Oral Surgery & Teeth Extraction
It’s not unusual to have to remove a wisdom tooth or other tooth, as necessary. But our team here at Urbanview Dental has the deft expertise and skills, as well as the tools, to make any tooth extraction as comfortable and pain-free as possible.
Click below to learn more about what kinds of extractions we perform:
Oral Surgery
The human mouth has 32 teeth – 16 on top and 16 on the bottom. And by age 18, most of us have them all. But, the average mouth is only made to hold 28 teeth, and it’s painful when all 32 try to find room. The four extra teeth include your wisdom teeth or your third molars and, often, they can become problematic.
Do I need my wisdom teeth removed?
These third molars, your wisdom teeth, are the last to erupt through the gums. If the gum tissue is healthy and the wisdom teeth align properly, they likely don’t require removal. Unfortunately, this is the exception rather than the rule. More often than not, these teeth can’t erupt properly and we have to remove them. Chances are, they’ll grow sideways, will only partially emerge, or sometimes remain trapped beneath the gum and bone–impacted. A tooth that’s only partially erupted causes an opening around the tooth that can attract bacteria growth, infecting the area resulting in swelling, stiffness, pain, and even illness. An erupting wisdom tooth can cause significant pressure that may cause the surrounding teeth to move, interfering in their natural or orthodontic alignment. If wisdom teeth are impacted, they can position in a variety of ways in the bone as they work to find a way to break through causing many issues. The most serious problems are if tumours or cysts form around impacted wisdom teeth. This can cause the destruction of the jawbone and healthy teeth. When we remove the offending teeth, it helps to resolve many of these problems. It’s recommended that they’re extracted early, to avoid potential complications in future and to decrease any surgical risk associated with the procedure.
Common dental problems caused by wisdom teeth include:
Periodontal disease (gum disease)
Recurrent pericoronitis (multiple episodes of gum infection)
Abscess, cellulitis or osteomyelitis (wisdom tooth infection spreads into surrounding tissues)
Untreatable pulpal and/or periapical pathology
Inability to treat a cavity in a tooth without removal of the wisdom tooth
Disease of follicles, i.e. a cyst (a sac filled with fluid) or tumor
Root, bone or crown breakdown to a wisdom tooth
Fractured wisdom tooth or neighbouring teeth
If one of these issues occurs, the following may develop:
Pain or tenderness in the gums or jawbone
Bad breath
Redness or swelling in the gums
An unpleasant taste in the mouth
Headaches or jaw ache
Extracting the wisdom teeth
If during your exam, we find that it’s in your best interest to have your wisdom teeth removed, we’ll schedule you an additional consultation with our oral surgeon. With them, you can ask questions and they will your options and explain any potential surgical risks before you book the procedure.
After Wisdom Teeth Extraction
Removing teeth that are impacted is a serious surgical procedure. As such, post-operative care is very important. But, if you follow the instructions for post-surgery care, you can minimize pain and swelling as well as mitigate complications. Immediately following your surgery:
For one hour, bite on the pad of gauze placed over the surgical site. After an hour, replace the gauze with another pad. For more information, refer to the section on BLEEDING.
Following surgery, avoid mouth rinsing vigourously or touching the surgical site or wound area. Vigorous rinsing or touching may dislodge the blood clot that’s formed causing the site to bleed.
Place ice packs on the sides of your face where surgery was performed to minimize swelling. For more information, refer to the section on SWELLING.
As soon as possible, take any prescribed pain medications so it gets digested before the local anesthetic wears off. Consume something that will coat the stomach and help minimize nausea from the pain medications. Refer to the section covering PAIN for more information.
On the day of surgery, restrict your physical activities. If you’re active on your surgery day, your heartrate will be elevated and you will experience excessive bleeding and throbbing from the wound. Resume normal activity as you begin to feel more comfortable.
NO SMOKING UNDER ANY CIRCUMSTANCES
Bleeding
You can expect to experience a certain amount of bleeding after your surgery. On dry skin, bleeding clots in about 10 minutes. Inside the mouth, where it’s moist or wet, it can take about 6-8 hours for bleeding to clot and subside. But, slight bleeding or oozing making the saliva red is common. For this reason, you will notice the gauze to appear red when it is removed. As saliva washes over the blood clots, it will dye the gauze red even if the socket bleeding has stopped.
Remember to GENTLY rinse or wipe old clots from your mouth. Place a gauze pad over the area and bite on it firmly for about an hour. This may help to control excessive bleeding. Repeat as necessary.
If bleeding continues, bite on a moistened tea bag for about 30 minutes. There is tannic acid in the tea bag which will help contract bleeding vessels and help to form a clot. Repeat as necessary several times.
To minimize further bleeding, sit upright, keep calm, and keep constant pressure on the gauze (no talking or chewing) and avoid exercise.
If bleeding continues after 6-8 hours, call the office for further instructions (416-368-2855).
Swelling
You will have swollen cheeks after the removal of impacted wisdom teeth – this is normal. Swelling does not become apparent until the day after surgery. It doesn’t reach maximum effect until 2-3 days’ post-surgery.
If you apply ice packs to the face immediately after, you can minimize swelling. Use plastic bags filled with ice, ice packs, or a bag of frozen peas or corn. For greater comfort wrap them in a washcloth when resting on your face.
Apply ice packs 20 minutes on and 20 minutes off for the afternoon and evening immediately following your surgery. After 24 hours, the ice will have no beneficial effect.
When you reach 36 hours after surgery, apply moist heat such as a warm, damp cloth to the side of the face to help reduce any swelling. This will have more effect than cold packs.
If you experience swelling or jaw stiffness for several days after your extraction, there is no cause for alarm. It should feel like soft, puffy swelling that you can indent with your finger. This is normal after oral surgery.
On the other hand, if the swelling becomes hot to the touch, bright red, rock hard, and gets larger, and you can’t indent with finger pressure, it may indicate infection. You will likely see these symptoms around days three or four after surgery. If this happens, call our office for support.
Temperature
Running a low-grade temperature (99°-100°F) for 7-10 days following oral surgery is normal. You may experience a higher temperature (over 101°F) 6-8 hours after surgery. It should decrease after that time. Two Tylenol or 2-3 200mg Ibuprofen (Motrin/Advil) every 4-6 hours will help to manage a fever.
If you show a temperature above 101°F several days after surgery – especially if you also experience redness, hard swelling and increased pain – this could mean infection. Please call the office for instructions.
Bruising
When we have to smooth bone to accommodate a denture, some bruising is normal. It will likely appear on the surface skin over the surgical area. Bruising is common over the upper eye teeth (on the cheek and below the eye) and it may not be obvious for a day or so. By the time it reaches the skin’s surface, the bruise may have already turned from purple to green to yellow in colour. Over several days, the yellow color will settle down towards the neck to as far down as the nipple line on the chest before it disappears.
Pain
You can expect moderate discomfort or pain to last four to five days following surgery. It surprises many patients to find that their third and fourth days may require more pain medication than the first couple of days. But, after the fourth day, pain should consistently subside.
Note that many pain medications can cause nausea or vomiting. We encourage you to consume something of substance, that can coat the stomach (i.e. yoghurt, ice cream, pudding or apple sauce) before taking any pain medicines, prescription or over-the-counter (especially aspirin or ibuprofen). Pepto Bismol or Milk of Magnesia is effective to prevent or moderate nausea.
For moderate pain, take one or two tablets of Tylenol or Extra Strength Tylenol every three to four hours or Ibuprofen (Motrin or Advil) two-three 200 mg tablets may be taken every four to six hours.
For severe pain, take the prescribed pain tablets as directed every four hours in addition to the Tylenol or Ibuprofen. Taking prescribed pain medicine will likely slow down your reflexes and make you groggy.
A few reminders:
Don’t drive an automobile or work around or operate heavy machinery if you are taking prescription pain medicine.
Prescription pain medication and alcohol DO NOT mix!
If you have to take prescription pain medications beyond four days after surgery, further treatment may be necessary. Please call the office and talk to us.
Antibiotics
We typically do not give antibiotics after oral surgery. As many of us know, the overuse of antibiotics can contribute to the development of resistant bacteria. That means we give very careful consideration to every circumstance, deciding if antibiotics are necessary. Only in very specific situations will we prescribe antibiotics to help prevent infection or treat one that’s existing.
If you have been prescribed antibiotics, take the tablets or liquid as directed. Take them on schedule until they are completely gone.
If you experience a rash or other unfavorable reaction, discontinue antibiotic use. Contact our office to report anything you experience regarding antibiotics..
Diet
It’s important to keep hydrated. As best you can try to drink five to six glasses of water the first day – do not use a straw. The sucking pressure can dislodge the blood clot that naturally forms in the wound. The blood clot is critical to healing and removing it can delay the process.
Avoid hot food or liquids until the numbness wears off.
On the day of surgery, only eat soft food and liquids. Avoid chewing hard, sharp, crispy foods for several days so as not to disturb the site of the surgery.
Unless otherwise directed, as soon as you feel able, you can return to a normal diet. Patients find eating multiple small meals a day is easier than three large meals for the first few days.
Oral Hygiene
To heal properly and more quickly, good oral hygiene is essential. Brush your teeth on the night of your surgery, being sure to rinse gently.
The day after surgery, you can begin rinsing with salt water (one cup of warm water mixed with a teaspoon of salt). Rinse at least 5-6 times a day, making a point to do so after eating.
If you use alcohol-based mouthwash, it can cause discomfort when it comes in contact with fresh oral wounds. Wait until about three days after surgery but dilute your mouthwash by half with water. Gradually build up to full strength as the wound heals, becoming less sensitive.
Smoking
Do not smoke for at least 48 hours (2 days) after your surgery. Smoking slows down the healing process dramatically. Contricting the blood vessels, the nicotine will slow the formation and expansion of the vital blood clot in the socket. The result is often apainful complication we refer to as dry socket.
If, 48 hours after surgery, you need even one Tylenol or Aspirin to control your pain, avoid smoking. The discomfort means that the clot is not grown over enough to cover and protect the exposed bone in the socket – filled with raw nerve endings. Until a healthy blood clot covers the nerve endings, they will cause pain. Smoking will significantly slow the healing process, worsening the pain.
Activity
Keep all physical activity to a minimum for 6-12 hours following surgery. Even after this time period, exercise can still result in throbbing or bleeding. If this is your experience, discontinue all physical activity.
Nausea and Vomiting
If nausea or vomiting persists for more than 12 hours, please call the office for advice. If, following surgery, you experience nausea and/or vomiting, do not consume anything – including prescribed medications – for at least 60 minutes. After this time, slowly sip on coke, ginger ale, or tea. Avoid milk products.
Take Pepto Bismol or Milk of Magnesia to help coat the stomach and help the nausea to subside.
Other Complications
Numbness of the lip, chin or tongue? There is no cause for alarm. This is typically a temporary symptom.
If you feel hard projections in the mouth with your tongue, these are not roots; they are the walls of the tooth socket. These projections will smooth out in time and you may not even notice them for days to weeks after surgery. If the rough edges bother you, irritating your tongue or cheeks, Dr. Afif or Dr. Poulos can assess the area and smooth them down for you.
The corners of your mouth get stretched during surgery. As a result, they may dry and crack. Keep them moist with an ointment like Vaseline.
It’s also not uncommon to experience a sore throats and pain when swallowing after surgery. It should subside within 2-3 days.
Stiffness of the jaw muscles can make opening and closin your mouth difficult for a week or more followin your surgery. This very common. Over time it resolves with chewing, eating, talking, and yawning.
Pulling out all the stops
When we pull a tooth, it’s called an extraction. We choose to extract a tooth rather than repair it for various reasons:
If it’s severely decayed or broken in a way that is difficult or impossible to repair
If gum disease is present
If the position of the tooth causes problems to other surrounding teeth (e.g. an impacted wisdom tooth causes the gums to inflame and allows the buildup of tartar and plaque)
Preparing for orthodontic treatment
We understand very well how stressful and extraction can be! We will take every measure to ensure ensure that your experience, from your diagnosis to the tooth extraction is as comfortable and stress-free as possible.
Please feel free to share your feelings of anxiety about the procedure so that we can take the appropriate steps to alleviate your dis-ease.