Oral Surgery

Dr. Skeie-Alameddine is an experienced tooth extraction dentist in Pleasant Hill. 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.

1.  DO NOT RINSE MOUTH TODAY - Tomorrow rinse mouth gently every 3 to 4 hours (especially after meals) using one quarter teaspoon of salt to a glass of warm water. Continue rinses for several days.
2.  BLEEDING -Following extractions some bleeding is to be expected. If persistent bleeding occurs, place gauze pads over bleeding area and bite down firmly for one-half hour. Repeat if necessary.
3. SWELLING -Ice bag or chopped ice wrapped in a towel should be applied to the operated area; one-half hour on, and one-half hour off for 4-5 hours.
4. PAIN - For mild to average pain use any non-aspirin type of medication you like. If the doctor prescribes a specific pain medication, follow the instructions and do not mix with other medications unless approved by your doctor.
5. FOOD - Light diet is advisable during the first 24 hours.
6. BONY EDGES - Small sharp bone fragments may work up through the gums during healing. These are not roots; if annoying, return to our office for their simple removal.
7. If any unusual symptoms occur, call the office at once.
8. The proper care following oral surgical procedures will hasten recovery and prevent complications.

When a tooth is extracted, it is important to complete bone grafting within the residual sockets that are left behind after the roots of the tooth are removed. When teeth and their roots are removed, unless this socket preservation is performed, the surrounding bone can resorb (disappear) in the first year at the rate of 40-60% of the original height of the bone. The bone "shrinks", causing the person's facial features to undergo a significant aging appearance. Additionally, because the bone shrinkage is so significant, any dental appliance (partial or complete denture) made becomes loose at a more rapid rate than had new bone formed in the socket, thanks to the graft. A membrane may be used to stabilize the graft and protect it from soft tissue invasion and/or "wash-out". Quite often, this site is left to heal over a period of months before a final appliance, or -in the case of implants- the implant is placed.

Before any oral surgical procedure you should:

• Eat a light and easily digestible meal the night before your appointment
• If you are going to be sedated, DO NOT eat or drink anything on the day of your appointment
• Wear short sleeves and loose-fitting clothing
• Arrange for a relative or friend to stay in the office with you and be ready to drive you home
• You may NOT drive a car on the day of the surgery if you are to be sedated!

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 and therefore activities that might disturb the clot should be avoided. Here's how to protect it:

1. Do not smoke, rinse your mouth vigorously or drink through a straw for 24 hours. These activities create suction in the mouth, which could dislodge the clot and delay healing.
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 and 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.

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 the following day 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!

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. DO NOT SMOKE 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 - 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 a cold, moist cloth can be used periodically. Ice should be used only for the first day. Apply heat the following day if needed. Be sure to follow your doctor's instructions.