Oral Surgery & Teeth Extraction
A common procedure we provide is wisdom tooth removal and, for various reasons, the extraction of other teeth. Our expert team at The Richmond Dental Centre has the experience, tools, and equipment to make the tooth extraction process as comfortable and pain-free as possible.
To learn more about the kinds of extractions we provide, please click the links below.
Oral Surgery
By the time we reach adulthood at aged 18, most of us have 32 teeth: 16 on the top and 16 on the bottom. But, the average human mouth can hold only 28 teeth. Consequently, when all 32 teeth try to fit, it can be problematic and quite painful. The extra teeth are your wisdom teeth or the third molars.
Why remove my wisdom teeth?
When wisdom teeth, the last of the teeth to erupt in the mouth, align properly and are surrounded by healthy gum tissue, there is typically no reason to remove them.
Unfortunately, this is not usually the case. More often than not, wisdom teeth may grow in sideways, emerge only partially, or even lie trapped beneath gum and bone. When they are impacted, taking a variety of positions within the bone as they attempt to find a path to break through, causing significant problems. Extracting wisdom teeth is necessary when they cannot erupt properly in the mouth. When the teeth only partially erupt, the opening that surrounds it can allow bacteria to grow, eventually causing an infection that results in painful swelling and stiffness and even illness. The pressure caused by erupting wisdom teeth can also cause the surrounding teeth to move, and there is the potential that they will interfere with the natural or orthodontic alignment of teeth. Among the most problematic complications is when tumours or cysts form around the impacted wisdom tooth, which can result in the destruction of the jawbone and healthy teeth. When we remove wisdom teeth, it helps resolve many of these problems. Early removal is often recommended to avoid painful and problematic complications in the future and to help decrease the surgical risk involved with the extraction procedure.
The most common problems associated with wisdom teeth include:
Gum or periodontal disease
Recurrent pericoronitis or infection of the gums
Abscess, cellulitis or osteomyelitis, which is the infection that spreads from the wisdom tooth into surrounding tissue
Untreatable pulpal and/or periapical pathology
Difficulty treating a cavity in another tooth unless we remove the wisdom tooth
Disease of follicles, i.e. a cyst (a fluid sac) or tumour
Root, bone or crown breakdown in the wisdom tooth
If the wisdom tooth or neighbouring tooth is fractured
If one of the problems listed is present, the following symptoms may develop:
Bad breath
An unpleasant taste in the mouth
Pain or tenderness in the gums or jawbone
Redness or swelling in the gums
Headaches or jaw ache
When to extract wisdom teeth
If we find, during your appointment, that it’s in your best interest to extract your wisdom teeth, we’ll schedule you an additional consultation with our oral surgeon. With them, you’ll discuss your options, as the surgeon answers your questions and explains any potential surgical risks. You’ll get as much information as possible!
Post-wisdom tooth removal
It’s a very serious procedure to extract wisdom teeth. As such, post-operative care is very important. If you follow the post-surgery instructions carefully, you can minimize unnecessary pain, as well as the potential for complications of infection and swelling. Immediately following surgery:
For 60 minutes, bite on the gauze pad that was positioned over the surgical site. After 60 minutes, remove the gauze pad and discard it. Replace it with another clean pad. For more details, refer to the section on BLEEDING.
Avoid touching the wound area or vigorous mouth rinsing following surgery. Touching or vigorous rinsing may dislodge the newly formed blood clot and initiate bleeding.
Place ice packs on the sides of your face on which surgery was performed to help minimize swelling. For more information, refer to the section on SWELLING.
As soon as you can begin taking prescribed pain medications, do so. The sooner, the better, so they’re digested before the local anaesthetic has worn off. To minimize nausea from the pain medications, it helps to consume something of substance to coat the stomach. For more specifics, refer to the section on PAIN.
Restrict physical activity on the day of surgery. You can resume normal activity as you feel more comfortable. If you are active on the day of your procedure, it elevates your heart rate and contributes to excessive bleeding and throbbing from the wound.
NO SMOKING UNDER ANY CIRCUMSTANCES!
Bleeding
You should expect some bleeding following surgery. On dry skin surfaces, blood clots in about 10 minutes. However, inside the mouth, where it’s moist and wet, it takes about 6-8 hours for the clot to form and the bleeding to subside. It is common to experience slight bleeding or oozing that causes red discolouration of your saliva. You can expect the gauze to appear red when you remove it. This occurs as saliva washes over the blood clots, dying the gauze red even if bleeding from the sockets has stopped.
To help control excessive bleeding, GENTLY rinse or wipe old clots from your mouth. Place a clean, dry gauze pad over the area and bite firmly for sixty minutes. Repeat as necessary.
If bleeding continues, try biting on a moistened tea bag for 30 minutes. The tannic acid in the tea bag promotes clotting by contracting the blood vessels. Feel free to repeat this several times.
To minimize further bleeding, sit upright and stay calm. Maintain constant pressure on the gauze (no talking or chewing) and avoid any exercise.
If the bleeding does not subside after 6-8 hours, call our office for further instructions (416-368-2855).
Swelling
Chances are you will experience swelling of the cheek(s) after wisdom tooth surgery. It is perfectly normal. And, it’s likely you won’t notice it until the day after surgery and reaching maximum effect 2-3 days post-operation.
To help minimize the swelling, immediately after surgery, apply ice packs – sealed plastic bags filled with ice or a bag of frozen peas or corn wrapped in a washcloth will do – to the side of the face upon which surgery was performed.
Apply ice packs alternating 20 minutes on and 20 minutes off for the afternoon and evening immediately following the removal. Note that after 24 hours of using ice packs, cold will no longer provide any beneficial effect.
After 36 hours applying moist heat, such as a warm, damp cloth to the side of the face, can help to reduce further swelling.
If you experience persistent swelling or jaw stiffness for several days, not to worry! When you have soft, puffy swelling that you can indent with your finger after oral surgery, it’s quite normal.
If, however, that swelling becomes bright red, hot to the touch and rock hard, where you can’t leave an indent with finger pressure and continues to enlarge, it could indicate infection. Symptoms of infection typically develop around day three or four after surgery. If you experience this, call our office for support.
Temperature
It’s not unusual to run a low-grade fever (99°-100°F) for 7-10 days following oral surgery. You might experience a temperature over 101°F for 6-8 hours after surgery, but it should decrease shortly thereafter. Two Tylenol or 2-3 200mg Ibuprofen (Motrin/Advil) every 4-6 hours is effective to help moderate a high temperature.
If you experience a fever above 101°F several days after surgery – especially if it’s accompanied by redness, hard swelling and increased pain – it’s an indicator of infection. Call our office for instructions.
Pain
Discomfort or pain following tooth extraction surgery is perfectly normal. In most cases, it lasts about four to five days, and for many, it’s on the third and fourth days that it requires more pain medicine than the early hours and days. But, after the fourth day, the pain should begin to subside consistently.
As many medications can cause nausea or vomiting, be sure to eat or drink something of substance to coat the stomach (i.e. yoghurt, ice cream, pudding or apple sauce) before taking them, including over-the-counter pain medicines (aspirin or ibuprofen). You can also use Pepto Bismol or Milk of Magnesia to help to minimize nausea.
If you experience moderate pain, take one or two tablets of Tylenol or Extra Strength Tylenol every three to four hours or Ibuprofen (Motrin or Advil), two to three 200 mg tablets every 4-6 hours.
If the pain is severe, take the prescribed tablets as directed every four hours in addition to Tylenol or Ibuprofen. Note that this medication will make you groggy and slows down reflexes. When using pain medication:
Don’t drive an automobile or work with, around or operate heavy machinery.
Alcohol and prescription pain medicines are a bad combination!
If you need to use prescription pain medications longer than four days, you may need further treatment – please call our office to discuss your experience with us.
Bruising
If we have to smooth the bone to fit a denture, it’s not unusual for you to experience bruising. It appears on the surface skin over the surgery area. It most commonly occurs over the upper-eye teeth (the cheek and below the eye). And it may not be visible for up to a day or two after the procedure.
Once it reaches the skin’s surface, it will have likely already turned from purple to green to yellow in hue. Over the course of several days, the yellow colour will make its way down the neck to around the nipple line on the chest before disappearing.
Antibiotics
We DO NOT routinely give antibiotics after oral surgery. There is a lot of documentation confirming that overusing antibiotics leads to the growth of antibiotic-resistant bacteria. Consequently, we give only the most careful consideration to each circumstance, deciding when and if antibiotics are necessary. It’s only in very specific situations that we prescribe antibiotics to help prevent or treat an infection.
If you are taking prescribed antibiotics, take them as directed – on schedule until they are completely gone.
If you experience a rash or other unfavourable reaction to the antibiotics, discontinue use and contact our office to report findings.
Diet
It’s very important to keep hydrated as you heal from oral surgery. As best you can, aim for 5-6 glasses of water the first day – DO NOT use a straw. When you suck a straw, the motion can dislodge the blood clot forming in the wound, delaying the healing process.
Additionally, avoid hot food and drink until the numbness in your mouth and face wears off. You can eat soft food and liquids after surgery once the numbness wears off. But avoid chewing hard, sharp, or crispy objects for several days so that you don’t interfere with the surgical site.
As soon as you feel able, you can return to a normal diet unless your dentist or oral surgeon directs you otherwise. A number of our patients find eating many small meals a day is easier than three large ones for the first several days.
Oral Hygiene
For proper healing after oral surgery, good oral hygiene is vital. Go ahead and brush your teeth the night of your surgery, but rinse only very, very gently.
The day after surgery, rinse with salt water (one cup of warm water mixed with one teaspoon of salt) at least 5-6 times a day, particularly after you eat, both snacks and meals.
Some mouthwash is alcohol-based and causes an uncomfortable sensation when it comes in contact with fresh oral wounds. Wait to use mouthwash again, diluted by half with water, until three days after surgery. Build up gradually to full-strength mouthwash as the surgery site becomes less sensitive.
Smoking
Do not smoke for at least 48 hours after surgery. Smoking will slow the healing process dramatically. Nicotine constricts blood vessels, slowing the formation and expansion of the blood clot in the socket. A blood clot is necessary for proper healing. If due to smoking, the wound heals more slowly, it can result in a painful complication called dry socket.
If you need even one Tylenol or Aspirin to control pain 48 hours after surgery, you must avoid smoking. This indicates that the clot has not grown over enough to cover the exposed bone – filled with raw nerve endings – in the socket. Until a healthy blood clot covers the nerve endings, you will experience pain. Smoking slows this process significantly and only makes the pain much worse.
Activity
Try to limit physical activity for 6-12 hours after surgery. Even beyond this time frame, throbbing or bleeding may still occur during exercise. If you experience bleeding during physical activity, discontinue it immediately.
Nausea and Vomiting
If you feel nauseous or are vomiting for more than 12 hours, please call our office for advice.
If you experience nausea and/or vomiting following surgery, do not consume anything – including prescription medication – for at least one hour. After this time, sip slowly on cola, ginger ale or tea. It’s best to avoid milk products. Take Pepto Bismol or Milk of Magnesia to coat the stomach and help minimize nausea.
Other Complications
If you experience numbness of the lip, tongue or chin, there is no cause for alarm. Numbness is typically a temporary symptom.
Days to weeks after surgery, sometimes, a patient can feel hard projections in their mouth with their tongue. These are the walls of the tooth socket, not the roots and they often smooth out in time. If the rough edges irritate your tongue or cheeks, Dr. Afif or Dr. Poulos can assess the protrusions and smooth them down for you. If you experience a sore throat and pain when you swallow, it’s not unusual. It should subside within a couple to three days. You may also notice stiffness of the jaw muscles, making it difficult to open your mouth for over a week following your surgery. It’s common and talking, eating, chewing, and yawning can help the discomfort resolve over time.
It’s also not unusual for the corners of your mouth to get stretched during surgery. As a result, they can dry and crack. Keep your lips moist with a balm such as Vaseline.
Why pull and not repair?
We call pulling a tooth extraction. And there are a variety of reasons why we choose to extract a tooth rather than repair it. They include:
If gum disease is a problem
In the case of severe decay or if the tooth is broken in such a way that repair is difficult or impossible
If the position of the tooth causes issues with surrounding teeth (i.e. an impacted
wisdom tooth causing gum inflammation where tartar and plaque can build up)Preparing for orthodontic treatment
We understand how stressful an extraction can be for many patients. To help reduce fear and anxiety, we take every measure to ensure that your experience, from your initial diagnosis to the tooth removal, is as stress-free and painless as possible.
We want you to your feelings of anxiety about your procedure with us. Communicating your concerns helps us take the necessary steps to alleviate your discomfort.