Oral and Maxillofacial Surgery
Root canals are tiny passageways that branch off from beneath the top of the tooth, coursing their way vertically downward, until they reach the tip of the root. All teeth have between one and four root canals. Many tooth problems involve infections that spread to the pulp, which is the inner chamber of the tooth containing blood vessels, nerves, and other tissues. When the infection becomes worse, it can begin affecting the roots. A traumatic injury to a tooth can also compromise the pulp, leading to similar problems. A diseased inner tooth brings a host of problems including pain and sensitivity as the first indications of a problem. However, a spreading infection inside the tooth can cause small pockets of pus to develop, which can lead to an abscess. Root canal therapy is a remarkable treatment with a very high rate of success and involves removing the diseased tissue, halting the spread of infection and restoring the healthy portion of the tooth. In fact, root canal therapy is designed to save a problem tooth; before the procedure was developed and gained acceptance, the only alternative for treating a diseased tooth was extraction.
Root canal treatment usually entails one to three visits. During the first visit, a small hole is drilled through the top of the tooth and into the inner chamber. Diseased tissue is removed, the inner chamber cleansed and disinfected, and the tiny canals reshaped. The cleansed chamber and canals are filled with an elastic material and medication designed to prevent infection. If necessary, the drilled hole is temporarily filled until a permanent seal is made with a crown. Most patients who have root canal experience little or no discomfort or pain and enjoy a restored tooth that can last almost as long as its healthy original.
In some cases, it may be necessary to extract a tooth. This can happen for a variety of reasons such as cases where a deciduous “baby” tooth is reluctant to fall out, a severely broken down and non-restorable tooth is present, or a “wisdom tooth” is poorly positioned and unable to fully erupt into place.
Tooth extraction procedures today are far less painful than ever before, thanks to powerful anesthetics and sedatives. In many cases, a patient who has a tooth pulled experiences little or no discomfort and only minor bleeding.
Before a tooth is extracted, the area surrounding the tooth is numbed with a topical or injectable anesthetic such as Novocaine.
Patients with extracted teeth sometimes need to take an antibiotic, and at the very least, take precautions following the procedure to ensure that infection doesn’t occur.
Smoking, vigorous brushing and rinsing, and drinking liquids through straws are discouraged during the post-operative period because they hinder healing and may cause the wound to open. Cold compresses applied to the outside cheek near the extraction area can help reduce any swelling and promote faster healing.
Wisdom teeth extractions
Wisdom teeth are the third and final set of molars that erupt in the back corners of the upper and lower normal adult mouth. Unfortunately, most people experience problems from wisdom teeth; in most cases, this is because the teeth erupt too close to existing permanent teeth, causing crowding, improper bites, and other problems.
If wisdom teeth are causing a problem, this could mean that they are impacted. Impacted wisdom teeth can be extremely painful, as well as harmful to your oral health. Symptoms are easy to spot and include severe discomfort, inflammation, and in some cases infections.
Many people need to have their wisdom teeth extracted to avoid future serious problems. In general, the lack of the four wisdom teeth does not hamper one’s ability to properly bite down, speak or eat.
If you experience any of the following symptoms, you may have an impacted wisdom tooth:
- Facial swelling
- Gum swelling
To remove your wisdom teeth, we will use either local anesthesia or sedation anesthesia depending on the expected complexity of the wisdom tooth extraction.
When using local anesthesia, we will first apply a substance to your gums to numb them followed by injections near the site of each extraction. You will remain awake during the tooth extraction and although you’ll feel some pressure and movement, you shouldn’t experience pain.
More often during wisdom tooth extraction, we will give you sedation anesthesia through an intravenous (IV) line in your arm. Sedation anesthesia suppresses your consciousness during the procedure. You don’t feel any pain and will have limited memory of the procedure. You’ll also receive local anesthesia to numb your gums.
Once you have been given anesthesia, your oral surgeon will make an incision in the gum tissue to expose the tooth and bone. We then remove the bone that blocks access to the tooth root, divide the tooth into sections if it’s easier to remove in pieces, removes the tooth and clean the site of the removed tooth of any debris from the tooth or bone. Stitches are then applied to the wound to close it and promote healing, though this isn’t always necessary. We will then place gauze over the extraction site to control bleeding and to help a blood clot form.
After your procedure, you may be able to manage pain with an over-the-counter pain reliever, such as acetaminophen, or be given a prescription for pain medication. Prescription pain medication may be especially helpful if bone has been removed during the procedure. Holding a cold pack against your jaw also may relieve pain. In some cases, swelling or bruising of your cheek may occur and will resolve in a few days. You should be able to resume normal activities within a day, but for at least a week should avoid strenuous activity that could result in losing the blood clot from the socket.
We will also provide you with additional instructions to follow regarding:
- Pain management
- Swelling and bruising
- Cleaning your mouth
- Tobacco use
Call our office if you experience any of the following signs or symptoms, which could indicate an infection, nerve damage or other serious complication:
- Difficulty swallowing or breathing
- Excessive bleeding
- Severe pain not relieved by prescribed pain medications
- Swelling that worsens after two or three days
- A bad taste in your mouth not removed with saltwater rinsing
- Pus in or oozing from the socket
- Persistent numbness or loss of feeling
- Blood or pus in nasal discharge