An oral and maxillofacial surgeon is a dentist who specializes in different aspects of surgery both in and around the mouth. They diagnose and treat defects, injuries, and diseases involving the head, mouth, teeth, gums, jaws, and neck.
Here at art of smile, we have developed procedures to remove teeth painlessly and an emphasis on saving as much of the supporting bone and gum tissues as possible. This is important because strong structures provide essential support for your implants, bridges, or dentures leading to the best possible functional and cosmetic results. We believe that every tooth is precious and one of the main goals of modern dentistry will always be the prevention of tooth loss because the loss of a single tooth can have a major impact upon your dental health and appearance.
However, it is still sometimes necessary to remove a tooth. Some of the reasons for doing so can be seen below:
Extracting teeth is made less difficult when the general principles of oral surgery are understood and practiced. If your dentist has recommended that a tooth be extracted, the following information will help you get through the first few days after your extraction. Should anything occur that seems out of the normal, do not hesitate to call your dentist.
The first step is the taking of dental radiographs to assist in extraction planning. This provides concrete evidence that an extraction is the only procedure possible and makes the action defensible in a court of law. The techniques of extraction include surgical and non-surgical procedures. Following a close study of your radiographs your dentist will be in a position to advise you on which is the best procedure for you.
Non – Surgical Extraction This method will be suggested when the affected tooth is already loose. Non-surgical extraction is performed by placing gentle traction and rotation on the affected tooth with dental forceps or needle holders. Excess tissue is removed as carefully as possible so as to avoid fracture. Once clean, the alveolus can be filled with osteoinductive materials, impregnated resins, or the newer bone morphogenic materials. After filling, the alveolus is sealed. Following the procedure we will try and make you as comfortable as possible by providing home care support including antibiotic therapy, pain management, and dietary advice.
Surgical Extraction Surgical extraction is performed on non-mobile teeth with normal or near normal attachment levels. If your dentist has studied your radiographs and concluded that extraction is necessary the next step will be the creation of a surgical flap. Your highly skilled oral surgeon will make a precise incision providing room to remove the alveolar bone. Following this the surgeon will isolate and gently elevate the roots of your tooth. After sufficient bone removal and elevation, the tooth root should become mobile. Small dental forceps or needle holders are used to grasp the tooth crown and then rotate the tooth on its long axis. Your surgeon will rotate the tooth to the point of resistance for 20 to 30 seconds. The rotation is then reversed and again held for 20 to 30 seconds. By using slow, continuous forces, the fibers are torn and the tooth becomes loose enough for gentle traction to remove it from its socket.
After the roots have been successfully removed, a post-extraction radiograph will confirm that the operation has been successful. The alveolus can then be
treated and sealed in the same way as practiced in the non-surgical extraction.
The last teeth to develop and erupt into the jaws are called the third molars. Third molars usually erupt in the late teen years, which coincides with passage into adulthood and is referred to by some as the age of wisdom; hence “wisdom teeth”.
Wisdom teeth used to serve a useful purpose, but are now considered vestigial organs. A vestige is a degenerative or imperfectly formed organ or structure which no longer performs a useful function. Wisdom teeth have become “outdated” for many reasons.
Our ancestors’ diet was made up of far coarser food than our own and a lack of hygiene meant that impurities such as dirt and sand were consumed regularly. This caused teeth to abrade significantly which meant they took up less space in the jaw. Permanent teeth were also frequently lost at an early age, which would create more space in the jaw. Due to the coarseness of the food it was harder to chew and the jaw itself would develop into a larger bone as it was working much harder. All of these factors would create more space for the wisdom teeth when they came in.
Unfortunately, the wisdom teeth are now usually trying to erupt into a jaw that is too small. The heavily processed diet of today does not produce the tooth abrasion or jaw development that we used to see. Modern dentistry has pretty much eliminated significant loss of permanent teeth at an early age. This leaves us with too many teeth and not enough jaw.
Wisdom teeth serve no useful function and will often cause damage because when a wisdom tooth becomes partially exposed through the gums it cannot be cleaned properly and can collect food debris, bacteria and plaque around itself. This can result in tooth decay, gum disease, infection and abscess of not only the wisdom teeth, of not only the wisdom teeth, but of the nearby molars and surrounding gum tissue. The molars in front of the wisdom teeth are sometimes lost because of cavities and gum disease caused by the inability to clean the wisdom teeth properly. Cyst formation and other destructive pathology are also seen around impacted wisdom teeth. There may be pain and swelling, or you may have no symptoms at all, even though the other teeth in your mouth may be at risk of damage.
If removal of the wisdom teeth is necessary, the procedure is recommended in the late teenage years, before the roots are completely formed. Surgical procedures in general are better tolerated when one is young and healthy, and the gum tissues tend to heal better and more predictably when young. Most people experience minimal disruption of their normal routines, and time off from work or school is usually minimal. At this point it is worth noting that the removal of wisdom teeth can be of great benefit to your ultimate oral and general health Wisdom teeth can be extremely problematic and more often than not
I advise patients to have their wisdom teeth removed. However, not everyone has problems with their wisdom teeth. If you’re genetically lucky, the jaws are long enough to accommodate the wisdom teeth in a proper erupted position. In this position, if they can be kept clean, they may be used.
How and where your wisdom teeth are removed depends on whether your wisdom teeth are erupted or impacted and how deep the roots are. Surgery may take place in your dentist’s or oral surgeon’s office rather than in a surgical center or hospital. Your dentist or oral surgeon will review the recommended procedure with you so that you are comfortable with the procedure from the very beginning. You will also be given information about eating, medication, rest, driving, and other considerations for the periods before and after surgery.
Wisdom Teeth Immediately after surgery your body sends blood to nourish the tooth socket and the healing process begins. Simple pressure from a piece of gauze should control the bleeding and help a blood clot to form in the socket. After surgery, you will rest while under close observation as you recover from the anesthetic. Once your doctor is satisfied with your recovery you will be able to go home and relax. Within a day or two, soft tissue begins to fill in the socket, aided by the blood clot. In time, the bone surrounding the socket begins to grow, eventually filling in the socket completely.
It is possible for you to heal more quickly and avoid complications by simply following the instructions that your dentist or oral surgeon gives you. However, if you experience excessive bleeding or swelling, persistent and severe pain, fever, or if you experience any reaction to medications, please do not hesitate to call your dentist for further advice. A follow-up examination may also be scheduled to make sure that the socket is healing properly and that your mouth is returning to a normal, healthy state.