Surgical

There are times when sedation is the ideal option. We use sedation for patients who:

• Are anxious and/or fearful.
• Have had previous trauma at a dentist’s office.
• Are undergoing surgical dental procedures or require multiple or very lengthy procedures.
• Have sensitive teeth.
• Have a strong gag reflex.

We want to make your visit with us as pleasant as possible! Often, we use oral sedation methods.

Intravenous (IV) sedation dentistry is used primarily for moderate to severe dental surgical procedures (such as wisdom teeth extraction) and for patients that want to be completely asleep during their dental treatment. In this case, the sedation drugs are administered intravenously to the patient.

If intravenous sedation is required, we will refer patients out to an oral surgeon. We only offer local anesthetic and oral sedation (one hour prior to extraction) for extraction of teeth.

An extraction of the tooth (pulling a tooth in laymen’s terms) is considered when the tooth is either severely decayed, fractured, or when periodontitis is causing problems. In addition, common teeth pulled are wisdom teeth and primary teeth. Sometimes in these cases, the best treatment is to remove the tooth if it cannot be saved. This may be the best option to relieve any pain and prevent the spread of infection.

Dry socket occurs after a tooth extraction when the blood clot has been removed or has not formed properly. The clot is necessary to protect the socket and stop bleeding, to promote the development of new bone and gum tissues and to prevent pain. However, when the clot is removed prematurely, it exposes the tissues and the underlying bone.

Symptoms of dry socket include:

• Severe throbbing pain
• Does not respond to pain medication
• Radiates into ear
• Foul odor or taste in mouth

Several things can cause a premature loss of the blood clot:

• Smoking and tobacco use
• Spitting
• Sucking through a straw
• Sneezing and coughing
• Carbonated, hot or alcoholic drinks
• Touching clot with fingers or tongue

Treatment for dry socket:

• Rinsing socket with medications.
• Packing the socket with gauze that contains a soothing anesthetic.
• Returning to the office several times for repacking of the socket and monitoring of symptoms.

Post extraction instructions

Follow these recommendations to ensure successful healing of your tooth extraction:

• During the first 24 hours after your appointment, it’s important for a blood clot to form in the extraction site to stop the bleeding, reduce pain and speed healing.
• To help the clot form, bite on a gauze pad firmly for 45-60 minutes after the tooth has been pulled.
• If bleeding or oozing continues after you remove the gauze pad, place another gauze pad and bite down for another 45-60 minutes.
• To protect the clot and avoid a painful condition called dry socket, don’t do anything to dislodge or dissolve the clot for the first 24 hours. Don’t spit or suck on candies or through a straw.  Don’t rinse, use tobacco or touch the dry socket. Don’t drink any carbonated, hot, or alcoholic beverages.
• Limit yourself to calm activities to reduce blood pressure and protect the clot.
• When the numbness from the freezing has worn off completely, drink lots of fluids and eat only soft nutritious foods, chewing on the opposite side of your mouth.
• To control discomfort, take pain medication before the anesthetic has worn off or as recommended. It is normal to experience some discomfort for several days after the extraction.
• To keep any swelling to a minimum, use an ice bag – 20 minutes on and 20 minutes off.
• After the first 24 hours or as soon as it’s comfortable, you can begin to eat normally.
• Resume brushing and flossing after the first 24 hours, but clean gently around the extraction site for about a week.
• If antibiotics are prescribed, continue to take them for the indicated length of time, even if all symptoms and signs of infection are gone.
• After the first 24 hours, you can reduce any soreness or swelling by applying moist heat. Swelling usually starts to go down after about 48 hours.
• You can further reduce discomfort after the first 24 hours by rinsing your mouth very gently 3 times a day and after meals with warm salt water (1 tsp. of salt per glass of warm water).
• Call the office if you have heavy or increased bleeding, pain or swelling that increases or continues beyond 2-3 days, if you develop a bad taste in your mouth, or if you have a bad reaction to the medication.

Crown lengthening is a surgical dental procedure. It involves reshaping the gum line by removing excess gum tissue around your upper teeth. This makes your teeth look longer by exposing more of them.

Crown lengthening is often used for:

• Improving aesthetics, either by exposing more of your teeth or reshaping an uneven gum line for a more symmetrical smile.
• Addressing decay or fracture found under the gum line, allowing the dentist to perform any restorative procedures needed.

What is bone grafting?

As part of its normal maintenance, your body and its blood cells continually work to remove damaged cells, replacing them with new, healthy cells.

Grafting procedures involve placing a framework of material into areas where there is missing bone. This enables cells to enter and start rebuilding. As time goes on, your cells will work to remodel the graft and make it part of your own natural functioning bone.

Root canal therapy

When the pulp of a tooth becomes infected and dies, root canal therapy is necessary to save the tooth. It is generally a comfortable treatment that can save your tooth and keep your mouth healthy.

Symptoms of infection

You may realize that you have an infected tooth when:

• The tooth is sensitive to hot or cold.
• The tooth hurts when biting or with pressure.
• There is throbbing, severe tooth pain.
• The area is swollen.
• You have a bad taste in your mouth.

It’s important to note that you may also be unaware of the problem because in some cases there will be no symptoms at all to indicate that you have an infected tooth.

Causes of infection

The pulp becomes infected when bacteria invade the inner layers of the tooth. The tooth pulp is a soft tissue made up of nerves and blood vessels. It is contained in the pulp chamber that extends from the middle of the tooth down through to the roots of the tooth.

Infection occurs most commonly through a deep cavity that allows bacteria through the enamel and dentin layers and into the pulp. Sometimes the pulp simply dies due to a fracture or a blow to the tooth.

Diagnosis and treatment

To determine if your tooth has an infected pulp, we do a thorough examination. The exam often includes x-rays and sometimes includes checking the health of the pulp with a pulp tester. We may also apply heat or cold, tap lightly on the tooth to see if it is sensitive, look for changes in the tooth’s color, or press gently on the gums next to the tooth to check for pain.

If we determine that you have an infected tooth, we will talk with you about root canal therapy to remove the infection and save the tooth. It is important to treat an infected tooth in order to prevent the infection from travelling through the root tips and causing a painful abscess in the jawbone.