Oral Surgery & Tooth Extractions
Occasionally, for various reasons, we have to remove wisdom or other of your teeth. The team at Waterview Dental has the expertise, experience, and tools to make your extraction process as comfortable and pain-free as possible.
To find out more information about the types of extractions we provide, please click the links below.
Oral Surgery
In early adulthood, most of us have all 32 of our teeth – 16 on top and 16 on the bottom. However, the average human mouth holds only 28 teeth. So, when 32 try to fit inside the mouth, the result can be painful. The four extra teeth include the wisdom teeth or third molars, and it’s not unusual that they pose problems.
Why have my wisdom teeth removed?
The last teeth to come in are the wisdom teeth. And it’s not always necessary to remove them. When they’re properly aligned and the surrounding gum tissue is healthy, they can remain in the mouth. Unfortunately, this isn’t the most common scenario. Extraction of the wisdom tooth must occur if the teeth can’t erupt into the mouth properly – they grow sideways, only partially emerge, or if they’re impacted – remain trapped beneath the gum and bone. A tooth that is impacted can position in the bone in a variety of ways as it tries to find a way to erupt successfully. This can cause problems. When a tooth only partially erupts, the opening surrounding the tooth is space for bacteria to grow and eventually cause an infection. The result is swelling, stiffness, pain, and even illness. Additionally, the pressure caused by an erupting wisdom tooth can cause the nearby teeth to move and potentially interfere with the natural or orthodontic alignment of the teeth. One of the most serious problems can occur when tumours or cysts form around the impacted wisdom teeth. This can result in the degradation of healthy teeth and the jawbone.
But, when we remove the problematic wisdom teeth, these problems are often resolved. We often recommend early removal to avoid future complications. Early removal decreases the surgical risk involved with the procedure.
The most common dental problems that we see with wisdom teeth include:
Gum, or periodontal disease
Recurring pericoronitis (frequent incidents of gum infection)
Abscess, cellulitis or osteomyelitis (an infection spread from wisdom tooth into surrounding tissues)
Untreatable pulpal and/or periapical pathology
Inability to treat a cavity in a tooth without removal of the wisdom tooth
The disease of follicles, i.e. a cyst (a sac filled with fluid) or tumour
Root, bone or crown breakdown close to a wisdom tooth
Fracture of a wisdom tooth or the neighbouring teeth
If one of these problems occurs, the following conditions may develop:
Tenderness or pain in the gums or jawbone
Bad breath
Redness or swelling in the gums
An unpleasant taste in the mouth
Headaches or jaw aches
Wisdom Tooth Extraction
If we find it’s in your best interest to extract your wisdom teeth, we will schedule an additional consultation with our oral surgeon. They’ll answer any questions, discuss the various options, and explain the potential surgical risks before we schedule the procedure.
Wisdom teeth – post-removal
Removing wisdom teeth is a serious surgical procedure. Post-operative care is very important. We provide detailed instructions to follow carefully. They help to prevent and minimize unnecessary pain and any complications of infection and swelling. Immediately following surgery:
Bite on the gauze pad over the surgical site for 60 minutes. After an hour, remove the gauze and discard it. Replace the gauze pad with another. For more details, refer to the section below on BLEEDING.
Do not touch the wound area, and avoid vigorous mouth rinsing. Avoid initiating bleeding by accidentally dislodging the blood clot that forms.
To minimize swelling, place ice packs on the surgery side of your face. For more information, read the section on SWELLING below.
Take any pain medications prescribed as soon as you can. Digest any prescribed medication BEFORE the local anaesthetic has worn off. Be sure to consume something that can coat the stomach to help minimize nausea from the pain medications. Refer to the section on PAIN below for specific details.
Restrict activities on surgery day. When you’re active on the day of surgery, it raises your heart rate and can contribute to excessive bleeding and throbbing at the surgery site. Afterwards, once you feel comfortable, you can begin to resume normal activities.
NO SMOKING UNDER ANY CIRCUMSTANCES
Bleeding
You can expect a certain amount of bleeding after the surgery. Where the skin surface is dry, the bleeding clots in 10 minutes. In the mouth, where it’s damp or wet, it can take 6-8 hours for the blood to clot and the bleeding to subside. If you see redness in saliva, don’t worry. It’s common to have slight bleeding or oozing that causes redness in the saliva. When saliva washes over the blood clots, it can cause the gauze to become red even after bleeding from the sockets has stopped. Consequently, the gauze will almost always appear red when you remove it.
If you rise or wipe old clots gently, place a gauze pad over the area and bite firmly for sixty minutes. It may help control excessive bleeding. Repeat as necessary.
If the wound continues to bleed, you can bite on a moistened tea bag for half an hour or so. The tea bag has tannic acid, which contracts bleeding vessels and can help to form a clot.
Sit upright to minimize further bleeding. Keep calm and maintain constant pressure on the gauze (no talking or chewing), and avoid exercise.
If bleeding does not subside after 6-8 hours, call the office for further instructions (416-368-2855).
Swelling
After the removal of impacted wisdom teeth, it’s normal to experience swelling of the cheek(s). Likely, the swelling won’t appear until a day after surgery. It won’t reach the maximum until 2-3 days post-op.
Help to minimize swelling by using ice packs applied to the affected side of the face. Fill a plastic bag with ice, an ice pack, or a pack of frozen peas. Cover it with a cloth and rest it against the surgery side of the face. Apply the ice packs alternating 20 minutes on and 20 minutes off for the afternoon and evening immediately following the surgery. After 24 hours, ice will have no beneficial effect.
36 hours after surgery, you can apply moist heat – a warm, damp cloth against the surgery side of the face may help with any delayed swelling.
If swelling or jaw stiffness persists for several days after surgery, there is no cause for alarm. If the swelling is soft and puffy, where you can indent it with your finger, that is normal.
Rather, if the swelling becomes hot to the touch, bright red is rock hard (doesn’t indent with finger pressure) and enlarges, it might indicate an infection. These symptoms typically develop around days three to four after surgery. If this occurs, call our office for support.
Temperature
It’s normal to run a low-grade temperature (99°-100°F) for up to 10 days following oral surgery. You might experience a fever (over 101°F) for 6-8 hours after surgery. It should diminish after that time. Two Tylenol or 2-3 200mg Ibuprofen (Motrin/Advil) every 4-6 hours will help to manage a high temperature.
A fever above 101°F for several days following surgery, especially when it’s accompanied by redness, increased pain, and hard swelling, which indicates infection. Call our office for instructions if this occurs.
Bruising
If the surgeon must smooth the bone to fit a denture, it’s not unusual for bruising to appear on the surface of the skin above the surgery area. It most commonly appears over the upper-eye teeth (on the cheek and below the eye).
You may not notice any bruising for a day or so. By the time it reaches the visible surface, the bruise may have already turned colour – from purple to green to yellow. After several days, you may find that the yellow settles down the neck to near the nipple line on the chest before it finally disappears.
Pain
Following surgery, managing discomfort or pain following surgery will likely last 4-5 days. It’s not unusual for many patients to experience most of their pain during the third and fourth days when they need to use more pain medicine. Following the fourth day, the pain begins to consistently subside.
Often, patients experience nausea or vomiting from their pain medications, prescription and over-the-counter (aspirin or ibuprofen). Before taking the medication, eat something that will help coat the stomach to minimize the feelings of nausea – ice cream or yoghurt, for example.
For moderate pain, take one or two tablets of Tylenol or Extra Strength Tylenol every three to four hours or Ibuprofen (Motrin or Advil), 2 - 3 200 mg tablets every 4-6 hours.
For severe pain, take the appropriately prescribed pain tablets as directed every 4 hours in addition to the Tylenol or Ibuprofen. Note that the prescribed pain medicine will likely make you groggy, slowing down your reflexes. While you take prescription pain medicine, do not:
Drive an automobile or work around, or operate heavy machinery.
Mix alcohol and prescription pain medicines!
If you need prescription pain medications longer than four days post-surgery, you may need further treatment. Please call our office and discuss your situation with us.
Antibiotics
After oral surgery, we do not routinely give antibiotics. There is plenty of documentation covering the overuse of antibiotics leading to the development of resistant bacteria. Given this fact, we give very careful consideration to each circumstance if there is a possibility antibiotics might be necessary. Only in specific situations do we prescribe antibiotics – to prevent infection or help treat an existing infection.
When prescribed antibiotics, take them only as directed. You should always take antibiotics on schedule until they are completely gone.
In the event of a rash or other unfavourable reaction, discontinue the use of antibiotics and contact our office to report your situation.
Diet
It’s critical that you stay hydrated. Try to drink 5-6 glasses of water the first day after surgery. Do not use a straw. It’s easy to dislodge the naturally forming blood clot in the wound with the sucking motion. This will delay the healing process.
Until you no longer feel any numbness, avoid consuming hot liquids or food. Eat liquids and soft food on the day of surgery. Do not chew hard or sharp objects for several days following the surgery so as not to harm or disturb the area.
As soon as you feel able, you can return to a normal diet unless you’ve been otherwise instructed. For the first few days, many of our patients find that consuming smaller meals, more frequently throughout the day, is easier than eating three big ones.
Oral Hygiene
After surgery, good oral hygiene is vital to proper healing. You don’t have to avoid brushing your teeth the night of surgery; just be sure to rinse very gently.
The day after your surgery, rinse your mouth gently with salt water (one cup of warm water mixed with a teaspoon of salt) 5-6 times a day or more, especially after eating.
Mouthwash is not an ideal post-surgery rinse as it is alcohol-based – can be unpleasant, even painful, when it contacts fresh oral wounds. You can resume rinsing with mouthwash approximately three days after surgery, but dilute it with half water. Gradually build up to full-strength mouthwash as the surgery wounds become less sensitive.
Smoking
For at least 48 hours after surgery, do not smoke. Smoking significantly slows healing. How does it retard your healing? Nicotine will constrict the blood vessels, which will delay blood clots forming and expanding in the open socket. The result is called ‘dry socket’ and is a very painful complication.
For 48 hours after surgery, if you need even one Tylenol or Aspirin to control your pain, it’s very important to avoid smoking. When you experience pain this long afterwards, it can often mean the clot has not grown large enough to cover the exposed bone in the socket, which is filled with raw nerve endings. Until those sensitive nerve endings are completely covered with a healthy blood clot, it will be painful. Smoking will only continue to slow this healing process while causing more pain.
Nausea and Vomiting
If you experience nausea or vomiting for more than 12 hours after surgery, please call our office. If you’re feeling ill or vomiting following your surgery, don’t consume any food or drink, including any prescribed medicine, for at least an hour. After an hour or so, try to slowly sip cola, ginger ale or tea. Avoid dairy products.
Help manage nausea by coating the stomach with Pepto Bismol or Milk of Magnesia.
Activity
For 6-12 hours post-surgery, try to minimize any physical activity. Even after this timeframe, if you exercise, it’s possible to experience throbbing pain or bleeding. If this occurs, discontinue all physical activity for another day or two.
Other Complications
If you experience any numbness of the lip, chin, or tongue, there’s no need for alarm. It’s usually only temporary.
If you feel hard projections in the mouth with your tongue, these are not roots. These projections are merely the walls of the tooth socket, and they usually smooth down with time. Keep in mind you may not notice them until days or weeks after your surgery. However, if the rough edges irritate your tongue or cheeks, Dr. Afif or Dr. Poulos can assess the area and smooth them out for you.
It’s not unusual for the corners of the mouth to get stretched during surgery. As a consequence, they are prone to drying and cracking. Keep lips moist with Vaseline.
It’s common, post-surgery, to experience a sore throat and pain when swallowing. It should subside within only a few days of surgery. Note that it’s not unusual to also experience stiffness of the jaw muscles, making it difficult to open your mouth for up to 10 days post-op. Talking, eating, chewing, and yawning can all help the stiffness to ease over time.
Pulling out all the Stops
Getting a tooth pulled is referred to as an extraction. There are many reasons we extract a tooth rather than repair it:
If it’s broken or severely decayed, the tooth is often very difficult or even impossible to repair.
If there is an issue with gum disease.
If the position of the tooth causes problems for the surrounding or other teeth (i.e. an impacted wisdom tooth causing inflammation of the gums and allowing tartar and plaque to build up).
To prepare for orthodontic treatment.
Extractions can cause patients a lot of anxiety – we’re sensitive to that! We make every effort to help your experience, from your diagnosis through to the procedure, be as comfortable and painless and stress-free as possible.
Please feel free to share your feelings of stress and anxiety about the procedure with us so we can take the necessary steps to make you more comfortable and at ease.