Cemented veneers.

Dental Veneer Placement

Overview

The porcelain laminate veneer (PLV) has gained significant notoriety throughout popular culture. The use of this treatment modality has elicited a discussion of its appropriateness and ethical usage. [1]Currently, there are no universally accepted guidelines as to the suitability of this treatment modality.

PLVs are routinely used in the correction of malposition and minor dental diastemas (see images below). In addition, malformations, minor chips, and discolorations not responsive to chemical bleaching are being remedied via the application of PLVs.

Preoperative view of a diastema

Preoperative view of a diastema

Postoperative view of a diastema closure.

Postoperative view of a diastema closure.

Successful implementation of PLVs requires meticulous planning, as well as a clear understanding of the patient’s expectations. With routine care and good oral hygiene, PLVs can be a conservative and ideal treatment option.

Two methods are currently being used to manufacture dental veneers—direct and indirect techniques. The direct method involves the direct application of composite resin on the tooth surface without laboratory fabrication. In most cases, the direct technique does not require the temporization of the dentition and may be completed in a single dental visit. The indirect method utilizes a dental laboratory for the manufacturing of the veneers. The indirect technique requires that an impression be recorded, which is an additional step. With the advent of computer-aided design and computer-aided manufacturing (CAD-CAM) technology, it is now possible to complete an indirect restorative procedure in a single dental visit.

Treatment via the direct or indirect protocol may or may not require the reduction of natural tooth structures.

Planning of Dental Veneer Placement

Preoperative protocol for dental veneer treatment requires that all sound dental and medical principles be followed. In doing so, the following should have been addressed and resolved preoperatively:

  • Active periodontal disease
  • Occlusal imbalances
  • Other active pathologies

For the vast majority of cases, the placement of a porcelain laminate veneer (PLV) is elective. The patient’s objectives and expectations should be thoroughly studied. The limitations and risks should be explained to the patient and fully understood. Alternatives such as traditional orthodontics, bleaching, and crown treatment must be explored prior to intervention. It is not uncommon for several treatment modalities to be combined in achieving the patient’s objectives.

A study of the current masticatory system requires the recording of impressions for the fabrication of study models (see image below).

Preoperative study models.

Preoperative study models.

To simulate the postoperative esthetics and functional prognosis, an esthetic wax-up may be constructed upon articulated models (see image below). This aids in evaluating treatment objectives and potential for additional needs in varying the periodontal architecture. Gingival architecture plays a crucial role in the smile design process.

Wax teeth planning (wax up) for planned veneers.

Wax teeth planning (wax up) for planned veneers.

Besides an articulated model, a survey of the patient’s extra-oral anatomy is ideal. The smile line, midline, interpupillary distance, and other pertinent anatomical landmarks are registered and considered. The recording and analysis of such data is best conducted through the use of digital photography (see image below).

Preoperative view.

Preoperative view.

Having interpreted the above, the clinician, in cooperation with the patient, can better select the appropriate veneering technique, along with the optimal substrate for the veneers.

Veneer Preparation

The preparation design for a porcelain laminate veneer (PLV) varies, and several preparation techniques exist. Overall, the tooth preparation should be optimized for the removal of the least amount of tooth stricture.

The following necessitates the removal of tooth structure during the preparation phase:

  • Providing sufficient thickness for the structural integrity of the PLV
  • Providing optimal clearance in relation to the opposing dentition
  • Accommodating space for the new morphology
  • Accommodating for a shift in the midline
  • Accommodating for change in tooth inclination
  • Removal of decay

It cannot be overemphasized that the mechanical properties and constraints of the materials used for the fabrication process be respected during preparation. With the variety of substrates available on the market, the minimum preparation depth for mechanical integrity varies. In general, when overlaying a veneer, it is important that a minimum of 1-2 mm of tooth structure be reduced. These guidelines exist for the consideration of occlusal and shear forces.

A study by Otani et al assessed an automated robotic tooth preparation system for porcelain laminate veneers for accuracy and precision compared with conventional freehand tooth preparation. The study concluded that the automated robotic procedure was able to prepare the tooth model as accurately as the conventional freehand procedure and the conventional procedure was able to prepare the tooth model with better precision.

Other guiding principles in veneer preparations include the following:

  • Maintaining enamel for bond strength
  • Terminating the veneer preparation at or above the gingiva for moisture control during cementation
  • Ensuring that occlusal contact points do not rest upon margins
  • Avoiding all sharp angles within the preparation as to mitigate force aggregation
  • Considering preparation characterizations that aid visualization for the laboratory technicians
  • Accommodating appropriate lines of draw
Veneer preperation.

Veneer preperation.

Temporization

The lack of temporization has become unacceptable to patients for reasons of esthetics and sensitivity. Besides patient needs, temporization serves as a diagnostic tool. The transitional restoration allows patients to visualize the final prosthesis. For the clinician, the temporaries permit an in vivo examination of functional esthetics. Concepts of guidance and occlusal stability derived in the study model phase may be reconfirmed. It is not uncommon for the patient to use temporaries for several weeks so both the doctor and patient can evaluate suitability.

A common technique used in the fabrication of temporary veneers utilizes a matrix, which is synthesized from a copy of the diagnostic wax-up. Numerous brands of acrylic resins may be introduced into the matrix and onto the prepared teeth for the fabrication of an accurate and acceptable transitional restoration. The temporaries are retained on the prepared teeth through mechanical and/or other bonding techniques. It is prudent that this restoration permits an efficient and effective oral hygiene regiment. Violation of this provision could result in gingival irritation, making the cementation phase of the final prosthesis nearly impossible.

After the trial phase of the transitional veneers, an impression is taken of the temporaries, along with the prepared teeth. This vital information will guide the laboratory technician in fabricating veneers that conform to form and function.

Temporary veneers.

Temporary veneers.

Cementation

Porcelain laminate veneer (PLV) cementation requires a high degree of technical skill.

All prepared teeth should be isolated with reliable moisture-control protocol. Contamination from blood, saliva, or any other fluid will compromise maximum bond strength and long-term stability.

The retention and removal of the temporary depends on the technique implemented by the clinician. After removal, the prepared teeth must be thoroughly cleansed of all residual cements and debris. Failure to do so will impede the precise seating of the veneers. Pumice may be used as an effective debridement material.

The use of a light-cured or dual-cured resin for the cementation of the final product is indicated.

Cemented veneers.

Cemented veneers.

Complications of Dental Veneer Placement

Numerous complications can contribute to failure of the porcelain laminate veneer (PLV) restoration. These include the following:

  • Dislodgement of the PLV owing to bond failure
  • Fracture of the PLV due to occlusal interference, bruxism, trauma, and/or excess unsupported porcelain (>2 mm)
  • Discoloration of margins
  • Recurrent decay
  • Occlusal interferences

Author: Abdullaibrahim Abdulwaheed, DMD; Chief Editor: Jeff Burgess, DDS, MSD

Dental Implant

Tooth Replacement Options: Dental Implants, Bridges, and Dentures

There are several options available to you if you’ve lost one or more teeth. Millions of adults have lost one or more of their teeth due to oral diseases (such as cavities or gum disease) or injury. Missing teeth can make chewing difficult, cause problems speaking, and impact a person’s sense of self-esteem. That’s why seeing a dentist about tooth replacements, which may include dental implants, bridges, or dentures, can be an important part of maintaining your dental health.

1. Tooth Replacement: Dental Implants

Dental implants are artificial tooth roots that a dentist inserts into your jaw to replace lost teeth. Putting in dental implants involves the surgical placement of a metal post into the bone underneath your gums. A replacement tooth, called a crown, will be attached to the post, giving the appearance of a natural tooth. In cases where you are missing multiple teeth, or all of your teeth, dental implants can be used in conjunction with bridges or dentures to make these tooth replacements more secure.

Dental implants are often a preferred tooth replacement option because they do not affect the adjacent teeth like a bridge does. Dental implants also look and feel like natural teeth, and are more secure than removable dentures.

But not everyone is a candidate for dental implants. To receive dental implants, you must be in good overall health, your jawbone must be able to adequately hold the implants in place, and your gum tissue should be healthy and free of disease. So, in some cases, a bridge or dentures without dental implants may be a better choice.

Dental Implant

Dental Implant

2. Tooth Replacement: Dental Bridges

A dental bridge, which is also called a fixed partial denture, may be a tooth replacement option if you are missing one or more teeth. Dental bridges get their name because they “bridge” the gap between your missing tooth or teeth and your surrounding teeth. Your dentist will bond the bridge onto the teeth that surround your gap.

Dental bridges are made from various materials, including gold, alloys, and porcelain. They can help maintain the shape of your face and the integrity of your bite, and allow you to chew, speak, and smile with more ease and confidence.

The dental bridge procedure

The dental bridge procedure

3. Tooth Replacement: Dentures

For people who have lost all or most of their teeth, dentures, or false teeth, may be the best tooth replacement option. There are two types of dentures:

Complete dentures. This type of denture is used when you have no teeth remaining, or when your remaining teeth need to be removed. They cover your upper and lower gums. If you have teeth removed, your dentist will give you an immediate denture to wear for six to eight weeks, until your gums have healed and a conventional denture can be custom designed for you.

Complete denture and partial denture

Complete denture and partial denture

Full/complete denture

Full/complete denture

Overdentures. These are removable dentures that can be used if you still have some remaining natural teeth, or have dental implants. Overdentures should only be used if your remaining teeth or dental implants are able to provide adequate support.

Over denture

Over denture

Like dental bridges, dentures can help you maintain your facial shape and your self-esteem. It may take some time before you’re able to chew and speak normally again, but these skills will improve with practice.

If you are missing teeth, talk with your dentist about whether dental implants, bridges, or dentures may be options for you.

6 Reasons You Need Regular Dental Checkups

Having to visit the dentist every six months may not be the appointment that everyone looks forward to, but it is one of the most important ones to keep. If you have found yourself wondering what the point of having regular dental checkups and cleanings really is, we’ve got something for you to think about.
If you are considering skipping a dental checkup because of cost or another factor like time or dental anxiety, make sure to consider all the risks. What you might end up paying in the long run for not visiting your dentist will likely be much higher, both for your wallet and your peace of mind. Here are some of the most important reasons why you should see your dentist regularly:

1. Oral Cancer Detection

Oral cancer is an extremely serious disease that manifests itself in various ways. Without knowing the signs of its early onset, oral cancer is often not diagnosed and can quickly progress and become life threatening. But thankfully, an early stage oral cancer diagnosis is often easily treatable.

Your dentist is highly trained to recognize these signs and symptoms, and with regular dental checkups every six months the likelihood of catching oral cancer in time is dramatically higher. Recognizing oral cancer in its early stages is key in treating it successfully, and while you may not notice oral abnormalities, your dentist will.
A VELscope Cancer exam is non-invasive, entirely pain-free, is covered by MSP in some cases, and lasts only a minute or two at most. The exam catches invisible signs of dead tissue caused by tumors forming by shining a special light inside the mouth. Takes very little time, totally painless, and could save your life? It’s a no-brainer!

2. Plaque, Tartar, and Cavities

Even with the most diligent daily brushers and flossers, there are still small areas in the mouth that are missed by a regular brushing and flossing. When plaque builds up it becomes more difficult to remove, solidifying and turning into tartar, which is extremely difficult to get rid of without professional help.

Regular dental cleanings prevent tartar from eroding teeth or creating holes in them, which is how cavities are created. Cavities rarely give any warning signs as they form, only resulting in a small ache once the tooth is already decayed. Once the damage has been done, you will have to go back to the dentist to have cavities and other tooth problems filled and fixed. This can all be avoided with regular cleanings that take care of plaque and tartar before it becomes destructive.

A cleaning appointment is also more affordable than getting a filling, so if money’s tight you should make sure not to miss the cleanings!

3. Gum Disease

Plaque and tartar buildup not only cause tooth decay but can also erode the mouth’s gum tissues. This happens when tartar buildup causes an infection where the gum is connected to the tooth, making the gum pull away from the tooth. This infection is known as gingivitis and as it progresses the tissue that attaches gums to the teeth breaks down.

Once it reaches this point it is officially gum disease, and only at this point will there likely be any swelling, bleeding, or soreness in the mouth. Along with the breakdown of gum tissue, gum disease also causes a breakdown of the bone that holds teeth in place. At this point it is common to see teeth loosening or falling out altogether and drastic treatment methods will have to be taken by a dental specialist.

Not only do specialists require more appointments and likely a blow to your wallet, but treatment of gum disease, depending on the severity, can include surgery, extremely deep cleaning, and medication. To avoid all of this, regular dental cleanings are essential in catching and addressing gingivitis before it gets out of hand.

4. Keeping Bad Habits in Check

There are many bad habits that can have a negative impact on your oral health, some of which you may not even realize are causing issues. Some of these habits include chewing ice, biting your nails, clenching your jaw, grinding your teeth, eating particularly sticky or hard sweets, brushing your teeth too hard, drinking coffee and red wine, and of course smoking.

When you go for regular dental checkups, your dentist can check for any oral damage caused by these or other habits which you may otherwise not have noticed. Being informed about specific destructive habits allows you to change or alter your lifestyle choice to prevent further damage. Visiting the dentist allows you to fix the damage that has already been done, and help your oral health be the best it can be.

5. Find Problems Under the Surface With X-Rays

A crucial part of visiting your dentist every six months is getting your teeth and jaw bone x-rayed. X-ray images allow dental professionals to see what is happening beneath the surfaces of your mouth, and can find and diagnose issues that may be invisible to the naked eye. Problems like this can include impacted teeth, which are growing teeth that are blocked from pushing through the gum line, as often seen in wisdom teeth.

Damage to the jawbone can also be pinpointed as well as any bone decay, swelling, cysts, or tumours, all of which are impossible to actually see without x-ray imaging. Finding these or any other major oral issues as soon as possible is critical in order to properly treat them.

Especially with destructive diseases that show little to no symptoms but progress quickly, up-to-date x-rays and bi-annual checkups are the best way to keep on top of your health.

6. Head, Neck, and Lymph Node Checks

In addition to checking your mouth, gums, and tongue for signs or oral cancer, your dentist will also check your neck, jaw, and lymph nodes, located just below your jawline, for any swelling, lumps, or other abnormalities. If an abnormality is found it could be a sign of a major health issue, and your dentist will alert you to it and refer you the appropriate medical professional.

Swollen lymph nodes are a particular area that do not necessarily hurt or seem out of the ordinary but when identified properly by a professional could be a sign of certain kinds of cancer or other diseases that require immediate attention. Not having regular dental checkups drastically cuts down how often your neck and thyroid glands are checked. So while looking for abnormalities only takes your dentist a minute, it could mean an extremely serious disease is identified early enough to make a huge difference.

So, Are Dental Checkups Worth the Effort?

Dentists and dental professionals are not only concerned with fixing teeth. They professionally clean your teeth, aim to ensure your teeth and gums are healthy, and check for abnormalities that may otherwise go unnoticed and could be a sign of larger health issues. Dental professionals make sure that your bones are strong, and will help you correct any habits that may be sabotaging your oral health, among other things.

Skipping dental appointments may not seem like a big deal, but oral issues can develop and progress extremely quickly whether or not you notice it. By keeping on top of your dental cleanings and checkups you’re doing yourself a big favour in the long run.

Here’s wishing you a great year of oral health.

Wisdom tooth removal

Introduction 

The removal of wisdom teeth, or third molars, is one of the most common procedures carried out in INDONESIA.

The wisdom teeth grow at the back of your gums and are the last teeth to come through. Most people have four wisdom teeth – one in each corner.

Wisdom teeth usually grow through the gums during the late teens or early twenties. By this time, the other 28 adult teeth are usually in place, so there isn’t always enough room in the mouth for the wisdom teeth to grow properly.

Because of the lack of space, the wisdom teeth can sometimes emerge at an angle or get stuck and only partially emerge. Wisdom teeth that grow through like this are known as impacted.

When to see a dentist

You should make an appointment to see your dentist if you’re experiencing severe pain or discomfort from your wisdom teeth. Your dentist will check your teeth and advise you on whether they need to be removed.

If your dentist thinks you may need your wisdom teeth removed, they’ll usually carry out an X-ray of your mouth. This gives them a clearer view of the position of your teeth.

As with any teeth problems, it’s important to see your dentist as soon as possible, rather than waiting for your regular dental check-up.

Why are wisdom teeth removed?

Your wisdom teeth don’t usually need to be removed if they’re impacted but aren’t causing any problems. This is because there’s no proven benefit of doing this and it carries the risk of complications.

Sometimes, wisdom teeth that have become impacted or haven’t fully broken through the surface of the gum can cause dental problems. Food and bacteria can get trapped around the edge of the wisdom teeth, causing a build-up of plaque, which can lead to:

  • tooth decay (dental caries) – this develops when plaque begins to break down the surface of your tooth. When tooth decay becomes more advanced, it leaves holes (cavities) in the tooth, which can affect the surrounding teeth.
  • gum disease (also called gingivitis or periodontal disease) – this occurs when plaque releases toxins that irritate your gums, making them red, swollen and painful. Gum disease can also affect the surrounding teeth and the bone around the wisdom teeth.
  • pericoronitis – when plaque causes an infection of the soft tissue that surrounds the tooth.
  • cellulitis – a bacterial infection in the cheek, tongue or throat.
  • abscess – when pus collects in your wisdom teeth or the surrounding tissue due to a bacterial infection.
  • cysts and benign growths – very rarely, a wisdom tooth that hasn’t cut through the gum develops a cyst (a fluid-filled swelling).

Many of these problems can be treated with treatment such as antibiotics and antiseptic mouthwash, so removing your wisdom teeth is only recommended when other treatment hasn’t worked.

How wisdom teeth are removed

Your dentist may remove your wisdom teeth or they may refer you to a specialist surgeon for hospital treatment.

Before the procedure, you’ll usually be given a local anaesthetic injection to numb the area around the tooth. You’ll feel some pressure just before the tooth is removed, as your dentist or oral surgeon needs to widen the tooth socket by rocking the tooth back and forth.

In some cases a cut may be needed in your gum, and the tooth may need to be cut into smaller pieces before it’s removed.

The time it takes to remove the tooth will vary. Some procedures only take a few minutes, whereas others can take 20 minutes or longer.

After your wisdom teeth have been removed, you may experience swelling and discomfort, both on the inside and outside of your mouth. This is usually worse for the first three days, but it can last for up to two weeks.

Possible complications

As with all surgery, there are risks associated with removing a wisdom tooth. These include infection or delayed healing, both of which are more likely if you smoke during your recovery.

Another possible complication is “dry socket”, which is a dull, aching sensation in your gum or jaw, and sometimes a bad smell or taste coming from the empty tooth socket. Dry socket is more likely if you don’t follow the after-care instructions given by your dentist.

There’s also a small risk of nerve damage, which can cause pain or a tingling sensation and numbness in the tongue, lower lip, chin, teeth and gums. This is usually temporary, but can be permanent in some cases.

 

Wisdom Tooth Pain Causes, Remedies and Relief

What Causes Wisdom Tooth Pain?

Painful wisdom teeth can occur for a number of reasons. Perhaps your wisdom teeth have come in crooked, can’t fit properly in your mouth, or have led to an infection around your teeth. Regardless of the cause, painful wisdom teeth can really impact your overall oral health and should be treated immediately.

Wisdom tooth pain can sometimes come out of nowhere, suddenly erupting overnight without warning. On the other hand, wisdom tooth pain can also come on slowly and gradually, and can be shrugged off or perhaps mistaken for something else.
An important first step if you think you may be experiencing wisdom tooth pain is to make an appointment to see your dentist. He or she will be able to evaluate the area, take necessary X-rays, and determine whether or not your pain is truly wisdom tooth pain.

Wisdom Tooth Pain Symptoms

Impacted wisdom teeth are prone to developing cysts (pockets of fluid) around them, which can damage the tooth and surrounding tissues, including bone. In rare cases, tumors can form around these cysts, complicating wisdom teeth extraction. The longer you hold off on seeking wisdom tooth pain relief, the more likely it is that you will require a more invasive surgical extraction procedure, or that the problematic teeth will permanently damage surrounding tissues.

It is also possible for your wisdom teeth to partially emerge from underneath the gums. In this position, it’s relatively easy for bacteria to enter through the opening around the tooth. By not seeking wisdom tooth pain relief, it’s more likely that you will experience infection. Infection will result in increased wisdom tooth pain, redness, swelling, jaw pain, stiffness and general illness. It is very easy for oral infections to enter the blood stream and affect the entire body.

At Home Wisdom Tooth Pain Remedies

So, you have made an appointment to have your painful wisdom teeth removed, but the oral surgeon couldn’t fit you in the schedule until next month. Here are some home remedies for wisdom tooth pain until your appointment.

  • Ice Chips: Apply to the painful wisdom teeth to help numb the pain and reduce swelling.
  • Over-the-Counter Pain Relievers: They can help temporarily ease the discomfort associated with painful wisdom teeth.
  • Salt Water: Using a mixture of about eight ounces of water with two teaspoons of salt, rinse to clean your mouth and help dislodge food particles and bacteria that could be causing a painful infection.

Find Wisdom Tooth Pain Relief

Wisdom tooth extraction is not an option for some people due to potential risk for complications, bleeding disorders, or some other cause. In these cases, your dentist may recommend the pain management options like those mentioned above. In cases where wisdom tooth extraction is not an option, your dentist may also prescribe a special mouth rinse that will clean your mouth after meals and kill bacteria that could potentially cause infection.

While these steps can lessen wisdom tooth pain temporarily, the only permanent solution will likely be complete extraction of the wisdom teeth. This procedure has become fairly routine; your dentist or oral surgeon will be able to fully explain the possible risks and potential benefits involved.

Wisdom tooth pain should not be taken lightly. While at-home pain management is an option for some patients, in most cases wisdom tooth extraction is the best way to alleviate wisdom tooth pain and protect your oral and overall health and well being. As always, your dentist will be able to evaluate your specific health needs and help you decide on the best option.

Wisdom Tooth Extraction Aftercare

Although usually a complication-free procedure, wisdom tooth extraction can cause some degree of pain and discomfort. Wisdom tooth pain following the surgery is usually minor and can be managed at home. Your oral surgeon will likely prescribe you medication to manage post-surgical pain following your surgery. Cold compresses and ice packs gently applied to the face can also help reduce pain and bring down swelling. Your dentist may also recommend over-the-counter pain relievers or dietary changes. Avoiding solid foods temporarily will allow the wounds to heal.

Infection is also a risk following wisdom teeth extraction. Your dentist may prescribe an antibiotic to take after surgery as a preventive measure. You will also likely be advised to use salt-water rinses multiple times a day while you heal from surgery. This will help clean out the incision site and remove food and other irritants. By keeping your mouth clean, taking antibiotics, rinsing your mouth, and taking either prescription pain medication or over-the-counter varieties, you will reduce your chances of infection and also achieve wisdom teeth pain relief.

Sources:

  1. https://www.mayoclinic.org/diseases-conditions/wisdom-teeth/basics/symptoms/con-20026676
  2. https://www.mayoclinic.org/diseases-conditions/wisdom-teeth/basics/definition/con-20026676
  3. https://cincinnatioralsurgery.com/procedure/wisdom-teeth-removal-cincinnati-oh/
  4. https://www.aaomsstore.com/p-18-wisdom-teeth-management.aspx

Why Should I Whiten My Teeth?

Maybe you’ve always wanted a beautiful white smile. Or your teeth have yellowed over time. Or you’re not happy with the staining that results from drinking coffee, tea or cola. Whatever your reason for wanting whiter teeth, you’re not alone.

Just like we all have different hair and skin color, people also have different tooth color. Some teeth are more yellow than others, while others yellow with aging. Your natural tooth color can also be affected by many factors.

  • Surface stains and internal discoloration can be caused by:
  • The natural aging process
  • Using tobacco (smoked or chewed), drinking coffee, tea, colas or red wine, and eating pigmented foods such as cherries and blueberries
  • Accumulation of plaque and tartar deposits
  • Ingesting too much fluoride (more than 2 parts fluoride per million parts water) when teeth are forming, which gives teeth a “mottled” look
  • Treatment with the antibiotic tetracycline during childhood
  • Trauma to the teeth that may cause a brown, gray or black color

There are many reasons for whitening your teeth, including:

  • The boost to your confidence and self-esteem that comes from a great smile
  • A younger appearance
  • A special event such as a wedding, job interview or class reunion
  • To make a positive first impression on others
  • To simply reverse years of everyday staining and yellowing

Before beginning any whitening procedure, be sure to consult with your dentist. Only he or she can evaluate whether you’re a suitable candidate for a particular treatment.

Tooth Removal

Overview
If a tooth has been broken or damaged by decay, your dentist will try to fix it with a filling, crown or other dental treatment. But when there’s too much damage for the tooth to be repaired, the tooth may need to be extracted — or removed — from its socket in the bone.

TOOTH REMOVAL Procedures
There are two types of extractions:

  • A simple extraction – this procedure is on a tooth that can be seen in the mouth. For a simple extraction, the dentist loosens the tooth with an instrument called an elevator. Then the dentist uses forceps to remove the tooth.
  • A surgical extraction – this is a more complex procedure, which is used if a tooth may have broken off at the gum line or has not erupted in the mouth. The oral surgeon will make a small incision into your gum to surgically remove the broken tooth or impacted wisdom tooth.

Tips for Pain Management After TOOTH REMOVAL

Here are a few tips to help minimize your discomfort and speed recovery:

  • You can put ice packs on your face to reduce swelling. Alternate 20 minute on and 20 minutes off.
  • Eat soft and cool foods for a few days.
  • Starting 24 hours after surgery, swish with warm salt water. Use one-half teaspoon of salt in a cup of water.
  • You should not smoke, use a straw or spit after surgery. These actions can pull the blood clot out of the hole where the tooth was.

What Is It?

Tooth extraction is the removal of a tooth from its socket in the bone.

What It’s Used For

If a tooth has been broken or damaged by decay, your dentist will try to fix it with a filling, crown or other treatment. Sometimes, though, there’s too much damage for the tooth to be repaired. In this case, the tooth needs to be extracted. A very loose tooth also will require extraction if it can’t be saved, even with bone replacement surgery (bone graft).

Here are other reasons:

  • Some people have extra teeth that block other teeth from coming in.
  • Sometimes baby teeth don’t fall out in time to allow the permanent teeth to come in.
  • People getting braces may need teeth extracted to create room for the teeth that are being moved into place.
  • People receiving radiation to the head and neck may need to have teeth in the field of radiation extracted.
  • People receiving cancer drugs may develop infected teeth because these drugs weaken the immune system. Infected teeth may need to be extracted.
  • Some teeth may need to be extracted if they could become a source of infection after an organ transplant. People with organ transplants have a high risk of infection because they must take drugs that decrease or suppress the immune system.
  • Wisdom teeth, also called third molars, are often extracted either before or after they come in. They commonly come in during the late teens or early 20s. They need to be removed if they are decayed, cause pain or have a cyst or infection. These teeth often get stuck in the jaw (impacted) and do not come in. This can irritate the gum, causing pain and swelling. In this case, the tooth must be removed. If you need all four wisdom teeth removed, they are usually taken out at the same time.

If you expect to have treatment with intravenous drugs called bisphosphonates for a medical condition, be sure to see your dentist first. If any teeth need to be extracted, this should be done before your drug treatment begins. Having a tooth extraction after bisphosphonate treatment increases the risk of osteonecrosis (death of bone) in the jaw.

Preparation

Your dentist or oral surgeon will take an X-ray of the area to help plan the best way to remove the tooth. Be sure to provide your full medical and dental history and a list of all medicines you take. This should include both prescription and over-the-counter drugs, vitamins and supplements.

If you are having wisdom teeth removed, you may have a panoramic X-ray. This X-ray takes a picture of all of your teeth at once. It can show several things that help to guide an extraction:

  • The relationship of your wisdom teeth to your other teeth
  • The upper teeth’s relationship to your sinuses
  • The lower teeth’s relationship to a nerve in the jawbone that gives feeling to your lower jaw, lower teeth, lower lip and chin. This nerve is called the inferior alveolar nerve.
  • Any infections, tumors or bone disease that may be present

Some doctors prescribe antibiotics to be taken before and after surgery. This practice varies by the dentist or oral surgeon. Antibiotics are more likely to be given if:

  • You have infection at the time of surgery
  • You have a weakened immune system
  • You will have a long surgery
  • You have specific medicine

There are two types of extractions:

  • A simple extraction is performed on a tooth that can be seen in the mouth. General dentists commonly do simple extractions. In a simple extraction, the dentist loosens the tooth with an instrument called an elevator. Then the dentist uses an instrument called a forceps to remove the tooth.
  • A surgical extraction is a more complex procedure. It is used if a tooth may have broken off at the gum line or has not come into the mouth yet. Surgical extractions commonly are done by oral surgeons. However, they are also done by general dentists. The doctor makes a small incision (cut) into your gum. Sometimes it’s necessary to remove some of the bone around the tooth or to cut the tooth in half in order to extract it.

Most simple extractions can be done using just an injection (a local anesthetic). You may or may not receive drugs to help you relax. For a surgical extraction, you will receive a local anesthetic, and you may also have anesthesia through a vein (intravenous). Some people may need general anesthesia. They include patients with specific medical or behavioral conditions and young children.

If you are receiving conscious sedation, you may be given steroids as well as other medicines in your IV line. The steroids help to reduce swelling and keep you pain-free after the procedure.

During a tooth extraction, you can expect to feel pressure, but no pain. If you feel any pain or pinching, tell your doctor.

Follow-Up

Your doctor will give you detailed instructions on what to do and what to expect after your surgery. If you have any questions, make sure to ask them before you leave the office.

Having a tooth taken out is surgery. You can expect some discomfort after even simple extractions. Usually it is mild. Research has shown that taking nonsteroidal anti-inflammatory drugs (NSAIDs) can greatly decrease pain after a tooth extraction. These drugs include ibuprofen, such as Advil, Motrin and others. Take the dose your doctor recommends, 3 to 4 times a day. Take the first pills before the local anesthesia wears off. Continue taking them for 3 days. Ask your doctor for complete instructions.

Surgical extractions generally cause more pain after the procedure than simple extractions. The level of discomfort and how long it lasts will depend on how difficult it was to remove the tooth. Your dentist may prescribe pain medicine for a few days and then suggest an NSAID. Most pain disappears after a couple of days.

A cut in the mouth tends to bleed more than a cut on the skin because it cannot dry out and form a scab. After an extraction, you’ll be asked to bite on a piece of gauze for 20 to 30 minutes. This pressure will allow the blood to clot. You will still have a small amount of bleeding for the next 24 hours or so. It should taper off after that. Don’t disturb the clot that forms on the wound.

You can put ice packs on your face to reduce swelling. Typically, they are left on for 20 minutes at a time and removed for 20 minutes. If your jaw is sore and stiff after the swelling goes away, try warm compresses.

Eat soft and cool foods for a few days. Then try other food as you feel comfortable.

A gentle rinse with warm salt water, started 24 hours after the surgery, can help to keep the area clean. Use one-half teaspoon of salt in a cup of water. Most swelling and bleeding end within a day or two after the surgery. Initial healing takes at least two weeks.

If you need stitches, your doctor may use the kind that dissolve on their own. This usually takes one to two weeks. Rinsing with warm salt water will help the stitches to dissolve. Some stitches need to be removed by the dentist or surgeon.

You should not smoke, use a straw or spit after surgery. These actions can pull the blood clot out of the hole where the tooth was. Do not smoke on the day of surgery. Do not smoke for 24 to 72 hours after having a tooth extracted.

Safe and Effective Infant Oral Care

It’s crucial that you have the right information early on when it comes to infant oral care. Even though your child’s first teeth are temporary, they are still susceptible to decay and infection, and mothers can actually transfer damaging bacteria to their infants, according to the American Dental Association’s (ADA) Mouth Healthy site. Knowing the correct approach to oral care for each stage of your baby’s development will ensure you’re providing the best care possible.

Infant Care Is Your Dental Care

Good oral care for your baby starts with your own dental health. Disease-causing bacteria called “streptococcus mutans” can transfer from mothers to infants easily, according to the American Academy of Pediatrics, and can result in infant dental decay. Poor dietary habits can increase bacteria production and the risk of transfer to your infant, so keep an eye on your diet and practice good oral hygiene yourself.

The Centers for Disease Control and Prevention notes that early childhood caries, or dental decay that leads to cavities, is a widespread infectious disease for infants in the U.S. It’s also one of the most avoidable, and taking the right steps at every stage can prevent it and improve oral health.

The Most Effective Care at Every Stage

Follow these four steps to ensure proper oral care for your child:

  1. Schedule your own dental cleaning and exam in the second trimester of your pregnancy. Basic cleaning and care is safe for your baby, and decreases risk of bacteria transmission and infection. Avoid any cosmetic procedures until after your child is born, and limit or delay emergency procedures, such as extractions, if possible.
  2. Schedule your baby’s first dental health and oral exam no later than one year of age, or when the first tooth erupts, according to both the ADA and The American Academy of Pediatric Dentistry. The goals of this first visit are:
  • Risk assessment: Your pediatrician will relay whether any additional steps must be taken based on the exam.
  • Education: Pediatricians and pediatric dentists recommend dental wellness visits every six months for the first five years.
  • Referrals: This means choosing a pediatric dentist who will provide comprehensive, consistent care over the next five years.
  1. In the first year, clean your infant’s gums at least twice a day, in the morning and evening, and after feedings, to prevent bacteria and food buildup. The best technique is to wrap a clean, damp gauze around your clean index finger and gently wipe your baby’s gums.

What to Avoid

Avoid overexposure to fluoride, whether in toothpaste or through bottled water. You should consult with your dentist or pediatrician for information about fluoride usage with your infant. Don’t let your baby fall asleep nursing or with a bottle in his mouth; this will minimize bacteria development. And don’t share your utensils, drinking straws or cups. Remember your bacteria is transferable and can cause infections.

Putting all these practices into place, from when to start care to what specific steps to take or to avoid, will ensure your newborn has the safest and most effective oral care. That’s great peace of mind for any parent.