Tooth Extraction, Endodontic Root Canals, Periodontal Treatment, and Surgical Procedures

Wisdom teeth extractions are a fairly common procedure. Wisdom teeth often cause problems as they are trying to grow through the gums. When a wisdom tooth is impacted, it means the tooth is unable to fully erupt. This is commonly the result of not having enough room in the arch for these third molars. Wisdom teeth also develop at the wrong angle and can get caught on the second molar.

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 can become trapped under this tissue. This makes it easy for an infection, called pericoronitis, to develop.  Like most dental infections, this is characterized by swelling and pain in the area. While this condition can sometimes go away on its own, it often requires surgical intervention.

After the surgery, you will need to rest. You may want to have someone drive you home. If general anesthesia is used (where you were fully asleep), this is required. We do not use full sedation at our office, but do refer to offices that can provide this. A friend or family member should bring you to your appointment and drive you home afterwords. They should plan to stay with you for several hours afterwards. For extractions performed at our office, a local anesthetic is utilized and less post operative supervision is necessary,  however, you can expect for the site to bleed for a short amount of time following the extraction. Gauze is placed over the extraction site and should be left in place for 15 to 20 minutes. Additional gauze, as well as written instructions, will be provided. Once home, check to see if the site is still bleeding. If so, place a moistened new gauze over the site and apply gentle pressure. You may need to fold the gauze or use multiple pieces to achieve enough pressure. Dr. Cochran or a staff member will instruct you on how much gauze was initially placed so you can replicate. The gauze must first be dampened with water so that it doesn’t stick to the newly formed clot. If, after an additional 15 minutes, there is still some bleeding, place a moist tea bag over the site and apply pressure for another 15 minutes. If bleeding continues for longer than 24 hours, you should call your dentist. Your dentist will make recommendations for pain management. For the type of extractions that are performed in this office, it is not generally necessary to prescribe pain medications. If an infection was present it may be necessary to utilize antibiotics. It is important that you take these as directed and until all doses are gone to ensure infection doesn’t return.

You should limit your diet to soft foods for a few days after your surgery. Some recommended foods are:

• Gelatin
• Pudding
• Yogurt
• Mashed Potatoes
• Ice cream
• Broth/Soups
• Other food you can eat without chewing

You should avoid foods with small particles or seeds such as rice, strawberries, or any other small-seeded food.

When drinking, do not use a straw. This can cause the loss of the clot, loosen any sutures that may have been placed, and slow the healing process. Smoking and other tobacco products should also be avoided as they to will also delay the healing process.

Dry socket can be caused by a number of things, but it is generally avoidable if proper care is taken. Symptoms to look for include worsening pain after a period of improvement, and/or additional bleeding, and/or swelling of the area. Call our office or the oral surgeon (if utilized) for additional treatment if needed.

If you have prolonged pain, bleeding, irritation, or don’t feel that the extraction site is healing properly, call to schedule a follow up appointment.

Post-operative management of pain and discomfort after surgery is important not only for our patients but also to Dr. Cochran.  While a small amount of soreness can be tolerable, if the discomfort reaches a level where it becomes pain, the use of medications is often indicated. Dental pain is often cased by inflammation within the tissue. While prescription medications are available, they are generally not necessary. These medications do not treat the source of this pain. They just mask it. To relieve both the pain and inflammation following an extraction, the use of OTC NSAIDs (Over-the-Counter Non-steroidal Anti-Inflammatory Drugs) is suggested as the initial medication. These types of medications actually get to the source of the pain and don’t just mask the symptoms. The primary example of this type of medication is ibuprofen, such as Advil and Motrin. Patients are often surprised by how effective these medications can be  The primary source of pain is the tooth itself and, once extracted, there is often very little residual pain.

If your physician has suggested you avoid the above NSAID an alternative OTC medication is acetaminophen. This is the active ingredient in Tylenol. Always take this pain reliever as instructed and never exceed the maximum listed dose. Acetaminophen is commonly used in other medications, so if you are taking any other pain medications, it is important to check to make sure that you are not duplicating medications.

The use of prescription pain medications is rarely indicated and Dr. Cochran does NOT call in these types of medications. In order to receive a prescription for medications from our office, you must first be seen and evaluated. This is to ensure that a more serious issue is not present and that more urgent treatment is not necessary.  If over-the-counter medications are ineffective, it is likely that an infection or other issue is present which needs to be evaluated and treated.

The area around the tooth is numbed with a local anesthetic to start the procedure. The dentist will then drill the tooth to gain access to the nerve. The infected tissue is then removed and the canal is cleaned and shaped. Gutta Percha is a rubber-like material placed into the core of the tooth to fill the space. A sealer is used to coat the inside of the tooth and prevent bacteria from re-infecting the area. The tooth is temporized for a time to ensure that symptoms resolve. This temporary filling is designed to last for only a short amount of time and should be replaced with a more permanent filling material. Once endodontic treatment has been completed, the tooth is considered non-vital and, over time, will become fragile. This occurs because there is no longer a blood supply to the tooth and the tooth ‘dries out’. It is highly recommended that a tooth that has undergone a root canal be crowned. This improves the appearance of the tooth and helps protect the tooth from fracture. The crown acts as a band around the tooth to prevent splitting (see Crown).