Pain? Dental Emergency?!
Master, College of Conscious Sedation American Dental Society of Anesthesiology
Anesthesia for a pleasant escape
Systemic dentistry for a better life
Michael A. Starkey, DDS MS and The Team
Oral Surgery including tooth extractions and bone grafting
We provide dental surgery such as extractions and bone re-contouring and grafting. Pulling teeth is stressful for patients, especially impacted wisdom teeth and we can provide you with the level of anesthesia and preventive antibiotics you need.
Difficult extractions done with local anesthetic alone will result in post operative pain and swelling. Most often one sees this in wisdom teeth removal; There can be huge swelling of the patient's jaws and cheeks. In addition the swelling will be around for about a week.
However, with IV sedation Dr. Starkey can include a steroid that reduces the amount of swelling and gives added pain relief. Plus you look like a normal human being the next week at work.
Sometimes a 3 D scan is advised.
This is to show where roots of certain teeth are relative to critical sites such as nerves, other teeth, and sinuses. Wisdom teeth are a particular problem in regards to proximity to the mandibular canal which contains an important nerve. In such situations when the root tips are growing close to or around the mandibular nerve for example. And it is a better indicator of how the surgery will turn out or whether it is prudent to wait or to get a second opinion or to be referred to a an oral surgery specialist.
There is an advantage to removing wisdom teeth when the patient is in late teens because less risk of post operative complications.
Tooth infections can create a huge risk for the patient. That is because of their location near facial planes between muscle sheaths as well as growing into sinus cavity. People can and have died from infected teeth in spite of today's powerful IV antibiotics and advancements in surgical instruments.
It is irony that some patients can have several bad teeth and not get a life threatening infection while another person can have just one infected tooth that results in death. Because you know some one with bad teeth that is getting around does that mean you can get by also?
There are also risks to having extractions such as infection, nerve damage, hole in the sinus and damage to other teeth and excess jaw bone removal and even a cracked or broken jaw. You will need to review oral surgery informed consent to get the complete list of potential problems.
Sometimes bone grafting or placement of PRF is helpful at the extraction sites. Sometimes implants can be placed at the time of extractions as well as the placement of an implant. This saves patient time and extra surgeries and money. But conditions have to be right.
There needs to be adequate bone and no extensive infection.
This is a two dimensional x ray of wisdom teeth. There is special risk of damaging mandibular nerve and causing permanent numb lip. It would be wise to obtain a 3 D scan to see where the roots are relative to the nerve channel inthe buccal lingual direction. The 3D scan below shows how the mandibular nerve passes between roots and not along the side as they usually do. Extra care is required and if a root tip breaks it may be more prudent to leave in place. The trauma of digging the root can damage the adjacent nerve. Root tips are left behind now and then without complication later.