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Oral Surgery
Root Canals

Why a Root Canal?
Root canals are necessary when a cavity that has been left untreated becomes larger. Once the cavity reaches the pulp of the tooth, an infection forms at the base of the root canal, causing an abscess. This abscess is generally painful and will need to be removed.

The doctors at R. Scott Smith, D.D.S. know that serious tooth decay can often require a root canal to solve the issue. A root canal may be needed if the decay has reached the tooth's nerve. Essentially, a root canal involves cleaning out a tooth's infected root, then filling and sealing the canal.

Root Canal Procedure:
1) An opening is made through the crown of the tooth into the pulp chambe
2) The pulp is removed, and the root canals are cleaned, enlarged and shaped.
3) The infected area is medicated.
4) The root canals are filled.
5) The crown opening is filled with a temporary.

If you are experiencing severe tooth pain, you may need a root canal. The only sure way to know is to call our Orange, CA dental office at (714) 771-3111 and setup an appointment with Dr. Smith.

Tooth Extraction

Dr. Smith is an experienced tooth extraction dentist in Orange. When the extraction of a tooth is required:

1) An incision in the gums is made
2) The tooth is removed
3) The area is stitched up and is allowed to heal

During this time, it is important to think about a tooth replacement option. An extracted tooth leaves an open area in the jaw which, in time, allows the neighboring teeth to drift into the area where the tooth was extracted. This in turn, causes a chain reaction to all the surrounding teeth. Also, if you are considering placing an implant in the future, you should consider asking your dentist to place a bone graft at the time of surgery to preserve the bone width and height.

Ankylosis
Ankylosis

This refers to a tooth or teeth (primary or permanent) that have become "fused" to the bone, preventing it or them from moving "down" with the bone as the jaws grow. This process can affect any teeth in the mouth, but it is more common on primary first molars and teeth that have suffered trauma (typically the incisors). Treatment can vary depending on the degree of severity of the ankylosis (how "sunken into the gums" a tooth may appear). The degree of severity usually will vary depending on how early the process started, and as a general rule, the earlier it starts, the more severe the ankylosis becomes with age. Several considerations must be taken before any treatment is provided, and your dentist will discuss all the risks and benefits of each treatment option.

Impacted Canine
Impacted Canine

Canine teeth are also commonly referred to as cusped or "eye teeth" since the teeth align under your eyes. You should have two canines in both your upper and lower jaw. They are the strongest teeth you have, used for tearing into your most meaty meals. Because of this need for strength, your canines have the longest roots of all your teeth. They are an essential part of your bite and balanced smile for two main reasons:

- Your Bite
Due to their length, the canines guide your other teeth together when chewing and biting. Canines are essential for maintaining a proper bite.

- Your Appearance
Without canines, large gaps appear in your smile. This can lead to your other front teeth becoming twisted or crooked.

Your canine teeth are generally some of the last teeth to erupt. Occasionally they do not erupt. The two most common reasons are:

- Overcrowding in your mouth
Extra teeth or a small jaw can cause the space where your canines are supposed to come in to be very small, resulting in impaction, or failure to erupt.

- Abnormal growths
Tissue may have developed in your jaw that prevented your canines from reaching the surface.

The fact that teeth don't always come in like they're supposed to highlights the need for regular dental visits when young teeth are developing. If you suspect your child has impacted canines, don't hesitate to make an appointment with R. Scott Smith, D.D.S.. With regular dental visits, X-rays and examinations, the problem of impacted canines can be found out early when treatment is easier. If you are an adult and your canines have not erupted R. Scott Smith, D.D.S. can help. Set an appoint today for an x-ray and consultation. Your smile is up there waiting for you.

Treatment for Impacted Canines
After assessing your situation, R. Scott Smith, D.D.S. will devise a plan to make room for your canines. Will a typical oral surgery and the assistance of an orthodontist your canine will find their way into their proper place over time.

Bone Grafting

Bone grafting is commonly performed by an oral and maxillofacial surgeon to replace or augment bone in areas of tooth loss. Bone grafting to the jaws and facial structures may be necessary in a wide variety of scenarios. The most common bone grafts are facial skeleton and jaw procedures. Other common procedures include tooth extraction site graft, bone graft reconstruction and for a sinus lift. Shrinkage of bone often occurs when a tooth is lost due to trauma, severe caries, or periodontal disease. Additionally, bone loss may have already occurred due to infection or pathology around a tooth. There are many artificial biocompatible bone substitutes available; however, the best material for a bone graft is your own bone, which most likely will come from your chin, the back part of your lower jaw or your hip bone. The hip is considered to be a better source because the hip bone has a lot of marrow, which contains bone-forming cells. There are also synthetic materials that can be used for bone grafting. Most bone grafts use a person's own bone, possibly in combination with other materials.

To place the removed bone in the recipient site, little holes are drilled in the existing bone to cause bleeding. This is done because blood provides cells that help the bone heal. The block of bone that was removed will be anchored in place with titanium screws. A mixture of the patient's bone marrow and some other bone-graft material will then be placed around the edges of bone block. Finally, a membrane is placed over the area and the incision closed.

The bone graft will take about 6 to 12 months to heal before dental implants can be placed. At that time, the titanium screws used to anchor the bone block in place will be removed before the implant is placed.

Post-Surgery Instructions
Post-Surgery Instructions

Fold a piece of clean gauze into a pad thick enough to bite on and place directly on the extraction site. Apply moderate pressure by closing the teeth firmly over the pad. Maintain this pressure for about 30 minutes. If the pad becomes soaked, replace it with a clean one as necessary. Do not suck on the extraction site (as with a straw). A slight amount of blood may leak at the extraction site until a clot forms. However, if heavy bleeding continues, call your dentist. (Remember, though, that a lot of saliva and a little blood can look like a lot of bleeding.)

The Blood Clot

After an extraction, a blood clot forms in the tooth socket. This clot is an important part of the normal healing process. You should therefore avoid activities that might disturb the clot.

Here's how to protect it:

  1. Do not smoke, rinse your mouth vigorously or drink through a straw for 24 hours.
  2. Do not clean the teeth next to the healing tooth socket for the rest of the day. You should, however, brush and floss your other teeth thoroughly. Gently rinse your mouth afterwards.
  3. Limit strenuous activity for 24 hours after the extraction. This will reduce bleeding and help the blood clot to form. Get plenty of rest.
  4. If you have sutures, your dentist will instruct you when to return to have them removed.

Medication

Your dentist may prescribe medication to control pain and prevent infection. Use it only as directed. If the medication prescribed does not seem to work for you, do not increase the dosage. Please call your dentist immediately if you have prolonged or severe pain, swelling, bleeding, or fever.

Swelling & Pain

After a tooth is removed, you may have some discomfort and notice some swelling. You can help reduce swelling and pain by applying cold compresses to the face. An ice bag or cold, moist cloth can be used periodically. Ice should be used only for the first day. Apply heat tomorrow if needed. Be sure to follow your doctor's instructions.

Diet

After the extraction, drink lots of liquids and eat soft, nutritious foods. Avoid alcoholic beverages and hot liquids. Begin eating solid foods the next day or as soon as you can chew comfortably. For about two days, try to chew food on the side opposite the extraction site. If you are troubled by nausea and vomiting, call your dentist for advice.

Rinsing

The day after the extraction, gently rinse your mouth with warm salt water (teaspoon of salt in an 8 oz. glass of warm water). Rinsing after meals is important to keep food particles away from the extraction site. Do not rinse vigorously!

Post-Surgery Instructions for Children
Post-Surgery Instructions for Children

Anesthesia - The feeling of numbness will begin to wear off in 30 minutes to 4 hours. Until that time, avoid all hot foods or liquids, and do not chew. This is to prevent accidentally burning or biting the lips, cheeks, inside of your mouth or tongue until the feeling has returned

Gauze Pack - Fold the gauze into a small pack and place over the extraction site and apply firm pressure for one to two hours. Change the gauze pack every 15-30 minutes.

Bleeding - It is normal for the extraction site to bleed slightly or ooze blood for 12 to 24 hours following surgery.

Ice Pack - For the first 2 to 8 hours after surgery, ice packs should be applied to the outside of the face over the area of the extraction site. The ice pack should be held in place for 15 minutes on, and then removed for 15 minutes. Doing this throughout the day will help reduce discomfort and swelling.

Medications - DO NOT TAKE ASPIRIN PRODUCTS due to the possible increase in bleeding potential. If prescription medications were prescribed please follow label instructions carefully. For most extractions, a non-aspirin over the counter pain medication will provide good pain relief. Do not take more than the recommended dosage!

Diet - A liquid or soft diet should be adhered to for the first 12 to 24 hours after surgery. It is important to drink plenty of liquids for the first day or two. Avoid the use of a straw as it may dislodge the blood clot that is forming in the extraction site.

Oral Hygiene - Clean the rest of your mouth as usual, however avoid bumping or brushing the extraction site. DO NOT RINSE OR SWISH YOUR MOUTH for the first 24 hours following surgery.

Possible Complications:

Dry Socket - This is sometimes a problem after surgery. The symptoms associated with dry socket are constant moderate to severe pain, bad taste, putrid odor, and poor clot formation at the surgical site. If you think you have ANY of these symptoms call our office as soon as possible.

Fever - Monitor your temperature for the first 24 to 48 hours. Any elevated temperature should be reported to our office.

Swelling - Some swelling during the first 24 to 48 hours can be expected.

Surgery FAQs

Pre-surgical
Q: Is there a food and drink restriction prior to surgery?
A: If treatment calls for the patient to be sedated then yes there are food and/or drink restriction. The patient must not consume anything, including water for 6-8 hours prior to surgery.

Q: Will antibiotics be prescribed prior to surgery?
A: We commonly use antibiotics to kill bacteria found in the mouth, which will also prevent infection after treatment, particularly with the placement of dental implants immediately after extracted teeth. The specific drug used depends on the medical profile and well being of the patient and the type of treatment.

Q: Do I need to avoid certain medications?
A: It is important to discuss all medication with R. Scott Smith, D.D.S. during your pre-surgical consultation. In most cases medication should be continued unless specifically instructed to withhold them. Typically Plavix, Aspirin, Coumadin and other types of blood thinners can also be continued. When necessary R. Scott Smith, D.D.S. will consult with your physician to safely manage your medications.

Q: Are the rules different for ORTHOGNATIC SURGERY different from tooth extractions of dental implant placement?
A: Yes, very different. Patients who are undergoing surgical procedures on only one jaw usually go home the same day. Patients who are having surgery on both jaws will generally stay overnight. Generally it is necessary to wire the jaws together after orthognatic surgery. In general, the jaws are immobilized securely with rubber bands for the first 1-2 weeks and then loosely for an additional 3-5 weeks. It is very important to discontinue any medication which are “blood thinners” or which may increase your tendency to bleed. Please stop taking the following medications at least 2 weeks before surgery. R. Scott Smith, D.D.S. will provide specific instructions prior to your surgery date.

Surgery
Q: Will anesthesia be used?
A: R. Scott Smith, D.D.S. will discuss your anesthesia options. Our goal is to provide minimal discomfort as possible.

Q: How is the anesthesia administered?
A: Depending upon your treatment we may administer a local anesthesia such as lidocaine or nitrous oxide. For a more involved treatment we may recommend an oral sedation or intravenous sedation.

Q: What do I need to be aware of before intravenous sedation?
A: You may not have anything to eat or drink (including water) for eight (8) hours prior to the appointment. No smoking at least 12 hours before surgery. Ideally, cut down or stop smoking as soon as possible prior to the day of surgery. A responsible adult must accompany the patient to the office, remain in the office during the procedure, and drive the patient home. The patient should not drive a vehicle or operate any machinery for 24 hours following the anesthesia experience. Please wear loose fitting clothing with sleeves which can be rolled up past the elbow, and low-heeled shoes. Contact lenses, jewelry, and dentures must be removed at the time of surgery. Do not wear lipstick, excessive makeup, or nail polish on the day of surgery. If you have an illness such as a cold, sore throat, stomach or bowel upset, please notify the office. If you take routine oral medications, please check with R. Scott Smith, D.D.S. prior to your surgical date for instructions.

Q: Will my vital signs be monitored during and after treatment?
A: R. Scott Smith, D.D.S. and/or one of their highly trained surgical assistants will continuously monitor your vital signs.

Q: How long will the surgery take?
A: The length of surgery depends on your treatment. Some surgery's are less than 30 minutes, while other procedures may take considerably longer. R. Scott Smith, D.D.S. will provide you with the estimated time of surgery at your pre-surgical consultation.

Q: Will there be a lot of bleeding with a tooth extraction?
A: It's important for a blood clot to form to stop the bleeding after a tooth extraction. You will be asked to bite on a gauze pad for 30-45 minutes immediately after the extraction. If the bleeding or oozing still persists, place another gauze pad and bite firmly for another 30 minutes. You may have to do this several times. After the blood clot forms, it is important not to disturb or dislodge the clot as it aids healing. Do not rinse vigorously, suck on straws, smoke, drink alcohol or brush teeth next to the extraction site for 72 hours. These activities will dislodge or dissolve the clot and retard the healing process. Limit vigorous exercise for the next 24 hours as this will increase blood pressure and may cause more bleeding from the extraction site.

Post Surgery
Q: How long is the on-site recovery before I can leave the office?
A: Plan to stay in our recovery room for at least 20 minutes if sedation was involved, or until R. Scott Smith, D.D.S. is satisfied that you are recovered sufficiently to go home. If your procedure required sedation you must be completely alert before leaving the office for home. You must have a ride home. You may not drive yourself. It is recommend that you do not drive for a minimum 24 hours after surgery.

Q: Will you prescribe antibiotics and pain medication?
A: Procedure and patient health are determining factors of what antibiotic and/or medication will be prescribed. Call the office if the medication does not seem to be working. If antibiotics are prescribed, continue to take them for the indicated length of time, even if signs and symptoms of infection are gone. Drink lots of fluid and eat nutritious soft food on the day of the extraction. You can eat normally as soon as you are comfortable. Dr. Smith will discuss what, when, how long and dosage with you in both the pre-surgery and post surgery interviews.

Recovery
Q: How long will I be off of work/out of school?
A: Depending on the extent of the procedure and type of sedation you may resume work and a normal life style anywhere from a few hours to a few days. It is important to resume your normal dental routine after 24 hours. This should include brushing and flossing your teeth at least once a day. This will speed healing and help keep your mouth fresh and clean. After a few days you will feel fine and can resume your normal activities. If you have heavy bleeding, severe pain, continued swelling for 2-3 days, or a reaction to the medication, call our office immediately.

Q: Will there be swelling or facial bruising?
A: After the tooth is extracted, you may feel some pain and experience some swelling. An ice pack or an unopened bag of frozen peas or corn applied to the area will keep swelling to a minimum. Take pain medications as prescribed. The swelling usually subsides after 48 hours. In some treatments there may be some minor bruising; however, in procedures such as dental implant placement ordinarily there is no bruising seen. For teeth removal or jaw procedures, women and/or very light skinned patients may experience slight bruising. Taking blood thinner will help reduce bruising. It is, however, not uncommon to have a black eye or discolored cheek or neck following extensive procedures. R. Scott Smith, D.D.S. will discuss what bruising if any would be related to your procedure treatment.

Schedule Your Appointment Today

R. Scott Smith, D.D.S. would love to meet you and your family and provide you with the dental care you need to give each of you the smile you deserve!




Or Call:

(714) 771-3111