Extractions and Minor Oral Surgery

Sometimes unfortunately there is no other option than to extract a tooth. While no one volunteers to have extractions or surgical procedures unless they have to, it is good to know, in that event, that you have an appropriately experienced dentist with modern anaesthetics and techniques carrying it out.

While all our dentists carry out extractions, Ian Brignall and Jordi Marques-Guasch carry out extractions and “minor” surgical procedures such as removal of soft tissue swellings, apicectomies and wisdom tooth extractions, as well as implants, for a number of other dentists on referral.

It is likely that, unless your own dentist has provided one, an initial Xray will be taken to assess the tooth concerned.

Soft Tissue Swellings

Most soft tissue swellings in the mouth are innocent, so there is no need to panic.  There are various causes for them and it is important to see your dentist to check precisely what it is. Some swellings can be left alone, some need removal, some can be a symptom of an underlying problem such as a tooth abscess, whilst sometimes, mouth cancer can also present as a swelling. Most simple swellings can be easily removed if necessary.

Apicectomies/Apical Surgery

An apicectomy is a procedure sometimes used when a root canal treatment has failed and an abscess has occurred. The procedure which can be carried out under local anaesthesia for most patients involves surgical treatment to the end of the root and in many cases can save the tooth. Unfortunately it is not something that can be carried out on roots with deep cracks/split roots.

An apicectomy should never be carried out unless an excellent root filling has already failed, the first option for root treatment failure being to attempt re-treatment, which is often best carried out by a Specialist. Nowadays there is some debate in the dental world as to when to apicect a tooth and when to extract it and maybe place an implant.

Wisdom Teeth

Wisdom teeth are removed less often these days than some years ago. Often when a wisdom tooth erupts (normally at 18-25 yrs old) it will be short of space and does not come fully through, being jammed often at odd angles against the tooth in front (this is what is meant by an impacted wisdom tooth). Sometimes there is a flap of gum over the top of the tooth – the operculum, which can become infected, giving rise to pain and swelling. Whilst years ago wisdom teeth were removed almost as a matter of routine, nowadays it is only recommended that they be removed if they cause more than two bouts of infection. If infection does occur, it can be treated in a straightforward manner. The best way to avoid having infections is by scrupulous cleaning of the gum overlying the wisdom tooth.

Post Operative Instructions

After any surgical treatment, it is important that you look after the area well to minimise infection and help the healing process. You will be provided with written instructions which are detailed below.

1. When the effect of the anaesthetic injection wears off an amount of soreness will inevitably be present and analgesics (pain killers) are advised.
   
   An excellent choice, which can be obtained from the Chemist is Ibuprofen (Nurofen) whilst Aspirin and Codeine or Aspirin, Codeine and Paracetamol are reasonable alternatives.  Some patients find soluble versions more effective. Alternatively, Aspirin or Paracetamol may be used alone, but are generally less effective.
   
   For patients unable to take Aspirin, Paracetamol and Codeine may be used. 
2. There may be some minor bleeding from the area concerned – this may be stopped by applying firm pressure to this area with a gauze pad (which will have been provided for you) or alternatively, you could use a rolled up handkerchief or a ball of cotton wool for 15-20 minutes. If this does not work, call the Dentist.
3. For the rest of the day after surgery, avoid hot foods and drinks, alcohol or strenuous exertion as this may start the bleeding. Smoking is well known to impair healing and we would advise not smoking for at least the rest of the day following extraction/surgery. 
4. From the day after surgery start rinsing your mouth with hot salt water (1 teaspoon of salt to a cup of hot water), 4 times daily for the next week. This will help the healing and reduce any swelling present.
5. Brush your teeth as usual, but avoid areas with stitches.
6. Swelling after most oral surgery is inevitable. Do not worry, it will disappear with time.  It is normally worse at 2 days and resolves by 7-10 days.  Mouth opening may be restricted for this period.
7. If an area of numbness is present in your mouth, lip or tongue, be careful not to bite or burn it.
8. Antibiotics may have been prescribed and it is strongly advised you complete the whole course as instructed. If you suffer side-effects such as an itchy rash, stop the drug and let us know.  Diarrhoea from antibiotics is not an allergy and may possibly be helped by eating a live yoghurt once or twice daily.
9. Antibiotics may decrease the level of the “Contraceptive Pill” so extra precautions are advised until the start of the next cycle.
10. If prescribed Metronidazole (Flagyl) it is important to avoid alcohol.
11. If you get pain which appears to worsen after a few days, it may be that the blood clot has broken down in the socket leaving an area of bare bone, known as a “dry socket”. Please contact the surgery and we can provide a dressing to relieve the discomfort and encourage healing.

In the event of a problem occurring out of hours please telephone the number provided on the “ Emergencies “ page.