Wednesday, January 27, 2010

More On Wisdom Teeth Removal

Wisdom teeth are a often a bothersome problem for many people. The reason for problems is that there isn't enough room for these teeth to erupt into the arches in a normal fashion. They may also  come in sideways. This causes them to become impacted, which means that they are impeded from normal eruption into the dental arch.

When twisdom teeth don't erupt normally, I ususally recommend them to be removed at your earliest convenience. Some people put this off, thinking that if their wisdom teeth aren't bothering them, that they should leave them alone. This is an unwise decision. Complications from wisdom teeth removal greatly increase the older we get. If you wait until they hurt, the extractions will be very difficult with serious risks of complications. If, however, they can be removed in the late teens or early twenties, complications are much less likely to occur.

Impacted and erupted wisdom teeth can be a source of serious, life threatening infection that can casue swelling,  close off your airway and prevent breating or can even spread to your brain. Why take those chances when wisdom tooth removal at a young age is such a routine procedure?

Wisdom Teeth Removal and Post Surgical Care

Here is some information to brief you on what it's like to have your wisdom teeth removed and how to take care of yourself afterward:
Impacted Tooth_ What Is It?

An impacted tooth is one that is prevented from erupting into the mouth normally. Impacted teeth are a risk factor for problems such as infections, abscesses, cyst formation, tumor growth, and damage to adjacent teeth.

The removal of impacted teeth is an operation. It requires incision of the overlying tissue, and often the removal of bone to be able to extract the tooth. The tooth may have to be sectioned. Take this operation seriously, and plan for a couple of days' rest afterward to promote good healing. The area around the surgery will swell considerably and will be very sore. This swelling will make it hard to open your mouth for a few days. You will probably need to take pain medications for a few days after. Plan on a soft diet for a few days as well
Your surgeon should provide you with instructions on how to cleanse the area of the surgery, how to control abnormal bleeding, and other aspects of post-operative care. Follow these instructions carefully for best healing results. If your surgeon hasn't done that, here are some instructions.

Taking care of yourself after wisdom teeth removal

Rest. Avoid any physical exertion for the rest of the day. After today, listen to your body. There are great variations in the amount of rest you will need until you heal depending on your age, the amount of bone that was removed, and your own individuality. If you begin to be active prematurely, you may experience increased pain in the area of the surgery.

Watch for bleeding. Some oozing of blood is normal for the first couple of days, and you will have blood-tinged saliva for that time. This is normal. But if there are dark red clots of blood in your mouth, that isn't normal. Your surgeon will give you gauze, use that and bite on it while you rest for about forty-five minutes or so.  If bleeding persists, call your surgeon.

Take all medications that have been prescribed. For pain medication, that should be taken as needed, in other words, take it only as often as you need it to control the pain. If you find the pain medication inadequate to control the pain in the dosage prescribed, call your surgeon.

Eat softer foods the day of the surgery. Advance your diet as your discomfort lessens. If it is hard to chew, don't push yourself, but continue to eat soft foods until you can comfortably handle normal food. And be sure that you get adequate nutrition. Make sure your diet includes protein. Ice cream, milk, and protein shakesare good sources of nutrients for healing.  AVOID STRAWS!

Keep the surgical sites clean as best as you can. But you don't want to disturb the surgical sites for a few days, so start by rinsing gently with salt water the first post op day if eating solid foods. A teaspoon of salt in a cup of warm water is all you need. Brush your teeth also, being sure you use a soft brush. After a couple of days, begin to brush the teeth furthest back, being sure not to disturb any loose tissue that has been sutured into place. Within a week, that loose tissue should be much firmer.

Possible  complications

The most common complication is dry socket. This ordinarily occurs in less than 10% of patients, and is much more common in the lower jaw. Dry socket results from dislodging the newly formed clots or premature breakdown of the clots. Symptoms include mild discomfort for three to five days, and then there is a dramatic increase in pain coming from the socket and radiating to the ear, down the neck and to other teeth. You may notice a foul taste in your mouth and foul odor. If this happens to you, call your surgeon. There is a dressing that will ease the pain; you may need additional prescriptions as well.

Sometimes sharp edges of bone may surface as the surgical sites heal. Often, this does not require surgical treatment. It occurs because, after the extraction, your body begins to work to reshape the soft tissues and bone in the area formerly occupied by the tooth. Unless these area cause major discomfort,salt water rinses should allow the gums to cover the area, and the normal healing process will prevail. If necessary, your surgeon can smooth the affected areas.

The roots of lower wisdom teeth may lie near the nerve in the lower jaw, and their crowns may be near the nerve that supplies the tongue. During the surgery, these nerves could be damaged. This happens in less than 1%  of cases. The result would be numbness in the lips, chin, and teeth and gums on the affected side, or in the side of the tongue if the lingual nerve was affected. Motion is not affected, only sensation. If this happens , call your surgeon immediately. It may also be possible that the nerves were not touched during the surgery, but there is swelling that is pressing on the nerve.  I often prescribe a low dose steroid post op to prevent this from occurring.
If you do have nerve damage, expect the symptoms to last for several weeks. The nerve may take a month or several months to repair itself. It is not very common for this numbness to be permanent, but that is a possibility. If the nerve was actually severed during the surgery, the numbness will likely be permanent unless the nerve is surgically repaired by a microsurgeon ( I happen to hold expertise in this field).

If the roots of your upper wisdom teeth lie close enough to the floor of one of your maxillary sinuses, your sinus floor could be perforated during the operation. If that happens, you may notice bleeding through your nose after the surgery, do not be alarmed, these perforations seal themselves off and heal normally without anty intervention. Call your surgeon who can advise you on how to care for it until it heals. Your surgeon may want to perform a minor post-operative surgical procedure to close the hole if it persists. In rare cases, the floor of the sinus can be so delicate that attempts at extraction cause the tooth or a piece of the tooth to be displaced into the sinus. If this happens, the piece or tooth should be surgically removed to prevent later sinus infections.

The degree of risk of complications varies from patient to patient and increases greatly with age. If you are over age 35 when the impacted teeth are removed, you have a greater chance of complications, because of  increased bone density. If you have the tooth extraction before their roots are completely formed, the risk of complications is usually minimal. The position of the teeth in the jaw and the difficulty of the surgery also affect the degree of risk.

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Wednesday, January 6, 2010

Bone Grafting and Its Importance 101

For patients that are seeking out dental implants, they often come to see me and hear that they are going to have to have to undergo bone grafting before they are able to have their dental implants placed. The  most obvious questions that follow involve the what bone grafting is and the purpose of bone grafting.

What Is Bone Grafting?

Bone Grafting is the procedure of adding bone to an area of the mouth where it is missing. It can be used in any area of the mouth where it is needed. When adding bone to a patient’s mouth, I  will use one of three types of bone: autogenous, allograft, or alloplasts. Autogenous bone is bone that belongs to the patient receiving it. Allograft bone refers to donor bone and alloplasts are synthetic bone substitutes. I often use a combination of the above as well.

In addition to the bone, I may in some instances add PRP, a healing agent that comes from your blood and is accessed through the IV. The area will be closed off with either a collagen, synthetic, or donor membrane.

Why Is Bone Grafting Performed?

Bone grafting is performed for two reasons: to create enough bone for dental implants or to fill out bone deterioration under the gums.  Bone grafting is often needed when a patient has been without teeth for a while or for another reason has lost bone in the area where the implant will be placed.  The human body resorbs or "melts away" bone in the jaws after teeth are lost because the area is not under function any longer.  The dental implant will need the bone in order to hold it in place.  If the bone grafting is to fill out the bone alone, the reason is generally cosmetic or for gum contour reasons.

Time Frame of Bone Grafting

Often, the dental implant can be placed at the same time the bone grafting surgery is performed. However, this will often depend on the individuals particular anatomy and clinical situation.

When bone grafting is done before the dental implant is placed, healing time for the bone to heal prior to having the implant placed usually ranges from 3 to 6 months.

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Gingival Grafting (Gum Grafting) Procedures and Their Importance

Gum disease, aggressive brushing, and factors such as genetics and the aging process can cause a patient’s gums to recede. If you’re self-conscious about the amount of tooth surface that shows when you smile, there’s an answer. It’s called gingival grafting or "gum grafting", this procedure is an important one offered at our office. Gum grafts improve a smile’s appearance and health. The procedure adds tissue to your gums, restoring the proper aesthetic ratio of gums to teeth and maintaining an optimal level of gum tissue.

Adequate gum tissue is vital to keeping teeth healthy, so if you are considering tooth replacements with dental implants, a gum graft treatment can help prepare your mouth for a successful implant process.

Gum grafts provide patients with:

•Protection against tooth decay
•Coverage of tooth roots
•Better overall oral health
•Reduced bone loss
•Greater chance of implant success

A gum graft is performed by a board certified oral and maxillofacial surgeon with the advanced tools and techniques needed to perform the surgery. Before undergoing a gingival graft, you will have the option to use your own tissue for the procedure or use donor tissue, which Dr. Dorfman utilizes called Alloderm. IV sedation or General Anesthesia options are available to help you stay comfortable during treatment.

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