Guidelines after tooth extractions

Today's post is about the instructions to be followed after tooth extractions.

  

So, dear and faithful readers of the blog,you had a tooth extraction.This might be due to many reasons,that have been covered in the posts about extractions and surgical extractions.The tooth of the photograph below had to be extracted, due to mobility as a result of periodontal disease(periodontitis). 

                                

The post today is not why the tooth had to be extracted.It simply had do.It happened. The question is what are the guidelines after the tooth extraction.

After tooth extractions we do the following                                                  

• First of all ,and that goes to all of the smokers out there, do not smoke;especially for 5-12 hours after the extraction.And the less you smoke during the healing process,the better it will be.Now,I know in advance that the smokers would look at me as if I were an alien! But there is a very good reason for my advice!

                                 
  Cigarette smoking causes a disfuction in the healing process  and lengthens the time it takes for the gums to heal. Also the puffing action of the smoiking itself and the increase of the temperature in the mouth doesn't help at all.There have been reported cases where the gums do not heal at all after a few days, as it should happen  under normal cisrumstance, and there is a continuous ache in the part of the mouth that the extract was done.This phenomenon is called "dry socket" and it is one of the situations that can happen after a tooth extraction. Under normal circumstances eg patient middle aged non smoker gums heal in 10-20 days.If sutures are done,they are usually removed in 10 days.

•  Avoid spitting blood. The increase in pressure prevents clot formation and subsequent healing of the wound tooth extraction site.

• Eat semi-liquid or liquid food.Avoid hard foods.

• Eat cold or semi-warm food.Avoid hot foods ie soups.

• If pain starts to kick in,take  some pain-killers(analgesic) or anti-inflammatory drugs, always in consultation with our dentist. Do not take aspirin, because it causes a problem in the healing of the trauma(prevents clot formation) at the extraction site.Take paracetamol or an anti-inflammatory drug
• If the tooth extraction was difficult we can put a cold patch at the external part of the mouth to the afflicted region ie ice to prevent the swelling.Under normal circumstances swelling of the region after extraction, might happen but is very small. If you have had a surgical extraction, which ment that a little bit of bone had to be removed,then the swelling is more likely to occur.
• Many patients ask about the use of antibiotics after tooth extractions. If the patient is a high risk one,medically speaking ie certain heart conditions or diabetes or other diseases, there is no need for antibiotics before the extraction. If there is a health problem, the dentist always prescribes antibiotics in consultation with the patient's attending physician(medical doctor) .
•  Is it possible to extract the tooth and then when the numbness starts to wear off,the patient might have a bit of a fever.This could be due to the fact that the extract was a little more difficult than anticipated or there was an inflammation, so the body raizes its' temerature in order to eliminate remaining microbial population.There is no need to start on antibiotics quite yet.We can take a simple anti-inflammatory drug, but definitely consult with the doctor first.The fever usually passes the next day.
  
• Finally, many people ask me about the pain during or after detal extraction. I tell my patients that the anticipation of pain is worse than the pain itself. If you have it in your mind that the procedure will hurt, then it will. I'm not asking you to be relaxed and smile,because afeter all,your tooth is about to be extracted.But the extraction itself will not hurt almost at all, because you will be under local anesthesia.After the numbness goes away it might or might not hurt.Everyone has a different threshold of pain ;so something that I find painful, might be aknowledged as simply annoying by you,the fans and fearless readers of the blog!

I hope I've helped.Good healing and remember; you're never old enough to stop believing in the tooth fairy!

                                

What is a surgical tooth extraction?

 Today's post  (and a previous promise of mine) is the analysis of the secrets of surgical tooth extractions.We will see what that intails, which teeth are most likely to be surgically extracted and overall to  extract the mystery surrounding this dental treatment.
  Surgical extraction is the treatment of teeth or tooth roots that are so damaged  they can not be removed in the usual way from the mouth.So in this case we are forced to cut open the gum a little and remove some bone.
  
"Whoa,Whoa Doctor. You mentioned too many new words and ugly pictures,and we  we did not understand one bit of it!

 Ok.Lets take it from the top,shall we?See the image below ?It is a mouth.

 

  Sorry, wrong picture.I ment to put a human mouth.
Here we are then

 

Now then,if any of these teeth need to be extracted,it is fairly simple to do so,because we have easy access to the teeth with our dental tools .

The sketch below depicts a wisdom tooth (third molar) which is impacted(meaning that the tooth is in the gums and not in the mouth).
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     Panoramic Dental x-ray

 
(Fig. 1)


 How it looks in the mouth of a patient

 

  (Fig. 2)

In order to extract this tooth,we have to cut open a part of the gum (or to put it medically "to perform an incision") and remove a small part of the surrounding bone,so that we can free the tooth,and then execute the well known extraction procedures we are well aware of from the previous post.

 Below is a video very helpful for the understanding of my words.We begin the video having on our minds the situation of the patient that is shown in Fig.2.

You see that we made an insision,we retracted the gum,we released the tooth,and we sutured the gums to help with the healing process.

If the tooth was further impacted we would have to remove the bone sourrounding the tooth a bit,but the process would be about the same.And to convince you,here is another animation about the extraction of a tooth further impacted in the mouth.

In this video the tooth was cut in half (bisected) to makethe extraction easier.

The same procedure is followed in all cases where a tooth is not easily accessible due to severe damage from dental decay or there is very little of the crown of the tooth left  or because the tooth is still impacted in the gums.

  A necessary procedure for tooth extractions,and of paramount interest in surgical extraction is the radiographic imaging of the region, ie the dental x-ray.  I believe that  a panoramic x-ray as the one shown in  Fig.1 is needed or an even more detailed radioografic test , to show us the direct connection of sensitive anatomical parts of the area in relation to the soon-to-be-extracted-tooth. The decision on the type of radiography is being made by the dentist who will perform the extraction.
  Who does surgical extractions?Surgical extraction can be performed by the general dentist, if he is familiar with the technique or by a specialized dentist ie an oral surgeon or maxillofacial surgeon or even a periodontist.
After the extraction,toy should be very careful about a few thing.We will list them in a following post

  I hope I've helped a bit in solving the mystery surrounding the surgical extraction of teeth.
Don't forget to smile!

Problem with the tooth;Extraction needed!

  Today's post is about the tooth extractions.Good old simple tooth extractions.

But are they really that simple?
   Let get one thing clear. There is no such thing as a simple extract.It might seem simple for the patient and many people thing that is the easiest thing for the dentist to extract teeth etc etc, but this is not exactly the case. Every extract has its' difficulties and may not forgive the dentist,should he chooses to take the procedure lightly!There are those teeth that will come out easy, others that seem to come easily but that was not the case, other teeth come out the hard way and others seem hard at first glance but in the end come out very easy.As for the patient,the key thing is to be relaxed.

 Because if the patient is relaxed, then the dentist is more relaxed. If the patient is on the dental chair and he is feeling like he /she is sitting on a bed of nails,then the dentist must first use his magic to try to calm the patient and then another some of that magic to extract  the tooth.

 

      

 

And sometimes there simply is not enough magic to go around! 

 

Now a key question is this

 

"Why does my tooth needs to be extracted Doctor?"

 

 There are many reasons. Maybe the tooth has been severy damaged due to tooth decay, maybe it starts to have great mobility due to periodontal disease (periodontitis),maybe it got fractured,maybe it is a wisdom tooth that needs extraction or extraction may be necessary due to orthodontic treatment maybe .. maybe .. maybe!

 In the picture below you can see a tooth that is fractured, but it can be simple extraction, and the dentist, with the proper tools,can easily access the tooth.There is no need of a surgical extraction(something that we will discuss in one of the next posts)
                                        

  How is an extraction done?

 First we would first do an x-ray, in order to obtain  information about what is happening in the area, what is the morphology of the tooth roots and what anatomic parts are near the tooth.Then we perform local anesthesia,to numb the area.

 I usually use a periotome,which is a tool to release the tooth from the periodontal fibers and the periodontic ligament that hold the tooth connected to the bone and the jaw.When we release the tooth from its' shackles, it starts to have a mobility.At this point I use a lever to further increase the mobility of the tooth.

 

                                   

 

   Eventually the tooth can be extracted with the lever or with the use of  dental forceps, to grasp the tooth and extract it.

 

 

 

 

 

 

 Under normal circumstances eg patient middle aged non smoker the gums heal in 10-20 days.If sutures are required,they are being done and are usually removed in 10 days.  

It is not uncommon for the patient to have a bit of a fever after the extraction and after the anesthesia has ceased.This is hardy a reason to alarm the patient;it might be due to that the tooth was a bit difficult to extract or that the area of the extraction had inflammation, whereby the body acts so as to eliminate the remaining microbial population.There is no need for antibiotics.If we want we can have an  antiinflammatory drug,but definitely consult with the doctor first.The fever usually passes the next day.

 All of the above are described in the following video.
                        

                          And this concludes today's post.Don't forget to smile!!