Oral Surgery & Tooth Extraction Care
At times, tooth extraction, particularly of wisdom teeth, might be necessary. At Kingsview Dental, our team is equipped with the skills and tools needed to ensure a smooth and nearly painless extraction experience for you.
For more insights on the range of extraction services we offer, feel free to explore the links below:
Oral Surgery
By adulthood, typically around 18, individuals have 32 teeth; 16 on the upper jaw and 16 on the lower. However, the average mouth is designed to accommodate only 28 teeth. The discomfort arises when 32 teeth vie for space in a mouth suited for 28. The extra four teeth, known as third molars or wisdom teeth, can be problematic.
Why Should I Have My Wisdom Teeth Removed?
Wisdom teeth are the last to make an appearance in the mouth. They may not need removal if properly aligned and surrounded by healthy gum tissue. However, more often, they misalign. Extraction becomes crucial when wisdom teeth are unable to erupt correctly due to obstruction. They might grow sideways, partially emerge from the gum, or remain trapped beneath the gum and bone. Such misalignments can lead to various issues. Partial eruption, for instance, allows bacterial growth around the tooth, causing infection, swelling, stiffness, and pain. Additionally, the pressure from emerging wisdom teeth might disrupt the alignment of other teeth. The most severe complications arise when tumours or cysts develop around impacted wisdom teeth, endangering the jawbone and other healthy teeth. Removing the problematic teeth usually alleviates these issues. It's advisable to consider early removal to prevent future complications and minimize the surgical risks involved.
Common problems with wisdom teeth include gum disease, recurrent gum infections, abscesses, untreatable pathologies, inability to treat cavities without extraction, cysts or tumors, and fractures to wisdom teeth or neighboring ones. These issues may lead to gum or jawbone pain, bad breath, gum redness or swelling, unpleasant taste, or headaches.
Wisdom Tooth Extraction
If extraction is deemed necessary during your consultation, an additional appointment with our oral surgeon will be arranged to discuss your options, answer queries, and explain potential surgical risks before proceeding.
Post Wisdom/Teeth Removal
The removal of impacted teeth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully. Immediately following surgery:
Directions immediately following surgery:
Bite on the gauze pad placed over the surgical site for an hour. After this time, the gauze pad should be removed and discarded and replaced by another gauze pad. Refer to the section on BLEEDING for more details.
Avoid vigorous mouth rinsing or touching the wound area following surgery. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
To minimize any swelling, place ice packs to the sides of your face where surgery was performed. Refer to the section on SWELLING for explanation.
Take the prescribed pain medications as soon as you can so it is digested before the local anesthetic has worn off. Having something of substance in the stomach to coat the stomach will help minimize nausea from the pain medications. Refer to the section on PAIN for specific details.
Restrict your activities the day of surgery and resume normal activity when you feel comfortable. If you are active, your heart will be beating harder and you can expect excessive bleeding and throbbing from the wound.
NO SMOKING UNDER ANY CIRCUMSTANCES
Bleeding
A certain amount of bleeding is to be expected following surgery. On the skin where the surface is dry, bleeding clots in 10 minutes. In the mouth where things are wet, it takes 6-8 hours for the clot to gel up and the bleeding to subside. Slight bleeding or oozing causing redness in the saliva is very common. For this reason, the gauze will always appear red when it is removed. Saliva washes over the blood clots and dyes the gauze red even after bleeding from the sockets has actually stopped.
First GENTLY rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for sixty minutes, may control excessive bleeding. Repeat as necessary.
If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. This can be repeated several times.
Minimize further bleeding by sitting upright, keeping calm, maintain constant pressure on the gauze (no talking or chewing) and avoid exercise.
If bleeding does not subside after 6-8 hours, call the office for further instructions (416-368-2855).
Swelling
It is normal to experience swelling of the cheek(s) after the removal of impacted wisdom teeth.The swelling will not become apparent until the day after surgery and will not reach maximum effect until 2-3 days’ post-operation.
The swelling may be minimized by the immediate use of ice packs. Sealed plastic bags filled with ice, ice packs, or a bag of frozen peas or corn wrapped in a washcloth should be applied to the side of the face where surgery was performed.
The ice packs should be applied 20 minutes on/20 minutes off for the afternoon and evening immediately following your extraction. After 24 hours, ice has no beneficial effect.
36 hours after surgery, the application of moist heat such as a warm, damp cloth to the side of the face may help to reduce any swelling that has formed.
If swelling or jaw stiffness persists for several days, there is no cause for alarm. Soft, puffy swelling that you can indent with your finger is very normal after oral surgery.
In the event that the swelling becomes hot to the touch, bright red and rock hard, which does not indent with finger pressure and is enlarging, it may indicate infection. These symptoms would usually develop around day 3-4 after surgery. If this should occur, call our office for support.
Temperature
It is normal to run a low-grade temperature (99°-100°F) for 7-10 days following oral surgery. A high temperature (over 101°F) might exist for 6-8 hours after surgery but should decrease after that time. 2 Tylenol or 2-3 200mg Ibuprofen (Motrin/Advil) every 4-6 hours will help to moderate a temperature.
A temperature above 101°F several days after surgery – especially when accompanied by redness, hard swelling and increased pain – are usually indicative of infection. You should call the office for instructions if this should occur.
Bruising
When the bone requires smoothing to allow for the fit of a denture, some bruising is likely to appear on the surface skin over the area. This most commonly occurs over the upper eye teeth (on the cheek and below the eye).
Bruising may not be obvious for a day or two. By the time it reaches the surface it may have already turned from purple to green to yellow in color. Over several days the yellow color will settle down the neck to about the nipple line on the chest before it disappears.
Pain
Moderate pain or discomfort following surgery is expected to last 4-5 days. For many patients, the third and fourth days may require more pain medicine than the first and second days. Following the fourth day, pain should subside consistently.
Many medications for pain can cause nausea or vomiting. It is wise to have something of substance in the stomach (i.e. yoghurt, ice cream, pudding or apple sauce) before taking prescription pain medicines or over-the-counter pain medicines (especially aspirin or ibuprofen). Pepto Bismol or Milk of Magnesia can also help to prevent or moderate nausea.
For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours or Ibuprofen (Motrin or Advil) two-three 200 mg tablets may be taken every 4-6 hours.
For severe pain take the tablets prescribed for pain as directed every 4 hours in addition to the Tylenol or Ibuprofen. The prescribed pain medicine will make you groggy and will slow down your reflexes.
Do not drive an automobile or work around or operate heavy machinery if you are taking prescription pain medicine.
Alcohol and prescription pain medicines do not mix!
If prescription pain medications are required beyond 4 days, further treatment may be indicated. Please call the office and discuss your situation with us.
Antibiotics
Antibiotics are not routinely given after oral surgery. The overuse of antibiotics leading to the development of resistant bacteria is well documented, so careful consideration is given to each circumstance when deciding whether antibiotics are necessary. Only in specific circumstances will antibiotics be prescribed to help prevent infection or treat an existing infection.
If you have been prescribed antibiotics, take the tablets or liquid as directed. You should take them on schedule until they are completely gone.
In the event of a rash or other unfavorable reaction, discontinue antibiotic use and contact our office to report any such finding.
Diet
Stay hydrated. Try to drink 5-6 glasses of water the first day and don’t use a straw. The sucking motion will dislodge the blood clot that naturally forms in the wound and delay the healing process.
Avoid hot liquids or food until the numbness wears off.
Soft food and liquids can be eaten on the day of surgery. Avoid chewing sharp or hard objects for several days so as not to disturb the surgical site.
Return to a normal diet as soon as you are able, unless otherwise directed. Many people find eating multiple small meals a day is easier than three large meals for the first few days.
Oral Hygiene
Good oral hygiene is essential to proper healing after surgery.
You can brush your teeth the night of surgery, but rinse very gently.
The day after surgery, begin rinsing your mouth with salt water (one cup of warm water mixed with a teaspoon of salt) at least 5-6 times a day, especially after eating.
Mouthwash has an alcohol base so it can cause an unpleasant sensation when it comes in contact with fresh oral wounds. Begin using mouthwash again three days after surgery by diluting the mouthwash by half with tap water. You can gradually build up to full strength mouthwash as the wound becomes less sensitive.
Smoking
Do not smoke for at least 48 hours following surgery. Smoking retards healing dramatically. Nicotine constricts blood vessels, which slows the formation and expansion of the healing blood clot in the socket. This leads to a painful complication called dry socket.
If, 48 hours after surgery, you need so much as one Tylenol or Aspirin to control pain, you should avoid smoking. This usually reflects that the clot has not grown enough to cover all the exposed bone in the socket. The exposed bone is filled with raw nerve endings. Until the nerve endings are covered with a healthy blood clot, they will cause pain. Smoking will slow this process significantly and worsen the pain.
Activity
Keep all physical activity to a minimum for 6-12 hours following surgery. If you are considering exercise beyond this time period, throbbing or bleeding may still occur, in which case you should discontinue all physical activity.
Nausea and Vomiting
If nausea or vomiting persists for more than 12 hours, please call the office for advice
In the event of nausea and/or vomiting following surgery, do not consume anything – including prescribed medicine – for at least one hour. After this period, sip slowly on coke, tea or ginger ale. Avoid milk products.
Coating the stomach with Pepto Bismol or Milk of Magnesiamay help the nausea to subside.
Other Complications
If numbness of the lip, chin or tongue occurs, there is no cause for alarm.This is usually a temporary symptom.
Patients may occasionally feel hard projections in the mouth with their tongue. They are not roots; they are the walls of the tooth socket. These projections usually smooth out in time. You may not notice this for days to weeks after surgery. If the rough edges bother your tongue or cheeks, Dr. Afif or Dr. Poulos can evaluate the area and smooth them down for you.
If the corners of your mouth were stretched during surgery, they may dry out and crack. Your lips should be kept moist with an ointment such as Vaseline.
Sore throats and pain when swallowing are not uncommon and should subside within 2-3 days.
Stiffness of the jaw muscles may make it difficult to open your mouth for 7-10 days following surgery. This is a common occurrence. Eating, talking, yawning and chewing will help the stiffness to resolve over time.
Pull out all the Stops
When you need a tooth pulled, it’s called an extraction. There are several reasons why a tooth would be extracted instead of repaired:
If the tooth is severely decayed or broken in a way that makes repair difficult or impossible
If gum disease is an issue
If the tooth’s position in the mouth is causing problems to other teeth (e.g. an
impacted wisdom tooth can cause inflammation of the gums and allow tartar and plaque to build up)In preparation for orthodontic treatment
We know that extractions can be stressful and will take every to ensure that your experience, from initial diagnosis to tooth extraction is as painless and stress-free as possible.
We encourage you to share with us any feelings of anxiety about the procedure so that we can take steps to alleviate your discomfort.