the skin lining the inside of the mouth
• A chronic sore throat or hoarseness, or difficulty chewing or swallowing

These changes can appear on the lips, cheeks, palate, the gum tissue around the teeth, the tongue, the face, or the neck. Pain does not always accompany pathology and, notably, is often absent in oral cancer. Any patient with facial or oral pain with no obvious cause may also be at risk.

We recommend carrying out an oral cancer self-examination once a month. Your mouth is one of the body's most important warning systems, so do not ignore a suspicious lump or sore — get in touch and we will take a look. Where a lesion needs investigating, a biopsy is taken and sent for diagnosis before any treatment is planned.

TMJ disorders are a family of problems related to the jaw joint. TMJ stands for temporomandibular joint, the name for each of the two joints, right and left, that connect your jaw to your skull. Symptoms such as pain or a clicking sound occur when the joints of the jaw and the chewing muscles do not work together correctly. These problems are far more easily diagnosed and treated than they once were, and because some types can lead to more serious conditions, early detection matters.

Why the joint gives trouble

TMJ disorders develop for many reasons. You may clench or grind your teeth, tightening the jaw muscles and stressing the joint. The joint may have been damaged by injury or disease — injury and arthritis can damage the joint directly, or stretch or tear the muscle ligaments. The disk, made of cartilage and acting as the cushion of the joint, can then slip out of position. Whatever the cause, the result may be a misaligned bite, pain, a clicking or grating noise when you open your mouth, or difficulty opening wide.

Do you have a TMJ disorder?

The more of these that apply to you, the more likely a TMJ disorder is:

• Are you aware of grinding or clenching your teeth?
• Do you wake with sore, stiff muscles around your jaws?
• Do you have frequent headaches or neck aches?
• Does the pain get worse when you clench your teeth, or when you are under stress?
• Does your jaw click, pop, grate, catch, or lock when you open your mouth?
• Is it difficult or painful to open your mouth, eat, or yawn?
• Have you ever injured your neck, head, or jaws?
• Have you had problems, such as arthritis, with other joints?
• Do you have teeth that no longer touch when you bite, or that meet differently from time to time?
• Is it hard to use your front teeth to bite or tear food?
• Are your teeth sensitive, loose, broken, or worn?

Treatment

No single treatment resolves a TMJ disorder completely, and treatment takes time to become effective. It works best as a team effort between self-care and professional care. Once an evaluation confirms the diagnosis, the initial goals are to relieve the muscle spasm and the joint pain, usually with a pain reliever, an anti-inflammatory, or a muscle relaxant. Steroids can be injected directly into the joint to reduce pain and inflammation. Self-care measures are often effective in their own right:

• Resting your jaw
• Keeping your teeth apart when you are not swallowing or eating
• Eating soft foods
• Applying ice and heat
• Exercising your jaw
• Practicing good posture

Stress management techniques such as biofeedback, or physical therapy, may also be recommended, along with a clear plastic appliance known as a splint. A splint or nightguard fits over the top or bottom teeth and holds them apart, relaxing the muscles and reducing pain. Different appliances serve different purposes: a nightguard helps stop clenching and grinding and reduces muscle tension overnight while protecting the cartilage and joint surfaces; an anterior positioning appliance moves the jaw forward, relieving pressure and helping to reposition the disk; an orthotic stabilization appliance moves the jaw into proper position and is worn either full time or at night.

Bite correction and surgery

If a TMJ disorder has changed how your teeth fit together, you may need bite adjustment (equilibration), orthodontics with or without jaw reconstruction, or restorative dental work. Surgical options such as arthroscopy and open joint repair are sometimes needed but are reserved for severe cases. We do not consider TMJ surgery unless the jaw cannot open, is dislocated and non-reducible, has severe degeneration, or appliance treatment has been tried without success.

Generally a root canal is all that is needed to save a tooth with injured pulp from extraction. Occasionally that non-surgical treatment is not enough to heal the tooth, and surgery is recommended instead. Endodontic surgery can locate fractures or hidden canals that do not show on x-rays but still cause pain, and it can treat damaged root surfaces or the bone around them. The most common of these procedures is an apicoectomy, also called a root-end resection.

What the procedure involves

An incision is made in the gum tissue to expose the bone and the inflamed tissue around the root. The damaged tissue is removed along with the tip of the root. A root-end filling is placed to prevent the root becoming reinfected, and the gum is sutured. Over the following months the bone heals naturally around the root and full function is restored.

Afterwards

There may be some discomfort or slight swelling while the incision heals, which is normal after any surgical procedure. An appropriate pain medication will be recommended. If you have pain that does not respond to the medication, call the office.

Several methods of anesthesia are available. Which one is chosen depends on the nature of the surgical procedure and on how apprehensive you feel about it. Local anesthetic is used alongside every other method in all oral surgery procedures.

Anesthesia options

• Local anesthetic. You remain fully conscious throughout. A local anesthetic is given in the area where the surgery is to be performed. Used for simple procedures such as minor soft tissue work and straightforward extractions.
• Nitrous oxide sedation with local anesthetic. A mixture of nitrous oxide (laughing gas) and oxygen is delivered through a nasal breathing apparatus. You stay conscious but relaxed; nitrous oxide has both a sedative and a pain-controlling effect. Used for anything from simple procedures to wisdom tooth removal and implant placement.
• Office-based general anesthesia with local anesthetic. Medications are given through an intravenous line. You fall asleep and are completely unaware of the procedure. Supplemental oxygen is delivered through a nasal breathing apparatus and your vital signs are monitored closely throughout. This is available for all types of oral surgery, and many patients choose it for wisdom teeth or implant placement. It may also be necessary where local anesthesia alone fails to numb the surgical site, which can happen in the presence of infection.
• Hospital or surgery center based general anesthesia. Anesthesia is administered by an anesthesiologist in a hospital or surgery center. Indicated for extensive procedures such as face and jaw reconstruction and TMJ surgery, and for patients with medical conditions such as heart or lung disease who require general anesthesia.

To administer general anesthesia in the office, an oral surgeon must complete at least three months of hospital-based anesthesia training and then pass an in-office evaluation by a state dental board appointed examiner. The examiner observes an actual surgical procedure under general anesthesia, inspects all monitoring devices and emergency equipment, and tests the doctor and the surgical staff on anesthesia-related emergencies. The resulting license is renewable every two years, subject to continuing education in anesthesia.

Intravenous sedation (twilight sedation)

IV sedation is designed to let you go through treatment deeply relaxed — comfortable and calm, drifting in and out of sleep, and generally without remembering procedures that would otherwise be uncomfortable. You may not be fully asleep, but the anxiety is taken out of the appointment. Because the sedation is administered and monitored by your surgeon, it avoids the cost of having treatment carried out in an operating room or a same-day surgical facility.

A thin needle is placed into a vein in your arm or hand and attached to an intravenous line through which the medication is given. Occasionally a vein cannot be maintained, in which case the medication is given and the needle withdrawn; both approaches achieve the same level of conscious sedation. Some patients sleep; others slip in and out. Patients with certain medical conditions or on particular drug regimens may only be lightly sedated and may not sleep at all.

The goal is to use as little medication as possible to complete the treatment. IV sedation is very safe — considerably safer than oral sedation — because a constant drip is maintained through the line and an antidote can be given at any time to reverse the effect of the medication if necessary.

Nitrous oxide (laughing gas)

Nitrous oxide is a sweet-smelling, non-irritating, colorless gas that you simply breathe. It has been the primary means of sedation in dentistry for many years. It is safe: you receive 50 to 70 percent oxygen with no less than 30 percent nitrous oxide, you breathe on your own, and you remain in control of all bodily functions. You may experience mild amnesia and may doze off, not remembering everything that happened during the appointment. Its advantages:

• The depth of sedation can be increased or decreased at any point.
• There is no after-effect — no hangover.
• It has no side effects on the heart or lungs.
• It is very effective at minimizing gagging.
• It works rapidly, reaching the brain within 20 seconds, with relaxation and pain-killing properties developing in as few as two to three minutes.

There are no major contraindications to nitrous oxide, but you may not want to use it if you have emphysema, other chest problems, multiple sclerosis, a cold, or any other difficulty breathing. You are welcome to ask for a short trial to see how it feels before going ahead.

When it comes to anesthesia, your comfort and safety come first. If you have any concerns about the type of anesthesia planned for your procedure, please raise them with your surgeon at the consultation.

Cone beam CT gives the practice the technology to diagnose potential issues more accurately and to treat them with real confidence. Unlike a traditional spiral CT scanner, a cone beam system produces precise, crystal-clear digital images while keeping your exposure to radiation low.

3D imaging lets us carry out a wider range of diagnoses and treatments in the office, which reduces the number of visits you need to make. The scanner allows us to choose the field of view — the scanning area — that best suits your treatment, which also helps limit radiation exposure by focusing specifically on the area of concern.

The result is unmatched visualization of anatomical detail: bone, nerves, and sinuses in three dimensions. That drives the treatment plan, and it also makes it far easier to explain the particulars of your case and answer your questions. Where you have been referred to us, the 3D images can be shared quickly with your referring doctor so that everyone involved in your care is working from the same picture.

Platelet rich fibrin (PRF) is a by-product of blood plasma that is rich in platelets. Its use was once confined to the hospital setting, largely because of the cost of separating the platelets and the volume of blood required. Newer technology allows a sufficient quantity of platelets to be produced from only a small amount of blood, drawn from you while you are in the office.

Why PRF matters

PRF lets the body use its normal healing pathways at a greatly accelerated rate. During healing, the body rushes many cell types to the wound, platelets among them. Platelets form the blood clot and release growth factors into the wound — platelet derived growth factor, transforming growth factor beta, and insulin-like growth factor — which stimulate stem cells to regenerate new tissue. The more growth factors released into the wound, the more stem cells are stimulated, so healing is faster and more efficient.

Where it is used

PRF can support bone grafting for dental implants, including onlay and inlay grafts, sinus lift procedures, and ridge augmentation. It also assists in repairing bone defects created by the removal of teeth or small cysts, and in repairing fistulas between the sinus cavity and the mouth.

Advantages

• Safety. PRF is a by-product of your own blood, so disease transmission is not an issue.
• Convenience. It can be generated in the office while you are undergoing an outpatient procedure such as implant placement.
• Faster healing. Saturating the wound with growth factors increases tissue synthesis and speeds regeneration.
• Cost effectiveness. Because only a small amount of blood is needed and the work is done in the office, there is no expense for harvesting at a hospital or blood bank.
• Ease of use. PRF is easy to handle and makes bone substitute and grafting materials more gel-like and easier to apply.

During the procedure a small amount of your own blood is drawn, placed in a centrifuge, and spun down. In less than 15 minutes the PRF is formed and ready to use. Applied to a bone graft, it increases the final amount of bone present as well as helping the wound heal faster.

Please follow these instructions to prepare for oral surgery under IV sedation.

• Have nothing to eat or drink, including water, for eight hours before your appointment.
• No smoking for at least 12 hours before surgery. Ideally, cut down or stop as far in advance of the day as you can.
• A responsible adult must come with you, stay in the office during the procedure, and drive you home.
• Do not drive a vehicle or operate machinery for 24 hours after anesthesia.
• Wear loose fitting clothing with sleeves that can be rolled up past the elbow, and low-heeled shoes.
• Contact lenses, jewelry, and dentures must be removed at the time of surgery.
• Do not wear lipstick, heavy makeup, or nail polish on the day of surgery.
• Let the office know if you have an illness such as a cold, a sore throat, or an upset stomach or bowels.
• If you take routine oral medications, check with us before your surgical date for instructions.

After implant surgery, do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of surgery. There will be a metal healing abutment protruding through the gum tissue.

Bleeding

Some bleeding or redness in the saliva is normal for 24 hours. Excessive bleeding — where the mouth fills rapidly with blood — can be controlled by biting on a gauze pad placed directly on the bleeding wound for 30 minutes. If bleeding continues heavily, call the office for further instructions.

Swelling

Swelling is a normal occurrence after surgery. To keep it to a minimum, apply an ice bag, or a plastic bag or towel filled with ice, to the cheek over the area of surgery. Apply the ice continuously, as much as possible, for the first 36 hours.

Diet

Drink plenty of fluids. Avoid hot liquids and hot food. Stay on soft food and liquids on the day of surgery, then return to a normal diet as soon as you comfortably can unless you have been told otherwise.

Pain

Begin taking pain medication as soon as you feel the local anesthetic wearing off. For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours. Ibuprofen (Advil or Motrin) may be taken instead: over-the-counter ibuprofen comes in 200 mg tablets, of which two to three may be taken four times daily, not exceeding 3200 mg a day for an adult. Do not take the two medications at the same time, and check with us first for anyone under 18.

For severe pain, take the prescribed medication as directed. Do not take any of the above if you are allergic to them or have been told not to. Do not drive or work around machinery, and avoid alcohol. Pain and discomfort should ease a little more each day; if pain persists, call the office.

Antibiotics

Take any prescribed antibiotics exactly as directed, to help prevent infection.

Oral hygiene

From the day after implant placement you can gently brush the rest of your mouth and gently spit out, avoiding the surgical site. Do not use mouthwash or salt water for 7 to 10 days.

Activity

Keep physical activity to a minimum immediately after surgery. Exercise can bring on throbbing or bleeding; if that happens, stop. Bear in mind you are probably not taking in normal nourishment, which will weaken you and further limit what you can do.

After an impacted tooth is exposed, do not disturb the wound. If surgical packing was placed, leave it alone — the packing is what keeps the tooth exposed. If it works loose or falls out, there is no need to be alarmed, but do call the office for instructions.

Bleeding

Some bleeding or redness in the saliva is normal for 24 hours. Heavy bleeding that rapidly fills the mouth can usually be controlled by biting firmly on a gauze pad placed directly on the bleeding wound for 30 minutes. If it continues, call for further instructions.

Swelling

Swelling is normal after surgery. To keep it down, hold an ice bag or a plastic bag of ice cubes against the cheek near the area of surgery, as much as possible for the first 36 hours.

Diet

Drink plenty of fluids. Avoid hot liquids and hard foods. Stay on soft food and liquids on the day of surgery, then return to a normal diet as soon as you comfortably can unless you have been told otherwise.

Pain

Begin taking pain medication as soon as you feel the local anesthetic wearing off. For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours. Ibuprofen (Advil or Motrin) may be taken instead: over-the-counter ibuprofen comes in 200 mg tablets, of which two to three may be taken four times daily, not exceeding 3200 mg a day for an adult. Do not take the two medications at the same time, and check with us first for anyone under 18.

For severe pain, take the prescribed medication as directed. Do not take any of the above if you are allergic to them or have been told not to. Do not drive or work around machinery, and avoid alcohol. If pain persists rather than easing day by day, call the office.

Oral hygiene

Keeping the mouth clean is essential to good healing. From the day after surgery, clean your mouth thoroughly after every meal and brush your teeth normally if you can. Rinse with warm salt water — a teaspoon of salt in a cup of warm water — six times a day, and keep this up until healing is complete. A clean wound heals better and faster.

Activity

Keep physical activity to a minimum immediately after surgery. Exercise can bring on throbbing or bleeding; if that happens, stop. Your nourishment intake is reduced, so exercise may leave you weaker than usual. If you feel light-headed, stop.

After a tooth is removed, a blood clot needs to form to stop the bleeding and begin healing. Bite on a gauze pad for 30 to 45 minutes immediately after the appointment. If bleeding or oozing persists, place another gauze pad and bite firmly for a further 30 minutes. You may need to repeat this several times before the flow stops.

Once the clot has formed, it must not be disturbed or dislodged. For 72 hours, do not rinse vigorously, suck on straws, smoke, drink alcohol, or brush the teeth next to the extraction site — any of these can dislodge or dissolve the clot and set healing back. Limit vigorous exercise for the first 24 hours, as it raises blood pressure and can restart the bleeding.

Some pain and swelling are to be expected. An ice pack, or an unopened bag of frozen peas or corn held against the area, will keep swelling to a minimum; it usually subsides after 48 hours. Take pain medication as prescribed, and call the office if it does not seem to be working. If antibiotics have been prescribed, finish the full course even once the signs of infection have gone.

Drink plenty of fluids and eat nutritious, soft food on the day of the extraction. You can eat normally as soon as you are comfortable doing so. After 24 hours it is important to resume your normal dental routine, brushing and flossing at least once a day, which speeds healing and keeps the mouth clean.

After a few days you should feel fine and be back to your normal activities. Call the office straight away if you have heavy bleeding, severe pain, swelling that continues for two to three days, or any reaction to the medication.

Removing impacted wisdom teeth is a serious surgical procedure, and post-operative care matters. Unnecessary pain and complications such as infection and swelling can be kept to a minimum if these instructions are followed carefully.

Immediately following surgery

• Keep the gauze pad over the surgical area in place for half an hour, then remove and discard it.
• Avoid vigorous rinsing and do not touch the wound area — this can dislodge the blood clot and restart bleeding.
• Take the prescribed pain medication as soon as you begin to feel discomfort, which usually coincides with the local anesthetic wearing off.
• Restrict your activities on the day of surgery and resume normal activity when you feel comfortable.
• Place ice packs against the sides of your face where surgery was performed.

Bleeding

A certain amount of bleeding is to be expected, and slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding can be controlled by first rinsing or wiping any old clots from the mouth, then placing a gauze pad over the area and biting firmly for thirty minutes. Repeat if necessary. If it continues, bite on a moistened black tea bag for thirty minutes — the tannic acid helps a clot form by contracting the bleeding vessels. Sit upright, stay calm, and avoid exercise. If the bleeding does not subside, call the office.

Swelling

Swelling is usually proportional to the surgery involved, and swelling around the mouth, cheeks, eyes, and sides of the face is not uncommon. It will not be apparent until the day after surgery and will not reach its maximum until two to three days afterwards. Ice packs applied immediately keep it down: two bags of ice against the sides of the face where surgery was performed, left on continuously while you are awake. After 36 hours ice has no further benefit, and from that point moist heat applied to the sides of the face helps reduce the swelling. Swelling or jaw stiffness lasting several days is a normal reaction to surgery and no cause for alarm.

Pain

For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours. Ibuprofen (Advil or Motrin) may be taken instead: over-the-counter ibuprofen comes in 200 mg tablets, of which two to three may be taken four times daily, not exceeding 3200 mg a day for an adult. Do not take the two medications at the same time, and check with us first for anyone under 18.

For severe pain, take the prescribed medication as directed. Do not take any of the above if you are allergic to them or have been told not to. Do not drive or work around machinery, and avoid alcohol. Pain should ease a little more each day; if it persists, call the office.

Diet

After a general anesthetic or IV sedation, take only liquids at first. Drink from a glass and do not use straws — the sucking motion can dislodge the blood clot and cause more bleeding. You may eat anything soft, chewing away from the surgical sites. A high calorie, high protein intake is important, and nourishment should be taken regularly. Your food intake will be limited for the first few days, so compensate by increasing fluids: at least five to six glasses of liquid daily. Try not to miss meals — you will feel better, have more strength, less discomfort, and heal faster if you keep eating.

If you sit up or stand suddenly from lying down you may feel dizzy. Sit up for a full minute before standing.

Keeping the mouth clean

Do not rinse at all for 7 to 10 days after surgery, and do not use mouthwash or salt water. From the day after surgery you can brush gently and gently spit out — brushing is fine, just be gentle at the surgical sites.

Discoloration

In some cases discoloration of the skin follows the swelling. Black, blue, green, or yellow discoloration is caused by blood spreading beneath the tissues and is a normal post-operative occurrence, usually appearing two to three days afterwards. Moist heat applied to the area may help clear it faster.

Antibiotics

If you have been given antibiotics, take the tablets or liquid exactly as directed to help prevent infection. Stop taking them and contact the office immediately if you develop a rash or any other unfavorable reaction.

Nausea and vomiting

If you feel nauseous or are sick after surgery, take nothing by mouth for at least an hour, including the prescribed medicine. Then sip slowly on a soft drink, tea, or ginger ale over a fifteen-minute period. Once the nausea subsides you can begin taking solid food and your medication again.

Other things you may notice

• Numbness of the lip, chin, or tongue is no cause for alarm and is usually temporary, as discussed at your consultation. Be aware that if your lip or tongue is numb you could bite it without feeling it.
• A slight rise in temperature immediately after surgery is not uncommon. Tylenol or ibuprofen will bring the fever down; if it persists, let the office know.
• Take care going from lying down to standing — low blood sugar or medication can leave you light-headed. Sit for a minute before getting up.
• You may feel hard projections in the mouth with your tongue. These are not roots; they are the bony walls that supported the tooth. They usually smooth out on their own, and if they do not they can be removed.
• If the corners of your mouth are stretched they may dry out and crack. Keep your lips moist with an ointment such as petroleum jelly.
• A sore throat and pain on swallowing are not uncommon, as the muscles get swollen. This settles in two to three days.
• Stiffness of the jaw muscles (trismus) may make it difficult to open your mouth for a few days. This is normal and resolves with time.

Finally

Sutures are placed to minimize post-operative bleeding and help healing. If one becomes dislodged there is no cause for alarm — simply remove it from your mouth and discard it. The sutures are taken out about a week after surgery, which requires no anesthesia, takes a minute or so, and is usually not uncomfortable.

There will be a void where the tooth was removed, which fills in with new tissue gradually over the following month. In the meantime keep the area clean, especially after meals, with salt water rinses or a toothbrush once you have passed the initial no-rinsing period.

A dry socket occurs when the blood clot is dislodged from the socket prematurely. Pain at the surgical site, and sometimes pain near the ear, two to three days after surgery are the signs. Call the office if this happens.

If you exercise regularly, remember your nourishment intake is reduced and exercise may weaken you. If you feel light-headed, stop. Every case is different, so discuss any problem with us or with your family dentist. Call the office if your pain or swelling worsens, or if any unusual symptoms occur.

Your initial appointment is a consultation, in which we explain your diagnosis and the treatment options open to you. Surgery can occasionally be performed on the same day as the consultation, though a complex medical history or treatment plan may call for a second appointment on another day.

Please bring the following with you:

• Your surgical referral slip, and any x-rays, if you have them.
• A list of the medications you are currently taking.
• If you have medical or dental insurance, the completed forms — this saves time and allows us to help you process any claims.

All patients under the age of 18 must be accompanied by a parent or guardian at the consultation visit.

A preoperative consultation and physical examination is required for anyone having IV anesthesia for surgery. Have nothing to eat or drink for eight hours before your surgery, and arrange for an adult to drive you home.

Please tell us in advance about any medical condition that may be relevant before surgery — diabetes, high blood pressure, artificial heart valves or joints, rheumatic fever and the like — and about any medications you take, including heart medications, aspirin, or anticoagulant therapy.

X-rays

If your dentist or physician has taken x-rays, you can ask them to forward them to us. If there is not enough time, collect them and bring them with you. Any additional images that are needed can be taken here.

You can preregister with the office by completing a secure Patient Registration and Medical History form before your appointment. Completing it in advance means your information is already in our system by the time you arrive, so your appointment can start on time.

The security and privacy of your personal data is one of our primary concerns, and every precaution is taken to protect it. If you would rather complete the form in the office, arrive a little earlier and we will give you the paperwork when you check in.

We accept cash, debit, and all major credit cards, and offer third-party financing through CareCredit. Payment is due at the time the service is rendered unless other arrangements have been made in advance.

We are out-of-network providers with all insurance plans. If you have out-of-network benefits, we can help you file a claim for reimbursement.

If you have any question about your account, please call the office. A short conversation usually clears up any misunderstanding.

When it comes to choosing an oral surgeon you have options. Personalized, gentle, comprehensive patient care is our first priority. A few things that set the practice apart:

Care and commitment

From the front desk to the exam room, the practice is made up of people who take your oral health seriously. State-of-the-art equipment, designed with safety and efficiency in mind, lets us offer that standard of care. Everything in the office is clean, comfortable, and thoroughly sterilized.

Honesty and affordability

The cost of care can be confusing. Alongside a number of in-office payment options, we give you cost information on your treatment up front, before it begins. Financing is available over time frames that fit your circumstances, and we are happy to help you navigate your insurance and the alternatives to it.

Easy access to care and information

Your time is valuable, and our staff will do everything possible to fit into your schedule. Appointment reminders and confirmations go out automatically, and we are glad to answer questions or concerns in the office, over the phone, or by email.

The full scope, in one location

We are qualified to handle every aspect of your oral and maxillofacial care, and we take pride in being expert in the conditions we treat daily. In the event that you need a different specialist, we will send you to a carefully vetted colleague who applies the same professional principles in their office that we do in ours.

Comfort

We understand that many patients feel anxious about dental treatment. Communicating clearly about what to expect goes a long way towards relieving that anxiety, and we do everything we can to make the experience an easy one.

Personalized service

Here you are never just a patient. We take an interest in you and in what your oral health needs, and we think you will feel you are treated as family.

Your health information is treated as confidential and handled in line with HIPAA. The security and privacy of your personal data is one of our primary concerns, and we take every precaution to protect it.

The practice's full Notice of Privacy Practices is being finalized and will be published here. In the meantime a copy is available at the office on request, and we are happy to answer any question about how your information is used and stored.

We would like to know how we did. A short survey covers the courtesy shown to you over the phone, how easy it was to schedule your appointment, your waiting time, and your overall impression of the staff and of the surgeon, with space for comments of your own.

Feedback is read by the practice and shapes how we run. With your permission, comments may also be published on our website and social media channels; nothing is published without your consent.