Oral Surgery

Oral surgery is a field of dentistry that involves a number of surgical procedures in and around the mouth and jaws. While some procedures are referred to an oral surgeon specialist, many basic oral surgery procedures can be done right her at our office in Randallstown, MD. Both Dr. Steven Markow and Dr. David A. Daniel are trained to do extractions. Wisdom teeth removal is probably the most common oral surgery procedure that is done. This is because for most people, the wisdom teeth, which typically come in between age 16-22 years, are coming in crooked or crowding other teeth.

Another more common procedure done by specialists and some dentists is the placement of dental implants. This is commonly done when a tooth is lost either from periodontal disease, or from extensive decay that destroyed the strength of the tooth, requiring extraction. This office is trained on the restorative phase of dental implants and we enjoy being able to offer this service to our patients who are missing teeth.

How will I know if I need my wisdom teeth out?

In general, as mentioned prior, wisdom teeth are commonly pulled because they are hard to clean, come in crooked, get infected from tissue growing over them, or get decay and are simply too hard to fill. They come in generally when children are finishing high school or entering college and therefore commonly called “wisdom teeth”. They are the last molar on each side of the arch and also called “third molars”.

While we may do most extractions, if they look more challenging because they are soft tissue or hard tissue impacted, we may refer out to our local oral surgeon.

Often, they may either give you conscious sedation or IV sedation to “knock you out” so you don’t remember the procedure.  The oral surgeon has several more years of training and they often deal with the more complicated cases including jaw surgeries in which skeletal discrepancies between the upper and lower jaw, that can’t easily be corrected with simple orthodontics, is done.

What is the healing time after surgery?

This depends upon a number of factors including the type of procedure, the health of our patient, any medications or physical complications or limitations that may be involved, and the extent of the procedure. For most patients, a simple extraction is fairly well healed within seven days and it could be as little as 3-4 days if the tooth is erupted and not very big. The procedure for dental implant placement has gotten so advanced and routine, that often patients are not feeling any discomfort after two days!

Should I try to save my teeth or just get dentures?

From time to time, we run into a situation where a patient gets so frustrated with their teeth because they are getting new cavities each time that they come in to see us. This could be genetic, chemical based, home care related, oral habits or diet that contribute to this. While Dr. Markow and Dr. Daniel will do and suggest everything possible to try to help you keep your natural teeth, there comes a time when it makes sense to let them go. When a tooth simply can’t be saved due to bone loss or too much tooth structure lost, we might suggest extracting it.

By “extracting” we mean pulling the tooth out. By doing so, it can help to contain an infection or remove the source of an ongoing infection, which could had been leading to a more serious problem.

Another common reason for pulling teeth out is due to orthodontic crowding. If you can’t clean your teeth due the overlap of teeth, or such severe crowding that it is nearly impossible to clean or maintain the teeth long-term, we may suggest extracting it along with orthodontic treatment to align the teeth for better long-term cleansability.

What is the process for taking out a tooth?

After doing a diagnosis and an evaluation that an extraction is the best option, we will schedule an appointment for you. If you need to see an oral surgeon, and they will be doing any type of sedation, you will need a ride to and from the office. It is usually suggested to have a good meal the night before and not eat much the morning of the procedure. In some cases, we might advice taking an anti-inflammatory medication such as Advil prior to the procedure and also afterwards to help with any potential swelling. In other cases, we may suggest antibiotics, particularly if there is active infection or potential infection.

In order to make you more at-ease during the procedure, wear comfortable clothes. Once there, after you are seated and medical review is done, we will numb the area up with local anesthetics to numb the tooth or the area we are working on. While it is common to feel localized pressure, the goal is to minimize any discomfort from shifting the tooth back and forth to loosen it and remove it.

Once the tooth is removed, we may do one of a couple things. We may suggest doing a bone graft to help preserve the ridge or to maintain stabilize the height of the bone for future restorations. If we are thinking you will have an implant, if there isn’t an active infection in the bone, it is advised to do it immediately, or very soon afterwards, while the bone is healing from the extraction. Just as how the skin heals with a scab, the fresh exposure of a tooth extraction site encourages bone growth. A small gauze or membrane may be placed over the socket to prevent food or bacteria from getting in to minimize risk of infection. It is a good idea to avoid chewing on that area for a few days to let the tissue heal on its own. Certain medications and also smoking have been shown to slow down the healing process.  

What should be done if you lose a tooth and why?

If you have an extraction done and it is a wisdom tooth, there probably isn’t much you will need to do, because the majority of the chewing function is forward of that in the first molar area. On the other hand, if it’s a front tooth, most people will want to have something done to replace the gap they will be showing. Some options include a “flipper” or a partial denture.  This is basically a simple acrylic appliance with a tooth attached. The next option is a dental implant. This is where a titanium or zirconium post is placed into the bone and the tissue grows around that post for a few months to stabilize it at which point a crown can be placed on top of that. The last option is a bridge. In this case, both the adjacent teeth are trimmed to make room for crowns that are connected to each other and replace the middle missing tooth.

The reason you should consider having something put in place of a missing tooth is because the adjacent teeth often shift into that missing area including the opposing teeth “super-erupting” out of the socket, looking for an opposing tooth to hit against. This can mess up your bite and cause periodontal issues along with cleaning issues on adjacent teeth.

What should I do after an extraction to make the healing as simple as possible?

We typically suggest a soft food diet which contains some protein such as eggs or even yogurt, avoiding harder chewy or crunchy foods that might disrupt a blot clot.

Avoiding brushing the exact area of the surgery for 1-2 days, again to allow the tissue to heal undisrupted. You can gently rinse with warm salt-water mix just to clear the area of debris.

Take any pain medication or antibiotics as suggested by your dentist to allow the body to heal as quickly as possible. Avoid smoking or alcohol during this time as well.

In some cases, either small ice chips or a bag of frozen peas or corn applied on the outside of the face can help slightly numb the area and minimize swelling. If you experience swelling or discomfort that you think is more than you should be please contact the office immediately!

At our office, we encourage taking Vitamin C 500mg per day, as long as you don’t have any reaction to it. We have found it to be beneficial in assisting the body to heal quicker. In addition, limiting your chewing, talking or heavy physical exercise, including bending over, can help minimize swelling.

Both Dr. Markow and Dr. Daniel are welcome to having you contact them after-hours should you ever have any complications or swelling that concerns you after any procedure. If you are in the Baltimore area and looking for oral surgery solutions, please feel free to call us! We are happy to give second opinions as well.