Despite the quick development of dental services there are still some mutations that cannot be cured with any of the dental treatments. That is when oral surgery can help.
Tooth extraction may be necessary if there is:
- a plexus tooth that maintains a chronic inflammation (i.e. upper tooth plexus may cause sinus infection)
- a broken tooth with massive dental caries that cannot be cured or used for a prosthesis
- an instable and loose tooth caused by parodontium disease a healthy tooth that needs to be removed for orthodontic treatment
The treatment is executed after a thorough dental examination and X-ray. The dentist decides whether the tooth needs to be simply pulled out or through operation. Both treatments can be executed straightaway. It is recommended to have a meal before the intervention as it is not allowed to eat after anaesthetic injection, as long as torpor lasts (3-4 hours).
Simple tooth extraction
A simple tooth extraction is executed with local anaesthesia. Firstly the gum is separated from the tooth with a special tool in order to protect the mucosal that surrounds the tooth. The tooth is loosened then removed with a forceps. In case of an inflamed tooth extraction the inflamed tissue, located in the wound cavity, also needs to be extracted. After the treatment it is necessary to bite on a gauze compress for twenty minutes.
Tooth extraction with operation
Sometimes the tooth cannot be extracted in a simple way, for example in cases of a broken dental root, a tooth that didn’t come out, a curved or splayed root (if it can be seen on the X-ray image) or an upper tooth that is located too close to the sinus (in this case the sinus will presumably open sometime). In such cases a tooth needs to be extracted with operation.
The intervention is executed with local anaesthesia. The dentist creates a gingival flap with removing the gum that surrounds the tooth. He removes the bone that obstructs the tooth extraction, then the tooth, too. He also removes the inflamed tissue, located in the wound cavity, and corrects the rough bone edges of the dental alveolus with nibblers. Finally, he closes the operation area with sutures. After the treatment it is necessary to bite on a gauze compress for thirty minutes, and when the bleeding stops the patient is allowed to go home.
Advices after tooth extraction:
After tooth extraction it is not allowed to rinse or spit as the callus may fall off the wound cause bleeding, besides, the chance of inflammation increases. Under the anaesthetic it is not allowed to eat as the patient may cause injury in his mouth. Dairy products are also prohibited for two days after the extraction, as these rations may result in the increase of bacteria in the wound. If there was an inflammation around the extracted tooth before the intervention, fever may occur afterwards; in this case febrifuge needs to be taken.
Potential complications after tooth extraction
Tooth extraction may result in the damage of the gum, crack on the side of mouth or herpes around mouth. The neighbouring tooth may get loose or its filling may fall out. Buccal may open at the upper teeth, or sensory nerve in the jaw bone may be injured at the lower teeth that may cause a temporary torpidity for months.
These complications may occur as a result of a simple extraction, therefore we might say that tooth extraction with operation is a safer way, besides, recovery is faster after operation.
Wisdom tooth extraction
Wisdom tooth often needs to be extracted, even among patients with absolutely healthy teeth. It is mostly necessary when a tooth is stuck in the jaw bone while coming out and stays in the wrong position.
Most common complaints related to displacement of wisdom teeth:
- painful feeling of tension by the temporomandibular joint
- limited ability to open the mouth
- gingival pocket and its inflammation due to displacement
- crowding of front teeth
- dental caries in the teeth, located in front of a wisdom tooth
Before wisdom tooth extraction a thorough condition survey is made that is based on taking an X-ray. In case of a severely inflamed tooth antibiotic treatment needs to be done before the intervention as the surroundings of an inflamed tooth is difficult to anaesthetize. After a proper preparation process, analgesic extraction can be carried out.
The advices after the wisdom tooth extraction are the same as in the cases of other extractions.
Sinus is located in the upper jaw bone. The opening of sinus is the most common intergrowth of the extraction of the small or big upper molar. It may occur if the dental root grows in the sinus, yet it sometimes cannot be seen on X-ray images.
After tooth extraction a so-called nose blowing test is done to check whether the sinus opening was successful. If so, the sinus has to be closed immediately with using local anaesthesia. The dentist creates a gingival flap, that is used for closing the cavity, and fixes it to the mucosal of the roof of the mouth with sutures.
Apectomy (root end surgery)
Apectomy means the removal of the root apex of dental root from the bone – while taking care of saving the tooth. The treatment is executed in case of a tooth with root canal filling.
Apectomy may be necessary if:
- there is a cyst-like deformation around the root apex of a dead tooth that cannot be cured;
- the root apex becomes inflamed a few months after root canal filling treatment, even in case of a seemingly healthy tooth;
- there is a chronic inflammation around the root apex;
- the root canal filling material had spread over the root end and got into the bone tissue;
- a kind of a pseudo-path evolves during root canal treatment, therefore the instruments, that are for broaching the root canal, move on the wrong path;
- the (above mentioned) instrument for broaching or the root canal filling condenser break into the root canal.
The operation is executed after root canal filling, with local anaesthesia; and it can be carried out before or even during the operation. The dentist creates a gingival flap, then sets the bone, that covers the root apex, free with a bone cutter (or an osteotome) and removes the freed root apex (at least 3 mm of it) and the possible inflamed tissue. If necessary, the synthetic bone needs to be filled in this gap. The wound is closed with sutures that are removed a week after the intervention. The tooth will be symptom-free and operable again in 4-6 months. It is recommended to have an X-ray based check-up in every half year afterwards.
Apectomy is a last chance to save the tooth from final removal; the chance of a successful operation is 60%.
Potential complications after the operation
The inflammation around the root apex may not subside if an abscess evolves again. This is why it is advised to have a check-up in every half year; the dentist can follow up the process of the healing and the ossification with the help of X-ray images. Other potential complications: injury of the gum, crack on the side of mouth, herpes around mouth or swollen face at the spot of the operation.
It is not allowed to suck or rinse the wound, to foment or warm the face with a pillow. It is allowed to chill the swollen part, but only from the outside for 1-2 minutes, 5-6 times a day. After brushing the teeth, it is advised to sterilize the oral cavity (e.g. with Chlorhexamed) 2-3 times a day. It is not allowed to do physically hard work for 7-8 days. If necessary, it is allowed to take a painkiller, however, antibiotics can be taken only if the doctor orders it.
Osteoplasty is one of the latest dental treatments; it may be a solution for different kinds of dental bone defects.
Such defect may evolve as a result of trauma, cyst, tumour, bone disease or an edentulous area. The decrease of the bone amount is mainly caused by the loss of a tooth, as it results in the cease of the mechanical stimulus that affects the bone; therefore the bone tissue begins to waste away.
For refilling the bone the following methods can be applied:
- own (autogenous) bone that helps the regeneration of the weak bone. However, later another operation is necessary to gain own bone. In most cases, hip bone, shin bone, the frontal part of jaw or skullcap is used as own bone.
- another person’s (allogenic)bone – however, this method is not applied in Hungary yet.
- synthetic (alloplastic) materials: mainly tricalcium phosphate, hydroxy apatite etc. that are suitable for refilling smaller amount of bone.
- brute (xenogeneic) materials that are made of pig bone (that had gone through a multi-phase sterilization process) under strictly controlled conditions.
The process of apectomy:
The intervention for gaining own bone is executed with local anaesthesia. With the help of X-ray, the dentist cuts the gum in particular spots and creates a gingival flap with removing the gum that surrounds the tooth. The refilling material is placed in the operation area; then the area is covered with resorbable and non-resorbable membranes. These membranes protect and help the ossification. The sides of the gum are set together again with sutures that are removed seven days later. Recovery takes three months after the intervention; during the recovery period the synthetic bone ossifies with its surroundings and becomes the part of the human body.
Sinus is located in the maxilla, above the small and big molars’ region. When losing molars, there are only teeth abutments left; and the more time passes after the extraction of a tooth, the thinner the bone amount becomes under the basis of the sinus. Sinus lift method was evolved to thicken this bone plate; by now it has become a routine surgery intervention.
In most of the cases the intervention is executed before the implantation of an artificial root (implant), if the own bone amount is not sufficient.
The process of the operation
The intervention is executed with local anaesthesia. Fenestration is made outside of the cheekbone, then it is lifted in towards the sinus; as a result, it pushes the mucosa ahead of itself. The bone refilling material needs to be placed between the mucosa and the basis of the sinus, thus the height of the bone increases towards the oral cavity. The bone regeneration takes 6-8 months.
Oral cavity mutations, histology (cancer screening)
The oral cavity is checked during each control. In case of any tumour, the prevention is the most important thing to do. Most of the oral tumours can be detected with a simple physical examination. The development of a tumour is basically related to the overall poor condition of the teeth; unfortunately most of the people only go to the doctor when they feel pain.
There is no need for a specialist to notice a mutation, one just has to observe himself carefully. Anyone is able to examine himself with the help of a mirror. One needs to take a good look at his lips, palate, tongue and the area under the tongue.
Please, visit your doctor if you notice any of the following symptoms:
- pain in the mouth, throat or ears,
- ulcer in the mouth,
- an unusual white or red discoloration,
- lump or swelling on the lips, in the oral cavity or on the throat,
- difficult or painful chewing or swallowing,
- torpor in the mouth,
Mandibular joint diseases
Mandibular joint (temporomandibular joint) is made of the mandible caput and the glenoid fossa that is located on the cranial base. There is a temporomandibular disk between the two bone surfaces; and the caput quasi lapses on this mandibular ribbon. The joint is held by special ribbons from the outside. The movement of the joint is not just a simple turn but a forward and backward slip combined with a mandibular joint rotation.
Diseases and injuries of the mandibular joint
- Ankylosis (bone adhesion between joint surfaces)
- Trismus, i.e. lockjaw (spasmodic traction of the jaw muscle; mostly it is the result of a wisdom tooth inflammation)
Teeth grinding at night (bruxism)
The exact cause of teeth grinding is still unclear. In case of children it often occurs at the time of changing teeth, when the position and size of the teeth are different, however, it may occur if one has a cold or upper respiratory infections. In case of adults it can be the result of stress. Grinding teeth is extremely straining for the teeth and the surrounding tissues. As the consequence, breaking of teeth and tooth fillings or damage of the enamel may occur.
- pain in the cheek or mandible jaw
- irritating sound
Night guide: a flexible, transparent tool made by impression.
Antiphlogistics to reduce the pain, muscle relaxants, tranquilizers, physiotherapy treatments, massage, behavioural therapy, hypnosis and autogenic training.
Gingival pocket and intraosseous pocket treatment
One of the most feared dental diseases is gingivitis and the connecting gingival bleeding, gingival retraction, gingival pocket, periodontal bone desorption and intraosseous pocket. In the end, gingivitis causes a complete edentulous area. The bacteria of the mouth and the metabolites of these cause gingivitis; genetics does not play an important role in the development of the disease. Many factors are connected with each other in this process, such as the saliva composition, the position of the teeth and the possibility of cleaning them properly. However, it is the pellicle and plaque to be blamed mostly. Once the process begun, it cannot be stopped, but it can be slowed down with maintaining a proper oral hygiene.
- Primary care of fresh dental injuries caused by accident (splinting, medication bond, tooth extraction)
- Acute inflammation care (root canal treatment, tooth extraction)
- Conservative treatment of periodontal and gingival inflammation
- Abscess opening in the oral cavity
- Removal of foreign objects that hinder swallowing or breathing
- Medical treatment of acute inflammation of the mucous membranes
- Trigeminal neuralgial paroxysm easing with local anaesthesia
- Anastalsis of any bleeding in the oral cavity or in its surrounding (with tampon, bond, coagulation enhancing drugs, sutures).
Soft laser treatment
Soft laser is basically used for pain and inflammation reduction and for acceleration of wound healing. Its high-energy laser rays are absorbed into the cells thus accelerating the biochemical processes that are necessary for healing.
Soft laser treatment is pain-free and takes only a few seconds each time.
It is used for:
- joint pain
- post-traumatic pain
- after bone surgeries (resection, implantation, tooth extract)
- dental inflammations (osteoperiostisis, root canal treatment complain, lymphoid inflammation)
- pain syndromes (atypical facial pain, trigeminal neuralgia)
- complications related to tooth fracture and orthodontics)
X-ray and camera based examinations
Dental X-ray is inevitable in diagnostics. It is able to explore such hidden mutations that cannot be seen even with thorough clinical examinations.
These hidden mutations are:
- dental caries that evolves on the surface of teeth facing to each other
- dental caries under old tooth fillings
- intraosseous pocket
- inflammations around the root apex
- cystic mutations in the oral cavity
Besides revealing pathological processes, with the help of X-ray it is possible to discover the position of permanent teeth in case of children. In case of adults it is used for the examination of wisdom teeth that did not come out and for checking the root canal filling.
Although dental X-ray radiation is low, patients have to wear lead apron for their own protection.
Intraoral X-ray is an image that is made inside the mouth for the examination of a tooth.
An orthopantomographic image shows both jaws with all the teeth and other body parts, as well as the whole oral and nasal cavity. This type is called extraoral X-ray. While operating, along with the ray source, it moves around the patient’s head along his jaws.
Oral camera is a small camera with high resolution; its screen shows the shots made in the oral cavity. With the help of the camera it is possible to show the diseased areas that cannot be seen, besides, the phases of the treatment and its result can also be demonstrated for the patient. It is a great help in diagnostics and an excellent way to motivate the patient.