Anesthesia
In the office there are two basic types of anesthesia.
The type of anesthesia used will often depend upon the patient's physical stature and health. Under normal circumstances, we do not recommend a local anesthesia for removal of impacted teeth unless the patient is a particularly stoic individual. Prior to an intravenous anesthetic the patient must not have had anything to eat or drink including water for at least 8 hours. The patient receiving a general anesthetic or sedation will be unable to drive himself or herself home so a driver must accompany the patient. No anesthesia is without risk. A drug reaction can happen at any time. Our office is equipped and trained to handle such an emergency. Our professional staff is certified in Advanced Cardiac Life Support (ACLS) and follow Pediatric Advanced Life support (PALS) guidelines. All personnel in the office are trained and certified in Cardio-Pulmonary Resuscitation (CPR). All anesthetic materials used are sterile. It is possible when using an intravenous anesthetic to bruise the vein either with the needle or the drugs. If this happens the vein may remain sore or hard for months.
Tooth Removal
Risks and Complications
Any operation carries some risk. This is reduced by pre-operative appraisal of your physical condition and how you may respond on that day to the operation. The wound remaining after a tooth is removed is quite large and healing may be delayed because the body is unable to build normal tissue as quickly as with a small wound. Due to the size of the wound, the clot formed, which is essential for healing, may break down. This leaves a large, empty, painful socket of exposed bone which may have to be packed several times until the patient is comfortable. This will eventually close over.
Lower teeth often rest on the main nerve to the lower jaw. sometimes, in spite of all precautions, this nerve is bruised. Most often, the result will be numbness of the lower lip or tongue on that side. This effect often does not last more than a few weeks, however, it could last months or even be permanent. Upper teeth lie against the wall of the maxillary sinus or antrum. The surgeon will use great care to see that no unnecessary injury occurs to this structure, but occasionally the thin wall of bone cracks slightly and blood seeps into the sinus. In such an event the patient may notice a trace of blood in the nose. It is also possible to open a hole (fistula) from the mouth to the sinus. If this occurs antibiotic therapy and further surgical procedures may be necessary. Smoking makes this complication worse.
Because the bone supporting the teeth is thin and we try to preserve bone, it is possible for small pieces of bone to come through the gingiva (gum tissue) for months after surgery. If these are painful or become infected we will treat them. If not, they will resolve. It may be necessary to leave a small piece of root in the jaw, when removal would require extensive surgery.
Stretching of the corners of the mouth with resultant cracking and bruising may occur.
The temporomanidublar joint is the hinge which allows us to open and close our mouth. During any prolonged dental procedures it is possible to fatigue or even bruise the muscles which support this joint. If this happens prolonged trismus (stiffness) or clicking in the joint may result. Usually with time, these symptoms will go away. However, it is possible that joint damage may occur, particularly in patients that have existing joint problems prior to surgery.
All patients about to have teeth removed should understand that adjacent teeth, especially those with large restorations, may be damaged during surgery. We will make every effort to avoid this problem. If a restoration is damaged you will have to return to your family dentist to have it replaced.
