Oral Surgery Basics

 

By: Consumer Guide to Dentistry

 

😀 An oral surgeon is skilled to treat different mouth conditions. They provide services suitable for your needs! The Woodview Oral Surgery DC Team

 

The American Dental Association recognizes oral and maxillofacial surgery – commonly referred to as oral surgery – as one of dentistry’s nine specialty areas. This dental specialty focuses on the diagnosis and surgical and adjunctive treatment of diseases, injuries and defects related to the functional and esthetic aspects of the face, mouth, teeth and jaws (maxillofacial area).

Conditions Treated With Oral Surgery

An oral surgeon is an important link in your referral network of primary care providers. When functional dental concerns – such as keeping teeth, overcoming congenital growth issues, controlling serious oral disease and treating trauma-related damage – supersede esthetics, oral surgeons are the appropriate dental specialists with whom to seek a referral.

General dentists, orthodontists, pediatric dentists and medical physicians usually serve as the referrers. Prosthodontists often work hand-in-hand with oral surgeons to develop orthotics and prosthetic appliances to treat a number of functional issues. However, it’s important to note that whenever surgery involves the face, a cosmetic dentist should also be consulted as part of the dental team. Some patients also may wish to consult with a plastic surgeon.

An oral surgeon is skilled in the following:

Removing diseased and impacted teeth and administering anesthesia. An oral surgeon can remove impacted and damaged teeth and provide in-office anesthesia services, including intravenous (IV) sedation and general anesthesia.

Placing dental implants. In collaboration with a cosmetic or restorative dentist who designs your new smile or restorations, your oral surgeon can help with the planning and subsequent placement of your tooth implants. Oral surgeons can reconstruct bone in areas requiring it for implant placement and, when necessary or desired, modify gum tissue around the implants to produce a more natural and attractive appearance.

Treating facial trauma. Oral surgeons can repair minor-to-complex facial skin lacerations, set fractured jaw and facial bones, reconnect severed nerves and treat other facial injuries involving the oral tissues, jaws, cheek and nasal bones, eye sockets, and the forehead.

Evaluating pathologic conditions. Oral surgeons treat patients with benign cysts and tumors of the mouth and face, as well as people with malignant oral, head and neck cancer, and severe infections of the oral cavity, salivary glands, jaws and neck.

Alleviating facial pain. An oral surgeon can diagnose and treat facial pain disorders, including those caused by temporomandibular joint (TMJ) problems. Your oral surgeon can order imaging studies of the joints and make appropriate referrals to other dental and medical specialists, or a physical therapist. When non-surgical treatment is insufficient or there is definite joint damage, your oral surgeon may suggest surgery.

Performing reconstructive and cosmetic surgery. Oral surgeons can correct jaw, facial bone and facial soft tissue problems that result from trauma or the removal of cysts and tumors. Such corrective surgeries restore form and function to the maxillofacial area and often involve using skin, bone, nerves and different tissues from other parts of the body to reconstruct the jaws and face.

Performing corrective jaw (orthognathic) surgery. Oral surgeons correct minor and major skeletal and dental jaw irregularities to improve chewing, speaking and breathing. Usually in collaboration with an orthodontist (a dental specialist who treats improper bites or malocclusions), an oral surgeon surgically reconstructs and realigns the upper and lower jaws into proper dental and facial relationships in order to improve biting function and facial appearance. Oral surgeons also surgically correct birth (congenital) defects of the face and skull, such as cleft lip and cleft palate.

Your dentist, orthodontist and oral surgeon all must collaborate to determine whether orthognathic surgery is right for you or your child. However, it is the oral surgeon who decides which procedure is appropriate. As part of the dental team, the oral surgeon often provides surgical consultation and educational and emotional support for the family over the course of long-term treatment.

Providing surgical treatment for obstructive sleep apnea (OSA). If your dentist suspects that you have a sleep disorder, you will likely be referred to a sleep clinic for a polysomnography, an overnight clinic test that monitors your sleep patterns. Your dentist then will help select the best treatment for you based on whether your OSA is mild, moderate or severe. If non-surgical treatments such as behavior modification or oral appliances do not work, your dentist may refer you to an oral surgeon for a surgical procedure. Surgical procedures to correct sleep apnea include:

  • Uvulopalatopharyngoplasty, which shortens and stiffens the soft palate by partially removing the uvula and the edge of the soft palate to correct airway collapses
  • Genioglossus advancement, which opens the upper breathing passage by tightening the front tongue tendon, reducing tongue displacement into the throat
  • Maxillomandibular advancement, which surgically moves both jaws forward to open the upper airway

Education and Training for Oral Surgeons

To be certified as a diplomate of the American Board of Oral and Maxillofacial Surgery, an oral and maxillofacial surgeon (commonly called an OMFS or oral surgeon) must graduate from an accredited dental school and be licensed in the state in which he/she is practicing. The oral surgeon also must have completed four or more additional years of training in an accredited, hospital-based oral and maxillofacial surgery residency program.

Oral surgeon residents train alongside medical residents in general surgery, advanced anesthesia, plastic surgery (reconstructive or bone grafting/tissue grafting), medicine and pathology. An OMFS may treat patients in hospitals, outpatient facilities and surgery centers, as well as in a dental practice setting.

Choosing an Oral Surgeon

When selecting an oral surgeon, key questions to consider include:

How long has the oral surgeon been in practice? Ideally you want to select and be referred to an oral surgeon who has built a successful practice through years of experience. The more procedures an oral surgeon has performed, the more experience and expertise he or she can offer you.

What is the oral surgeon’s training and clinical experience in performing the specific procedure(s) you require? Ask about his or her experiences, knowledge and background with your particular problem.

What professional dental societies does the oral surgeon belong to? Has the oral surgeon received any credentials or credible accolades from these groups? Select an oral surgeon that is certified as a diplomate of the American Board of Oral and Maxiollofacial Surgery.

What continuing education courses has the oral surgeon taken? How recently have they been completed? Each state and the American Dental Association require that dentists take continuing education classes to keep them up-to-date on the latest procedures and technological advances in the field.

What is the oral surgeon’s diagnosis and proposed treatment plan? Be sure to ask about all the options to treat or correct your condition, as well as the pros and cons of each. Make sure that all aspects are thoroughly explained to you.

What are the estimated costs of the proposed treatment options? In cases where dental insurance does not cover treatment costs, does the oral surgeon offer third party and/or in-house financing?

What is the oral surgeon’s referral process and dental/medical/laboratory/hospital network? When your oral surgeon works in collaboration with other dental and medical professionals on your case, it is important that you have the same level of trust and confidence in their professional skills and care as you do in those of your oral surgeon. You also need to determine whether these dental/medical professionals – as well as the hospital and/or other surgical center where they and/or your oral surgeon may practice – accept your insurance, and whether the specific treatments/procedures they will perform are covered under your insurance plan. If laboratory-fabricated restorations are involved, is the laboratory technician certified or accredited? How long has your oral surgeon worked with this laboratory/technician? Is your oral surgeon satisfied with the quality of the laboratory and/or technician?

Emergencies are unlikely, but do find out what provisions the practice offers. What type of emergency care does the oral surgeon offer? For instance, can the oral surgeon be reached and readily available after office hours, on weekends and holidays? 

 

Source: https://www.yourdentistryguide.com/oral-surgery/

Advances in Dental Care: What’s New at the Dentist

 

By: WebMD

 

😃 With technological advancement, tooth restoration was made easy. Thanks to these modern tools used in dental practices today, there are a lot of good options to keep our teeth beautiful. Check them out! The Woodview Oral Surgery

 

Are you behind on your dental visits, and now you’re being driven in by a toothache, other dental problems, or guilt?

If so, be prepared — not for a lecture from your dentist — but for discovering that there is a host of new options to keep teeth healthy and beautiful.

Here are some of the newer dental care procedures and techniques that leading dentists are bringing into their practices.

Improving Dental Health: How High-Tech X-Rays Can Help

In some dental offices, digitized X-rays (think digital camera) are replacing traditional radiographs. Although digital X-rays have been on the market for several years, they have recently become more popular with dentists.

Digital X-rays are faster and more efficient than traditional radiographs. First, an electronic sensor or phosphor plate (instead of film) is placed in the patient’s mouth to capture the image. The digital image is then relayed or scanned to a computer, where it is available for viewing. The procedure is much faster than processing conventional film.

Your dentist can also store digital images on the computer and compare them with previous or future images to see how your dental health is being maintained.

And because the sensor and phosphor plates are more sensitive to X-rays than film is, the radiation dose is significantly reduced.

Digital X-rays have many uses besides finding cavities. They also help look at the bone below the teeth to determine if the bone level of support is good. Dentists can use the X-rays to check the placement of an implant — a titanium screw-like device that is inserted into the jawbone so that an artificial tooth can be attached.

Digital X-rays also help endodontists — dentists who specialize in root canals— to see if they have performed the procedure properly.

Lasers for Tooth Cavity Detection

Traditionally, dentists use an instrument they call the “explorer” to find cavities. That’s the instrument they poke around within your mouth during a checkup. When it “sticks” in a tooth, they look closer to see if they find decay.

Many dentists are now switching to the diode laser, a higher-tech option for detecting and removing cavities. The laser can be used to determine if there is decay in the tooth. The dentist can then choose to watch the tooth, comparing the levels at the next visit, or advise that the cavity be removed and the tooth filled.

When healthy teeth are exposed to the wavelength of the diode laser, they don’t glow or fluoresce, so the reading on the digital display is low. But decayed teeth glow in proportion to the amount of decay, resulting in higher readings on the display.

The diode laser doesn’t always work with teeth that already have fillings, but for other teeth, it could mean earlier detection of cavities. Note also that the diode laser does not replace X-rays; it detects decay in grooves on the chewing surface, while bitewing X-rays can find decay between and inside teeth.

Faster Dental Care: CAD/CAM Technology

The CAD in this technology stands for “computer-assisted design,” and the CAM for “computer-assisted manufacture.” Together, they translate into fewer dental visits to complete procedures such as crowns and bridges.

Traditionally when a patient needs a crown, a dentist must make a mold of the tooth and fashion a temporary crown, then wait for the dental laboratory to make a permanent one. With CAD/CAM technology, the tooth is drilled to prepare it for the crown and a picture is taken with a computer. This image is then relayed to a machine that makes the crown right in the office.

Thinner Veneers Preserve More Tooth

Veneers are the thin, custom-made shells or moldings that are used to cover the front of crooked or otherwise unattractive teeth. New materials now make it possible to create even thinner veneers that are just as strong.

What’s the advantage for you? Preparing a tooth for a veneer – which involves reshaping the tooth to allow for the added thickness of the veneer — can be minimal with the thinner veneers. Less of the tooth surface must be reduced and more of the natural tooth is kept intact.

Better Bonding and Filling Materials

If you’ve chipped a tooth, you can have it fixed to look more natural than it would have in the past, thanks to improvements in bonding material and bonding techniques.

Today’s bonding material is a resin (plastic), which is shinier and longer lasting than the substance used in the past. Often, dentists will put layers of resin on a tooth to bond and repair it. Because of the wider range of shades available, they can better blend the bonding material to the tooth’s natural color.

In restorations, when a cavity needs to be filled, many dentists have also abandoned amalgams for “tooth-colored” composite or porcelain fillings, which look more natural.

Better Dental Implants

Implants to replace lost teeth are now more common than in years past. First, a titanium implant or screw-like device is inserted to serve as a replacement root, fusing with the jawbone and protruding above the gum line. An abutment covers the protruding part and a crown is placed over that.

In the past, implants often failed. Now, the typical life of an implant is about 15 years or longer. About 95% of implants today are successful, according to the American Academy of Oral and Maxillofacial Surgeons.

New Gum Disease Treatments for Better Dental Health

When the supporting tissue and bone around your teeth doesn’t fit snugly, “pockets” form in the gums. Bacteria then invade these pockets, increasing bone destruction and tooth loss.

A variety of treatments can help reverse the damage. They range from cleaning the root surfaces to remove plaque and tartar to more extreme measures such as gum surgery to reduce the pockets.

In recent years, the focus of gum disease treatment has expanded beyond reducing the pockets and removing the bacteria to include regenerative procedures. For instance, lasers, membranes, bone grafts, or proteins that stimulate tissue growth can be used to help regenerate bone and tissue to combat the gum disease.

 

Source: https://www.webmd.com/oral-health/advances-in-dental-care-whats-new-at-the-dentist#3

Ibuprofen And Acetaminophen Together May Give Profound Pain Relief With Fewer Side Effects After Dental Surgery

 

By: Colgate

👍🏻 A study conducted by dental experts shows that combining Ibuprofen and Acetaminophen together provides a pain-relief after a wisdom tooth removal. Learn more about their findings! The Woodview Oral Surgery Team

 

Taking ibuprofen and acetaminophen (APAP) together can help manage pain after dental surgery without significantly increasing the side effects that often are associated with other drug combinations, according to an article in the August issue of The Journal of the American Dental Association.

Taking combinations of drugs to manage pain after oral surgery has been advocated in the last few years as a substitute for taking over-the-counter drugs—such as ibuprofen, naproxen and APAP—by themselves because the drug combinations can provide greater pain relief. The most common combination is APAP and an opioid—a prescription drug. The ibuprofen-APAP combination has been suggested as an alternative to taking opioid-APAP combinations to help patients avoid the potential adverse reactions associated with opioids.

Drs. Paul A. Moore, chair of the Department of Dental Anesthesiology, School of Dental Medicine, University of Pittsburgh, and Elliot V. Hersh, professor of pharmacology, Department of Oral Surgery and Pharmacology, School of Dental Medicine, University of Pennsylvania, evaluated the scientific evidence for using the ibuprofen-APAP combination to manage pain in patients after they had their wisdom teeth (third molars) removed.

They found that the ibuprofen-APAP combination may provide more effective pain relief and have fewer side effects than many of the opioid-containing combinations. They also found evidence indicating that the ibuprofen-APAP combination provided greater pain relief than did ibuprofen or APAP alone. The adverse effects associated with taking the ibuprofen-APAP combination were similar to those of the individual component drugs.

“The demonstrated improvement in postoperative pain relief for the combination of ibuprofen and APAP provides another strategy for pain management, and an alternative to prescription opioid formulations after third-molar extraction surgery,” stated Drs. Moore and Hersh in their article.

 

Source: https://www.colgate.com/en-us/oral-health/procedures/tooth-removal/ada-08-ibuprofen-and-acetaminophen-together-may-give-profound-pain-relief-with-fewer-side-effects-after-dental-surgery?

Pain Relief for Wisdom Teeth Removal

 

By: Adeola Abisogun, Livestrong

🙂 Pain may occur after a wisdom tooth removal. To avoid this and prevent the occurrences of complications, follow your dentist’s guidelines for a best dental experience! The Woodview Oral Surgery Team

 

Having your wisdom teeth removed is a common procedure, but some risks are involved. These risks include pain, temporary swelling and bruising and some less common complications. Pain relief for wisdom teeth removal is best managed by following your dentist’s instructions, which may include over-the-counter or prescription medication, comfort measures and ways to avoid preventable painful complications.

Over-the-Counter Medications

Simple extractions are performed for wisdom teeth that are not completely buried under gum or bone tissue, are positioned relatively straight compared to the other teeth and are easy for the dentist to loosen and remove. Simple extractions involve a minimal amount of trauma to remove the tooth, so postoperative pain can often be managed with over-the-counter pain medications. Nonsteriodal antiinflammatory drugs such as ibuprofen (Motrin, Advil) or naproxen (Aleve) are typically recommended for relief of mild or moderate pain. These medications have the combined benefits of relieving pain and reducing inflammation. If you have a health condition that prevents you from taking NSAIDs, your dentist or oral surgeon may recommend acetaminophen (Tylenol) or a prescription medication.

Prescription Pain Relievers

When wisdom teeth are difficult to loosen and remove, a surgical extraction may be performed. In these cases, postoperative pain can be more prominent and bruising or swelling may occur. Over-the-counter pain medications may not be adequate, so prescription-strength medications are often recommended. For moderate to severe pain, commonly prescribed pain relievers include prescription-strength ibuprofen (Motrin) and combination medications, such as codeine and acetominophen (Tylenol No. 3), hydrocodone and acetaminophen (Vicodin) and oxycodone and acetaminophen (Percocet). When taking these or any pain medications, it is important to follow specific dosage and safety instructions.

Comfort Measures

It is normal to have some discomfort or pain after having wisdom teeth removed. Avoiding alcohol, hot liquids and spicy foods and eating a soft diet in the days following the procedure can make the healing process more comfortable. Using warm salt water as a gentle mouth rinse for 24 to 48 hours after the procedure can have a soothing effect. Icing a swollen area at home can also help reduce swelling and pain. Place an ice pack wrapped in a thin cloth or towel on the swollen area for up to 15 minutes at a time.

Considerations

Some postoperative complications can lead to an unexpected increase in pain. Pain that increases 2 to 4 days after the procedure may indicate the development of a complication. Pain relief for these complications can include prescription pain medications and specific additional treatment. For example, antibiotics would be used to treat an infection or a special medicated dressing would be used for a complication known as dry socket. Before taking any medication, make sure your dentist or oral surgeon is aware of any medical conditions you have. Pregnancy, gastrointestinal problems, liver or kidney disease, high blood pressure or drug allergies are a few examples of conditions to pay special attention to before taking any new pain medication.

Source: https://www.livestrong.com/article/294960-foods-to-eat-after-wisdom-tooth-is-pulled/

Common Types of Oral Surgeries and What You Can Expect

 

By: Dental Pointe

 

💉 From wisdom tooth removal to a reconstructive operation, each oral surgery type has different functions. Determine which of them is suitable for your needs. The Woodview Oral Surgery Team

 

There are several conditions that may warrant getting oral surgery in Naperville. Sure, no one relishes the idea of surgery; however, your Naperville oral surgeon is ready to share some facts that will ensure that you’re prepared for your upcoming procedure. Here are some of the most common types of dental surgeries and what you can expect when you come into our office:

Impacted Wisdom Teeth

These third molars are the last teeth to develop. While sometimes these teeth may erupt and not cause the patient any issues, more often than not these teeth either don’t fully erupt or aren’t properly aligned. This causes them to become impacted between the gums and the jawbone, which will also affect the health of surrounding teeth.

Dental Implants

To replace a missing tooth, we will surgically implant a metal post into the jawbone, which will fuse with the gum tissue and bone over time. This creates a strong foundation on which to place a realistic-looking artificial tooth (or crown). Dental implants are great for those with tooth loss who are looking for a long-term treatment option.

Biopsies

If you have a lesion in your mouth that looks suspect, we will perform a biopsy to check for oral cancer. We will remove a small piece of tissue and then send it to the lab for analysis.

Jaw Surgery

If your jaws aren’t properly aligned, this can cause problems not only with appearance but also with function. Surgery is often necessary to correct this problem and restore function.

Sleep Apnea

If other conservative treatments don’t help serious sleep apnea sufferers, then we can remove excess tissue from the back of the throat to significantly reduce symptoms.

Reconstructive surgery

Knocked-out teeth and facial injuries can make even the most everyday functions a challenge (e.g. eating). These procedures replace missing or damaged teeth, treat jawbone and gum damage, and correct jaw joint issues.

Pre-procedure

Before surgery, we will provide you with an outlined treatment plan. We will also discuss anesthesia options with you and you can feel free to ask any questions you may have about your surgery. Most surgeries are done under general anesthesia to ensure that the patient doesn’t experience any discomfort.

Post-procedure

As with any surgery, there will be a recovery period. If you’re under general anesthesia, you will not be able to drive yourself home afterward. You will want someone to pick you up, as you will be groggy and tired. We may prescribe painkillers for treating recovery-related pain. We will provide you with some detailed do’s and don’ts for after surgery.

Complications During and After Surgical Removal of Third Molars

 

By: by Hans Ulrich Brauer, DDS, Dr. Med Dent, MA; Robert A. Green, DDS, MD, Msc, FRCD(C); Bruce R. Pynn, Ms, Oral Health Group

 

💉 There are recent studies which identify risk factors during and after removal of third molars. Complications may arise, therefore, thorough planning and surgical skills are very important. The Woodview Oral Surgery Team

 

INTRODUCTION

Third molar surgery is one of the most common procedures performed in oral and maxillofacial surgery offices.1-6 Nevertheless, this procedure requires accurate planning and surgical skills. With surgical procedures in general, complications can always arise. The reported frequencies of complications after third molar removal are reported between 2.6 percent and 30.9 percent.1 The spectrum of complications range from minor expected sequelae of post-operative pain and swelling, to permanent nerve damage, mandibular fractures, and life-threatening infections. Minor complications are generally defined as complications that can recover without any further treatment. Major complications can be defined as complications that need further treatment and may result in irreversible consequences.5,6 Although impacted third molars may remain symptom-free indefinitely, they may be responsible for significant pathology.7 Pain, pericoronitis, development of periodontal disease on the second molar, crown and/or root resorption of the second molar, caries in third or second molars and TMJ-symptoms are associated with retained third molars.2 More significant pathology such as fascial space infections, spontaneous fracture of the mandible, and odontogenic cysts or tumors may also occur.2

There are numerous recent studies, which identify risk factors for intraoperative and/or postoperative complications.1,5,6,8-15 Common intra- and postoperative complications and side effects associated with third molar removal are summarized in Table 1. For the general dental practitioner, as well as the oral and maxillofacial surgeon, it is important to be familiar with all the possible complications. This improves patient education and leads to early recognition and management. In this review, complications are considered rare or unusual if the incidence is commonly quoted below 1 percent. The aim of this systematic review is to remind us of the unusual complications associated with third molar surgery.

METHOD AND MATERIALS

Studies were found using systematic searches in Medline and the Cochrane Library electronic databases between 1990 and the present. Additionally, hand searching of key texts, references, and reviews relevant to the field was performed. Key words included the terms “third-molar,” “wisdom tooth,” “complications,” “unusual,” and “rare.”

Data was included if the following criteria were met:

1. The study had to deal with intra- or postoperative complications associated with the removal of third molars.

2. The date of publishing had to be between 1990 and 2013.

3. The text had to be published in English or German language.

In order to gather all the important studies, the references from the found studies were double-checked.

RESULTS

There are many studies reviewing permanent inferior alveolar and lingual nerve injuries and mandibular fractures during and after lower third molar removal. Several other studies/reports include inflammatory processes, unusual abscess formations and displacement of teeth in different spaces. An overview is shown in Table 2. All of these complications are considered major.

Furthermore, there are single case reports that describe extreme events, such as asphyxial death caused by postextraction hematoma, life-threatening hemorrhage, benign paroxysmal positional vertigo, subcutaneous and tissue space emphysema, subdural empyema, and herpes zoster syndrome. The reviewed case reports are presented in Table 3.

The main patient age among the cases was 28 (SD 12.7) years. In the majority of the cases, the complication occurred after third molar removal of the lower jaw. A second surgical intervention was needed in nearly all cases. In order to find the cause of the complication, computer tomography (CT) or magnetic resonance imaging (MRI) was need all of the cases. In the majority of the cases, the first surgical procedure was described as complicated and the intervention was reported as extensive or lengthy.

DISCUSSION

Permanent nerve damage

Permanent inferior alveolar or lingual nerve damages is extremely rare, but in general, well-known risks associated with third molar surgery. Injury of the lingual or the inferior alveolar nerves during removal of lower third molars is among the most common causes of litigation in dentistry.16 A close anatomic relationship between these nerves and the third molar places them at risk for injury. The incidence of these extremely rare complications vary among the studies and are difficult to be determined exactly due to the small study populations. The incidence of permanent inferior alveolar nerve lesions ranges from 0 percent17,18 to 0.9 percent;19 the usual accepted rate is about 0.3 percent.20,21 The complication rate for temporary lingual nerve damage is around 0.4 percent22 and for permanent lingual nerve damage, it is even lower.2,20

Mandibular fracture

Immediate or late fracture of the mandible is a rare event, but a major complication.23 The reduction of bone strength may be caused by physiologic atrophy, osteoporosis, pathologic processes, or can be secondary to surgical intervention.24 There is no valid data on the incidence of mandibular fractures and the risk factors are not clearly understood.24 Libersa et al., found an incidence of 0.0049 percent.25 In a study by Arrigoni & Lambrecht, 3980 third molar removals were analyzed.8 This group detected a complication rate of about 0.29 percent. The peak incidence occurs in patients over 25 years, with a mean age of 40 years.24-26 Due to a greater masticatory force, men may be more likely to have late fractures.25 Intraoperative fractures may occur with improper instrumentation and excessive force to the bone during tooth removal. Most late fractures occur between two to four weeks after surgery during masticating.51,62

Unusual inflammatory processes and abscess formation

In the reviewed case reports, extensions of the inflammatory processes to atypical regions of the brain and cervical region are discussed. In one case, a subperiosteal abscess of the orbit appeared in a 57-year-old man following the uneventful extraction of the left maxillary third molar27 which might have been caused by extension of infection via the pterygopalatine and infratemporal regions to the inferior orbital fissure. Another group presents a subdural empyema and herpes zoster syndrome (Hunt syndrome).28 In this case, a 21-year-old man had all four third molars removed. An abscess involving the right pterygomandibular and submasseteric spaces and extending to the infratemporal fossa was found. Although antibiotic therapy and drainage was initiated, he developed severe frontal headache and vomiting with a Glasgow coma score of 13. Magnetic resonance imaging (MRI) showed a subdural collection in the right temporoparietal region. He had emergency craniotomy and subdural drainage.28 Burgess reported a case of epidural abscess of a 20-year-old woman after extraction of a wisdom tooth.29 First, she was diagnosed with a musculoskeletal neck sprain resulting from posture during the operation. Three days later, the patient presented with an increased right-sided neck pain and sensational numbness to the right arm. Nine days after surgery, an epidural abscess to the right side of C4/C5 vertebrae was seen in the MRI29. In another case, a brain abscess developed after removal of the right lower third molar of a 26-year-old man. He needed emergency neurosurgery and antibiotic treatment for eight weeks.30

Displacement of third molars and instruments

Accidental displacement of impacted third molars, either a root fragment, the crown, or the entire tooth, is not common during extraction, but is nevertheless a well-recognized complication that is frequently mentioned in the literature.31-33,58 However, there is only limited information about its incidence and management. Displacement of mandibular teeth/roots usually occurs when it is located lingually, or when the lingual cortical plate is fenestrated and if surgical technique is poor.32 When a root fragment “disappears” during extraction, its retrieval should not be attempted. Immediate referral to a specialist should be arranged.34,35 Upper third molars can be displaced into the infratemporal fossa.38,39,52,56 Further reports describe third molar displacement into the submandibular space,33,38 the sublingual space,39,40,60 the pterygomandibular space,35,41 the lateral pharyngeal space42,43 or into the lateral cervical area. In one case, the symptoms started after two months. The patient experienced recurrent inflammatory swelling in the right submandibular space. Over a period of 14 months, the same dentist supervised treatment with antibiotics. After extensive imaging procedures and surgery the tooth was located beneath the platysma muscle.44 Parts of dental equipment or burs can also be lost in the adjacent tissues. A 35-year-old woman had severe trismus, swelling, and pain three weeks after removal of tooth 48. A 20 mm long diamond bur was found in the submandibular space.33

Further unusual complications

Airway compromise was described by Moghadam & Caminiti.45 A 32-year-old man experienced swelling of the soft palate due to post extraction hemorrhage after he had undergone extraction of teeth 18, 38, and 48 at his dentist’s office. Computed tomography revealed a hematoma in the submandibular and lateral pharyngeal spaces which resulted in deviation of the oropharynx and constriction of the airway at the level of the oropharynx. The patient was intubated for two days and was treated with antibiotics and high-dose steroids.45 Funayama et. al.,46 report a case of asphyxiation caused by a postextraction hematoma in a 71-year-old man. Respiratory arrest occurred 12 hours after treatment. The hematoma involved the submandibular, lingual and buccal spaces leading to severe narrowing of the oropharynx. Wasson et. al., reported a case of severe hemorrhage during the removal of an impacted third molar in a 60-year-old male patient. Over 2L of blood loss occurred prior to obtaining control, using embolization of the facial and inferior alveolar arteries.57 A single case report by Goshlasby et al., discussed the development of a right sided retrobulbar hemorrhage after the removal of an impacted maxillary right third molar. The resulting hematoma caused right periorbital swelling and ecchymosis with evidence of proptosis. The maxillary incision was extended and the hematoma was drained and bleeding was controlled. It was believed that a branch of the posterior superior alveolar artery was injured during the extraction and bleeding tracked into the orbit via the infra-orbital fissure.53 Severe intraoperative or postoperative hemorrhage is one of the few life threatening complications in which a dentist may have to initiate management.45

Thoracic complications are very rare, but have been reported in the literature.47,48,49,55,61 Sekine et. al.,47 reports on a case of extensive subcutaneous emphysema with a bilateral pneumothorax during removal of the left lower third molar in a 45-year-old man. As with many cases of emphysema, an air turbine dental handpiece was used.47-49 Recognition of mediastinal emphysema following surgical extraction is difficult because there are no absolute clinical symptoms and signs.48,49

Benign positional paroxysmal vertigo was described in one case after the removal of all third molar teeth.50

CONCLUSION

Third molar surgery is a very common procedure, but is associated with many attendant risks and complications. Fortunately, significant complications are rare, but need to be diagnosed and managed early in order to reduce morbidity, and perhaps, mortality. For the general dental practitioner, as well as the oral and maxillofacial surgeon, it is critical to be familiar with all potential complications associated with this procedure. OH

Source: https://www.oralhealthgroup.com/features/complications-during-and-after-surgical-removal-of-third-molars/

What To Eat After Tooth Extraction

By: Amy Freeman, Colgate

 

🍰 It is very important to plan the right kinds of food after your tooth extraction. They can ease your recovery and aid in faster healing. The Woodview Oral Surgery Team

 

If you need a tooth removed, summer might just be the best time. The kids are off from school, so they won’t have to miss a few days after having their wisdom teeth out. If you need to have a tooth extracted yourself, it’s often easier to get time off during this season because business slows down and you’re already more relaxed.

Once you’ve scheduled the surgery, you might wonder what to eat after tooth extraction. And as you might expect, soft foods are ideal during the first few days of recovery.

What to Eat

Eat: Ice Cream

Unless you have particularly sensitive teeth, ice cream tops of the list of what to eat after tooth extraction, especially in the summer. It’s cool and soft, so you can eat it comfortably even when your mouth is tender. Because ice cream is cold, it can help minimize any natural swelling that occurs in the mouth.

Choose your ice cream with care, though. Soft serve is ideal right after surgery since it doesn’t require as much jaw muscle to eat. You’ll also want to avoid any mix-ins or solid sprinkles along the top of the ice cream. Remember to pick a cup over a cone, too.

Eat: Cool Soup

Pureed, lukewarm or cool soups are also great to eat after a tooth’s removal. It is summer time, however, so you might prefer a smooth gazpacho over a bowl of lukewarm broth. Soup is not only easy to eat after your surgery, but it also contains plenty of nutrients and, in some cases, protein, to help the muscles in your face feel better. To avoid any discomfort, make sure the soup is as smooth as possible before you eat it. A few small pieces of cooked vegetables or pasta in the soup should be manageable, but you want to avoid anything that will require a lot of chewing.

Eat: Smoothies

Fresh fruits tend to be at their peak in the summer. One of the best ways to enjoy them after you’ve had a tooth pulled is in smoothie form. Blend the fruits with some yogurt or kefir to add protein, calcium, and probiotics to the drink. Adding yogurt or a similar type of dairy to the smoothie also helps it become less acidic, and less likely to irritate tender gums as a result.

Eat: Scrambled Eggs

As long as they aren’t too hot, scrambled eggs are another good pick following a tooth extraction. They’re gentle, high in protein and don’t require much effort in the way of chewing when eating them.

What NOT to Eat

Avoid: Spicy and Acidic Foods

You may love adding a dab of hot sauce to the things you eat during the day, but after you have a tooth removed, the best thing to do is put the bottle down and play it “cool.” If you’ve ever felt the burn of a hot pepper, you know that spicy foods can irritate your gums and mouth. And because outside irritation is the last thing you want while your mouth is healing, it’s best to wait until your dentist gives you the all-clear before enjoying your favorite spices. Like spicy foods, acidic foods can irritate your mouth after a tooth extraction and should be avoided just the same.

Avoid: Crunchy Snacks

During the first week after your tooth is pulled, steer clear of crunchy snacks, even those that may be cold or otherwise forgiving. Not only are they difficult to eat when your mouth is sore, but there’s also the chance they’ll break off and bits of them will get stuck in the socket. Stick to soft foods until your dentist tells you otherwise.

Straws and Other Concerns

As the U.S. National Library of Medicine notes, using a straw right after you have a tooth pulled causes a sucking motion that can increase your risk of developing dry socket. To minimize your risk for these complications, it’s best to take small sips of cool beverages after surgery, without a straw.

To keep your mouth in good shape, it’s usually OK to start brushing again the night after your extraction. But be as gentle as possible, sticking with a soft-bristled toothbrush such as Colgate® 360®, and avoid brushing near the area of the extraction.

 

Source: https://www.colgate.com/en-us/oral-health/basics/nutrition-and-oral-health/what-to-eat-after-tooth-extraction-0416?utm_content=buffere1570&utm_medium=social&utm_source=facebook.com&utm_campaign=buffer