One of the most common procedures done in our office is tooth extraction. The removal of teeth can be necessary for a number of reasons, including:
- Too much damage to tooth to be repaired
- 3rd molars (Wisdom Teeth) impacted (wedged between the jaw and another tooth or teeth)
- May be needed to create room for other teeth (such as when you’re getting braces)
- Shifting or mal-aligned teeth
- Baby teeth that don’t fall out, a.k.a. ankylosed teeth
- A tooth with an associated pathology, such as a cyst or a tumor
- Joint problems in your jaw
Prior to Surgery
In preparation for surgery, we must obtain a full medical and dental history; hence the reason for a pre-operative consultation. In some instances we may have to get medical clearance from your MD prior to any surgery. We will also review a list of all medications you take, to make certain they will not interact with any of the new medication we may be providing you during the time of surgery. We need to know any vitamins, herbal supplements, or over-the-counter drugs, as well as any medications you are taking. Allergies to medication will also be reviewed.
Typically a panoramic x-ray is then taken to assess the affected tooth and determine its proximity to to vital structures such as nerves, arteries and/or sinuses. In some instances a 3D image, a.k.a CBCT, may be required for more complex cases.
You may be required to take antibiotics before or after surgery, depending on the duration of the surgery, or if you have a specific medical condition. Dr. Massoomi will discuss this with you if necessary.
Day of Surgery
At the time of surgery, your oral surgeon will provide local anesthesia, a.k.a numbing medication, at the site of the surgery. This is is provided whether you will have sedation or not. You are always provided with local anesthesia at the site of the surgery. Additionally, as a convenience Dr. Massoomi will usually provide a longer-lasting local anesthesia in order to reduce the pain when you get home. This will allow you enough time to take your pain medications before the numbness wears off.
As with most other types of surgeries, you will be sedated for the majority of the cases. This mean you will most likely not remember much of anything about the surgery itself. This will ensure a comfortable experience. Additionally, the IV access will allow us to provide with additional medications through the IV to only help expedite your recovery after surgery. In most cases, as a preventative measure, Dr. Massoomi will provide you will anti-swelling, anti-nausea, anti-biotics, anti-anxiety and short & long-term pain medication through your IV. As with any surgery the swelling usually presents itself 3-5 days after the surgery. As a result of the administered IV anti-swelling medication, most patients will have very little swelling after surgery – this is one of the advantage to IV sedation.
If you are not sedated, during the simple extraction you will still be provided with local anesthesia at the site of the surgery. You should not experience any pain, however it is common to feel pressure during the actual extraction. The only way to feel absolutely nothing….you have to be sedated. The affected tooth is firmly rocked back and forth with a forceps, to loosen it for removal.
A “surgical extraction” is a slightly more complex procedure that occurs when a tooth has not yet broken through the gum line, or has not yet fully grown into the mouth, or has decayed to a point that it cannot be grasped with a forceps. When a surgical extraction is needed, a small incision into your gum in order to access the affected tooth. Then some removal of bone with a drill may be required to access the tooth. From here, the procedure is similar to a simple extraction. Dr. Massoomi will always stitch the incision site, in order to bring the tissue back to its original state. In the interest of time, some practitioners do not suture the extraction site, leading to food entrapment in the extraction site and other dreaded complications such as “dry socket”. This is why he always sutures any extraction site closed – unless there is a severe infection necessitating natural drainage of the infection, a.k.a pus.
After Oral Surgery
After the extraction you will be asked to bite down on a piece of gauze for the first hour, in order to reduce the bleeding from the extraction site. This pressure helps to form a blood clot in the extraction site, a crucial part of the healing process. From time to time over the next few days you may have to place a new gauze and apply pressure, if you only notice new bleeding – but eventually the bleeding will stop. You should not eat or drink with the gauze in the mouth. It should always be removed first and only replaced if there is active bleeding.
- Take pain medication as prescribed and recommended PRIOR to the pain and swelling. You want to prevent the pain and swelling by taking the medications early on.
- Research has shown that taking anti-inflammatory drugs, such as ibuprofen (Advil or Motrin) greatly decrease pain after an extraction. This is why we provide you with prescription strength 600-800mg of ibuprofen to help with the swelling. In the 200-400mg range of ibuprofen, is mostly helpful for pain and not much effect on swelling.
- We will provide you with a “compression dressing” that includes multiple re-freezable icepack. We encourage all of our patients to wear the compression dressing as much as possible the first 2-3 days, as this will reduce and hopefully prevent the swelling that my show up on the 3rd day.
- Eat liquid to soft foods for the first week or until we see you for your first post-op appointment.
- Avoid hot (temperature) foods
- Avoid alcoholic beverages while on any medication, especially if on antibiotics and pain medications.
- Chew food on the opposite site of the extraction site
- Do not use a straw or spit after surgery. This can cause the blood cut to dislodge, greatly delaying healing, leading to “dry sockets.”
- Avoid brushing the area around the extraction site for the first week or until we see you for your first post-op appointment.
- Use the provided prescription mouthwash to keep the mouth clean.
The mucosa, a.k.a gums, over the extraction site will generally close up in about 2 weeks time, but it can take three to six months for the bone to heal. Remember, tooth extraction is a common procedure and our caring team has years of experience helping patients through this easy treatment.