Surgical Extractions & Root Canal Therapy

Extractions

Wisdom teeth extractions are a fairly common procedure. Wisdom teeth often cause problems as they are trying to protrude through the gums. When a wisdom tooth is impacted, it means the tooth is coming in at an angle and not straight through the gum line. This can cause pain, the tooth can come in unevenly, or the tooth may only emerge partially.

When a wisdom tooth only emerges partially a flap of skin, called an operculum, may form over the tooth. This can make the tooth hard to clean, and pieces of food may be caught under the skin. This makes it easy for an infection, called pericoronitis, to develop. It will usually go away on its own, but it causes swelling and pain in the area.

Impacted teeth and wisdom teeth that can potentially cause problems, like infections, need to be removed. Extractions can range from a single tooth, to removing all four wisdom teeth at once. Based on the preference of the doctor and/or the patient, a local anesthetic could be used to numb the areas where the teeth will be extracted. Others will prefer to go under a general anesthetic so that they will be sedated during the procedure.

The gum tissue around the wisdom tooth is cut open to reveal the tooth. The tooth is loosened by gripping it tightly and wiggling it back and forth until it can be lifted out of the gums. Sometimes a tooth may be impacted so tightly that it cannot be simply lifted out of the gums. In cases like this the tooth will be broken up into pieces first before being removed. Depending on the incision and extraction site, sutures may be needed to close the area. Soluble sutures are the best option, which will dissolve on their own.

After the surgery you will need to rest. You need to be driven home by a friend or family member because of the anesthesia. You can expect for the extraction site to bleed for a little while after the surgery. Gauze will be applied at the completion of the surgery, and you will need to change it when it becomes soaked. If bleeding continues for longer than 24 hours you should call your dentist. Rest when you return home, but do not lie flat. This could prolong the bleeding. Prop your head up on a pillow when lying down. Your dentist will prescribe you pain medication, so if you become sore take as directed. You can also use an ice pack for the pain. Your dentist might also provide you with a cleaning solution to clean the extraction site.

You will be limited to soft foods for a few days after your surgery. Some recommended foods are:

 

  • Gelatin
  • Pudding
  • Yogurt
  • Mashed Potatoes
  • Ice Cream
  • Thin Soups
  • …and other food you can eat without chewing.

When drinking, make sure you do not use a straw. The sucking motion can loosen your sutures and slow the clotting process. The same goes for smoking. If you have prolonged pain, bleeding, irritation, or don’t feel that the extraction site is healing properly call your dentist for a follow up.

 

Oral Sedation dentistry (valium nitrous)

Nitrous oxide is used in roughly one-third of dental practices in the United States. The benefits of nitrous oxide are many, and the risks are few. The gas is administered with a comfortable mask placed over the nose, and the patient is instructed to breathe in through the nose and out through their mouth. As a precaution, patients should not eat anything for about two hours prior to use of the gas. The patient begins to feel a pleasant level of sedation anywhere from 30 seconds to three or four minutes. The cheeks and gums will also begin to feel numb in about a third of the patients.

After the gas is adjusted to the appropriate dose and the patient is relaxed and sedated, the dentist can comfortably give the injection (if needed) to the patient, and then proceed with dental treatment. After the treatment is completed, the patient is given pure oxygen to breathe for about five minutes, and all the effects of sedation are usually reversed. Unlike IV sedation or general anesthesia, the patient can almost always leave the office by themselves, without an escort.

Nitrous oxide has few side effects. High doses can cause nausea in some patients, and about 10 percent of patients do not benefit from it. Patients that are claustrophobic or have blocked nasal passages cannot use nitrous oxide effectively. Nitrous oxide is one of the safest anesthetics available. Interestingly, it is also routinely used by anesthesiologists for general anesthesia in combination with other more potent gases.

Dentists find nitrous oxide especially useful for fearful patients as well as young children. The effect of nitrous oxide is often remarkable. A patient that was anxious just a minute or two before treatment will become relaxed and calm. Because nitrous oxide is so effective, dentists rarely need to prescribe Valium for anxious patients before treatment. If you are nervous before or during dental treatment, ask you dentist if he or she has nitrous oxide available — it works wonders!

Laughing Gas: How Sweet Is That Air, Anyway?

While inhaling nitrous oxide, you might feel warm, pleasant and relaxed, along with lightness in the limbs – others describe a weighted feeling.

Aside from its long track record of success, laughing gas dentists still sweeten the air for several other reasons:

  1. Nitrous oxide is safe and easy. Dentists, hygienists, and in some states, dental assistants, may raise your pain threshold with conscious sedation laughing gas. Many states require board certifications for hygienists and assistants, but others do not. All states require a dentist’s supervision.
  2. It has dose versatility. Your nitrous oxide dentist or hygienist will raise the gas level incrementally and monitor your responses. Other oral sedation methods tend to come in set dosages.
  3. Laughs come fast and then they’re gone. Nitrous oxide takes effect within minutes and lasts for as long as you’re inhaling. And once your laughing gas dentist turns the nitrous oxide off, he or she flushes your lungs with oxygen to leave them 99 percent nitrous oxide free within minutes, according to RDH Magazine. Just try bouncing back that quickly from the effects of heavier sedation. Once laughing gas clears your system you should be able to drive yourself home.
  4. It reduces pain and anxiety. Maybe the first is obvious, but when it comes to painful dental procedures like an impacted wisdom tooth extraction, it doesn’t hurt (pun sadly intended!) to remember the reason you’re undergoing nitrous oxide sedation in the first place. (Though laughing gas does reduce pain, it may not control it completely. Your laughing gas dentist may administer a local anesthetic too.) And if you’re one of those people paranoid about dental work, the fact that laughing gas helps your dental anxiety evaporate means a faster, more comfortable dental procedure or oral surgery. You and your nitrous oxide dentist both benefit when you’re not anxious.
  5. Nitrous oxide is generally safe for all ages. Have a child or parent with dental fears? Laughing gas could be the solution for everyone from timid tykes to anxious adults. Your child should be old enough to follow instructions, be unafraid of wearing a mask and be able to breathe through the nose.

Nitrous Oxide: When the Air Goes Slightly Sour

Laughing gas lives up to its name. Because of its euphoric effect, some people get the giggles, which might get a little embarrassing if you’re a reserved person. On a serious note though, your nitrous oxide dentist will ask you not to eat a few hours before your procedure. Some patients feel nauseous from nitrous oxide, so fasting reduces incidents of vomiting. Others may get a slight headache.

Because of the mind-altering aspects of laughing gas (some people dream during their procedures, even though they are conscious and able to respond to questions and instructions), laughing gas dentists recommend certain people explore other forms of sedation dentistry, especially if they are:

  • Under the influence of drugs and/or alcohol
  • Suffering phobias
  • Unable to understand the procedure
  • Have mental illnesses

Others should ask a nitrous oxide dentist for more information if they are:

  • In the first trimester of pregnancy
  • Have sinus infections or nasal blockages
  • Recently underwent eye surgeries or tympanic membrane grafts
  • Taking prescription medications
  • Cystic fibrosis or chronic obstructive pulmonary disease patients

Recent studies, cited by the American Dental Association (ADA), show a possible link between nitrous oxide sedation and pneumonia, fever, severe nausea and infection. Complications occur after major medical surgeries in the studies, rather than dental procedures. The problems may relate to higher laughing gas to oxygen ratios used in those procedures – about a 70/30 percent mix. Dental patients typically get 50 percent or less nitrous oxide, according to the ADA. The studies are ongoing.