Patient Info

ORAL SURGERY

 

Examples of oral surgery procedures may include removal broken or decayed teeth, removal of retained roots of teeth, removal of impacted wisdom teeth, removal of soft lumps and bumps or surgical root canal treatments through the apices of teeth.

 

The following information is generic and may not necessarily be relevant to the procedure that is planned for you.

 

I fully expect that your appointment will go very smoothly.

 

 

Before your appointment

Your allocated time is an ARRIVAL TIME, and not necessarily the time that you will see me. There are a number of arrangements that are required before your treatment can start, so please arrive on time.

 

Have a light meal before you arrive, unless instructed otherwise.

 

You should inform me of any allergies you have and any medical conditions you have ever been diagnosed with, even if you believe that they are not relevant to your oral surgery treatment.

 

Take all your regular medications as normal, unless instructed otherwise.

 

Bring a list of any medications that you take, and if you have had any blood tests within the few days prior to your appointment, bring the results with you.

 

Patients having treatment under local anaesthetic alone may drive to and from their appointments.

 

 

Before the procedure

I will see you and make a full assessment and discuss everything with you. You must take this opportunity to ask all questions that you may have. You must ensure that you understand everything before agreeing for the surgical procedure to be performed.

 

 

Dental Implants

If replacing an extracted tooth with a dental implant is something that interests you, please inform me prior to the procedure, as it will necessitate a slightly different surgical technique.

 

 

The procedure

Most oral surgery procedures can be completed within 45 minutes. The majority take even less time.

 

You will initially be made numb with a number of small scratches in the gum as necessary. I will first ensure you are numb before embarking on the procedure. It is normal to feel a substantial amount of pressure and pushing, however it is not sharp and does not hurt. If it does, then you must inform me so that the numbness can be maintained.

 

Sometimes, opening the gum may be necessary to access the site of surgery. This feels no different. A machine that vibrates and sprays water may then be used. Once the procedure is completed, the gum will be placed back in position with stitches. Unless informed otherwise, you can assume that I have used dissolvable stitches, so there would be no need for you to return to have them removed.

 

 

After the procedure

I will not discharge you until satisfied that there are no concerns such as bleeding. I will provide you instructions on how to take care of your mouth during the healing phase.

 

The jawbone is no different from any other bone in your body, so as you would expect with an operation on any bone, such as in your leg or arm, there may be a small degree of discomfort after the procedure. This is normally readily controlled with simple painkillers such as Ibuprofen and Paracetamol. Swelling, bruising and stiffness of the jaw are not uncommon.

 

 

Potential risks and complications

Complications are rare and therefore should not be expected, but it is important to recognise that they are possible. As is the case with any intervention, the risks and benefits must be carefully considered prior to proceeding with surgery.

 

Procedures involving lower teeth may rarely cause trauma to a nerve that runs through the lower jaw and supplies the lip, chin, gums and tongue with feeling. This may result in an altered sensation of any of these areas, which could be anything ranging from numbness, tingling, pins and needles, burning, or even pain. In most cases, the feeling returns to normal eventually, but very rarely, the effect may be permanent. I will discuss this in more detail with you, including the relative chances of it affecting you in particular. In the greatest majority of people, it is reasonable to expect that nothing untoward will happen at all.

 

Procedures involving upper back teeth may affect your sinuses, which lie just above the teeth. Sometimes, a small opening occurs between the mouth and the sinus, which tends to heal spontaneously depending on its size. If it doesn’t, it can be managed with another small surgical procedure involving stretching the gum across the opening.

 

Operating on a tooth requires leaning on the adjacent tooth. If this is heavily restored or has a crown, or is decayed and fragile, then there is a susceptibility for the tooth to fracture or the restoration to be dislodged. This would then require you to return to your dentist for further management.

 

Working on your back teeth involves stretching your lips so it is not uncommon for them to be a little sore or chapped after the procedure. A little Vaseline will help.

 

Smokers and patients on particular medications may have delayed healing and susceptibility to infections. I will discuss the relevance of this to you.

 

 

Questions

You should always feel free to ask any questions, before, during or after your procedure. I am here to take care of you and you are fully in control of everything that happens.

GUM DISEASE
 
Gum disease can be in its minor form, which is called GINGIVITIS. This is inflammation of the gums and may cause bleeding. Gingivitis may progress to the more serious form called PERIODONTITIS, which is when the bone that holds the teeth in place dissolves. As this destruction progresses, the teeth become less and less supported until they become loose and are eventually lost.
 
 

WHAT CAUSES GUM DISEASE?
 
Gum disease is a disease of bacterial origin that occurs in people whose immune system make them susceptible to the attack of these bacteria.

 

Everyone has bacteria in their mouths, but patients suffering periodontal disease don’t have the immune system needed to defend themselves against the bone-dissolving type of bacteria. It is therefore essential to have these bacteria removed. Patients who have the protective immune system don’t need to remove all the bacteria.
 
The bacteria will be removed by me, then kept off your teeth daily by you. This will be achieved by me showing you a specific regime of brushing your teeth. This is different from routine tooth brushing and will be devised specifically for you. I will supervise your performance and support you with anything you need.
 
The susceptibility of a weak immune system may be due to your genetic predisposition or a medical disease. The most common causes of the susceptibility are SMOKING and DIABETES, but there are many others. Although your immune system may not be defending you against disease around your teeth, there is no reason to suggest that you have a generalised weak immune system or that you are susceptible to any other diseases.
 

WHAT DOES GUM DISEASE RESULT IN?
 
The bone surrounding the teeth dissolves, causing the teeth to be less supported. The gum that overlies the bone may recede a little, but generally stays roughly where it is. In healthy areas without bone destruction, the space between the gum and bone is 3mm or less. As bone dissolves, leaving the gum behind, it creates a space between the two that dentists call a PERIODONTAL POCKET.
 
The presence of this pocket has the following relevance:
 
The bristles of a toothbrush may reach 2-3mm under the gum if angled correctly. If a pocket is any deeper than this then the bacteria can harbour in this relatively deep area and be inaccessible for cleaning and therefore cause further bone destruction.
 
The deeper the pocket, the less oxygen is available, as it is further away from the outside world. It so happens that the species of bacteria that cause bone destruction are those that survive in conditions of low oxygen availability. The conditions are therefore conducive to disease progression.
 

TREATMENT
 
Oral Hygiene
You will be a shown a specific regime to remove the bacteria from the junction where the teeth meet the gums. The technique is specific to you, based on the shape of your gums and teeth and the measurements I would have taken during the assessment.
 
Professional cleaning above the gum
Any bacteria that have collected above the gum would have calcified to form tartar. This may look bad and smell bad but more importantly it sticks more recent bacteria to it and makes it difficult for you to perform oral hygiene.
 
Professional cleaning below the gum
The bacteria that have now migrated into the periodontal pocket also need to be removed with specially designed instruments, some of which vibrate and wash during the process. Some of these bacteria are soft and some have calcified to form hard deposits that are stuck on the tooth root surface. We will remove as much as possible. You will be made numb first so that you cannot feel this being done. Sometimes stitches are placed to assist in healing.
 

 

TREATMENT AIMS
 
If you are maintaining a successful oral hygiene routine than there will be minimal bacterial re-colonisation.
 
As previously mentioned it is the periodontal pocket that is conducive to the progression of the disease. The aim is to reduce this space as much as possible. This will occur in two ways:
 
1. As the root surface is made smooth by the removal of the calcified bacteria, the gum will STICK to it, providing some support. Although this cannot be as strong as the support initially provided by the bone, it is a substantial improvement.
 
2. The gum will RECEDE so that it migrates closer to the position of the dissolved bone. The space between the gum and the bone will therefore be less, therefore there will be more oxygen at the site. These are conditions that the disease-causing bacteria struggle to survive in.
 
POST-OPERATIVE CONCERNS
 
After giving you a thorough scrub, it may be sore as the gums heal. Operating on gums can be compared to similar operations on the skin. Soreness during this healing phase can be controlled with pain-killer tablets, mouthwashes and specific toothpastes and should only take a few days.
 
As we are hoping for the gums to recede a little, the disadvantages of this is that it exposes parts of the tooth surface that were previously covered by gum. Gum recession can be over the neck of the tooth and in-between the teeth. These areas can initially be a little sensitive but they will eventually de-sensitise as they become used to the outside world and take up fluoride from the water and toothpaste. 
 
As more tooth surface becomes exposed, the teeth will also appear longer. If this is towards the back of the mouth it is often irrelevant but there may be some aesthetic concerns if it happens towards the front of the mouth depending on how much the natural position of your lips mask your teeth when you smile.
 
As teeth are roughly triangular, the gum recession in-between the teeth will give rise to triangular spaces between the teeth. Again, if at the front of the mouth, this could be of an aesthetic concern to you. Another disadvantage is that these larger gaps get food caught in them, which therefore may need cleaning following meals.
 
 
RE-EVALUATION OF DISEASE AND TREATMENT SUCCESS
 

Further measurements of pocket presence are made 2 months after treatment. If you and I have succeeded then we should expect most of the pockets to have reduced in depth, giving rise to conditions where the disease is unlikely to progress. It is extremely unlikely to have 100% success, so a few sites may not have reduced as much as required. These can be managed in the following way:
 
1. Re-instrumentation
This involves having the sites cleaned and debrided of any re-colonising bacteria before they get a chance to cause disease progression. This should be planned for every 2-3 months.
 
2. Surgery
This involves opening the gum to gain better access to the adhered calcified bacteria therefore improving the likelihood of successful removal. The gum will then be closed again, not quite where it was before, but nearer the bone, therefore immediately ELIMINATING the pocket.  
 
 
MAINTENANCE
 
Gum disease is often successfully CONTROLLED. However it is never CURED. Following successful treatment, you will need to attend for occasional check-ups and superficial debridement so that your gums can be maintained in health.
 
 

QUESTIONS & ANSWERS

 

You are always welcome to ask me any questions at any time and I will continually encourage you to do so. It is vitally important that you are happy with the treatment you are receiving and this requires a basic understanding of the science of gum diseases. My role in managing your disease is relatively small as it will be you that keeps it under control, but I will be supervising you and supporting you every step of the way.