In the event that a tooth is unable to be restored or bone loss surrounding the tooth requires its removal, we offer extraction services at our office for most cases. For advanced surgical cases that require a specialist, we partner with local trusted oral surgeons.
The first step with any questionable tooth is to have an exam performed. This way we can determine if there any is any way to save the tooth. After this evaluation, if an extraction is the best option, we determine if the procedure can be performed here in office, or if a referral is needed.
For in-office extractions, we will utilize a local anesthetic to numb the area. Teeth that are generally good candidates for non-surgical extractions are fully erupted and have enough remaining tooth structure above the tissue to allow Dr. Cochran to grasp the tooth without any surgical removal of tissue or bone. For teeth that are partially or fully impacted, these cases are refereed to a local oral surgeon. The oral surgeons that we refer you to have the ability to perform surgery under general anesthesia, where you will be asleep during the procedure. You can also elect to utilize a local anesthetic, but for larger cases, sedation is something to consider.WISDOM TEETH:
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:
- Mashed Potatoes
- Ice cream
- 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.
Endodontic Root Canals
Endodontics is the dental specialty dealing with the nerves of the teeth. When a tooth becomes infected or dies, the pulp (nerve and blood supply) needs to be removed in order to prevent pain and allow you to keep the tooth. If left untreated, an abscess (a more serious infection in the bone at the tip of the root) can develop. This can show on an x-ray and may also have drainage into the mouth. The removal of the pulp is known as a root canal and is probably the most notorious procedure in dentistry. For most, to be told that they need a “root canal” causes great fear, but the benefits of the procedure and advances in dental technology have made it much less scary. Local anesthetics and proper pain medication allow the procedure to be performed with little to no pain in most cases. There may be some soreness following the procedure, but that is minimal and most symptoms associated with Root Canlas refer to the pain before the procedure is completed. Over-the-counter painkillers are usually enough to relieve any pain afterwards, but you may be prescribed medication. Dr. Cochran can perform this procedure in the office; however, for more challenging cases, we may refer to a endodontic specialist to ensure quality results.Read More:
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).
Periodontal Tissue Surgery: We partner with a local periodontist to perform surgical procedures such as tissue grafting and reshaping. Our partners are able to perform surgeries to reshape the gum tissue to produce a more aesthetic and healthy smile.
Implant Procedures: If you have a missing tooth and do not wish to have a bridge, it may be possible to have an implant surgically placed in the site of the absent tooth. We work closely with local oral surgeons to place implants within the remaining bone. Once the implant has healed into place, we are then able to place a crown onto the implant abutment to return the area to correct form and function. Regular care and cleaning in the same manner as for your natural teeth is recommended to maintain a healthy implant.