Oral surgery is the branch of dentistry that involves the extraction of teeth. Very often, your own dentist will carry out your extractions but, in some cases, you may be referred to us for the procedure. These more complex treatments include removal of impacted teeth, wisdom teeth and broken teeth, and also the exposure of misplaced teeth. These situations often require a minor surgical procedure but, in experienced hands, this is generally straight forward and should not be a cause for anxiety.
Some teeth that are heavily decayed or badly broken broken down cannot be saved. This is also true for some teeth that are surrounded by advanced gum disease, so much so that the tooth is lose beyond repair. If these teeth are left in place then further problems can occur, like pain, infection, abscesses, and the spread of gum disease. Hence they need to be extracted to prevent such problems. Some of these teeth that require extraction are either broken at gum level, or already were below the level of the gum.
In order the remove these teeth, a “surgical” extraction is required. This involves making a little nick in the gum, in order to uncover the tooth, so that we can remove it in full. This is a very simple procedure that in most cases is carried out under local anaesthetic (with an injection).
Patients cannot feel discomfort during this procedure, as the local anaesthetic used removed all sensations of pain. Where appropriate, this procedure can also be carried out with sedation (see nervous patients section) or under general anaesthetic.
Many people require removal of their wisdom teeth, as there is not enough room in the jaws to allow them to come through normally. When this is the case, the teeth sometimes start to come through the gum on their sides, and hence some of the tooth is visible poking through the gum. In other cases, the wisdom teeth remain buried below the gum entirely. In many of the above cases, these wisdom teeth cause pain and infections as when they are below the gum, we cannot keep them clean and hence it is common that food gets trapped around them and infections can develop. Not all people who have wisdom teeth buried in the gum require them to be removed. This is discussed on an individual basis, following a clinical and radiographic (x-ray) exam. The wisdom teeth are only removed when it is felt that there will be an obvious benefit to the patient in doing so. Such benefits would include preventing pain, decay and infection that are already present, or such symptoms that appear to be developing.
Some adult teeth remain buried in the gum and do not erupt along with other teeth into the proper position. It can look like that these teeth are missing as they are not visible in the mouth. However, when some patients attend an orthodontist in order to have their teeth straightened, an x-ray can reveal that these teeth are present, buried in the gum. If the orthodontist feels that this is a good tooth, and one that can be aligned with the others, then they may request that you attend our clinic for an “exposure”. This is where we make a nick in the gum, to uncover the tooth for the orthodontist. On some occasions we will place an orthodontic bracket on the tooth for the orthodontist, or in other cases we will let the tooth exposed for the orthodontist to put on their own bracket. With this bracket, they will be able to move the tooth into the desired position, in line with the other teeth.
Cysts are fluid filled cavities that can sometimes develop in the jaws. They can be present for many years in some cases before ever being noticed or found. They tend to stay dormant in the jaws for many years and very often are noticed coincidentally on an x-ray, when a dentist may be looking at other teeth in that area. Sometimes they become noticeable if they begin to increase or get infected.
Not all cysts need to be removed. Some can be monitored by taking a series of x-rays over a number of years to ensure they are not getting bigger, whereas others need to be removed with a short procedure. These cysts that are removed, are taken away to prevent them from growing excessively, as some types of cysts can dissolve the bone in the jaw if they are left in place. Depending on the size and location of the cyst, this procedure can be done under local anaesthetic (with injection), sedation (see below) or general anaesthetic.
In order to place dental implants into the bone of the jaw, there has to be sufficient bone in order to hold the implant firmly. In some instances, there is not sufficient bone present and so “grafting” can be carried out in order to improve this. Bone can be taken from elsewhere in the jaw (where it is plentiful) and moved into where it is lacking. Bone substitutes (from other sources) can also be used in some cases, where the amount of bone that needs to be replaced is small.
We all have sinuses in our upper jaws, one on either side of the nose. These sinuses occupy a lot of space in the upper jaws and expand backwards, extending along above the uppers back teeth. However, as we get older these sinuses can get bigger, and hence the amount of bone surrounding them can decrease. If we are looking to replace missing teeth in this area with dental implants, then sometimes there is insufficient foundation bone for the implants, as the sinuses have become larger, hence reducing the amount of bone. A sinus lift is a procedure where we can increase that volume of bone below the sinus, so that an implant can be placed.
Many lumps and bumps can appear in the mouth. The vast majority of these are not sinister and can occur for a number of innocent reasons. Oral Medicine is the study of these areas that can occur in the mouth. Some of these can be left alone and ignored, while others require further monitoring.
In some instances, when the exact cause of a lump or bump in the mouth is uncertain, it is best to do a biopsy, where a little sample of the lump or bump can be taken away and looked at in greater detail under a microscope, in order to tell is more about it. This can provide useful information on the vest way to manage that area.
There are many forms of facial pain. The most common cause of this is toothache. However, in a few cases, after all teeth have been checked, the pain can still persist. This can be due issues such as tempero-mandibular joint dysfunction (see below), headaches (e.g. migraines), referred pain (e.g. from neck or back), small nerve abnormalities (trigeminal neuralgia) and others where there is no other obvious cause (atypical facial pain). Some of these pains require further investigation in order to accurately diagnose the correct origin, so that it can be treated correctly.
Temporo-Mandibular Joint Dysfunction occurs when the hinge joints on each side of our face become sore. These joints are responsible for the opening and closing of our mouths, but like any other joints in our body, these joints can suffer from wear and tear and become painful. The most common causes of this are grinding or clenching of the teeth. Other causes include previous trauma or an imbalanced bite due to missing teeth. This problem can come and go over time, but when it is present it can cause a lot of pain. Hence there are exercises and treatments that can help reduce this pain.