Dental Questions: Does every tooth extraction require stitches?

Wether you've had a tooth extracted before or not, chances are that you have some idea of what is involved in this procedure. You would probably expect that every patient gets stitches (professionally called sutures) before they are allowed to leave. A dentist wouldn't let you go with a giant hole in your jaw, right? On the contrary, there are many times that sutures aren't a necessary step after extracting a tooth and do not improve the healing process. Take a look!

In the mouth, sutures can assist in the healing of gums and other soft tissues by holding them in a desired place. In complex dental extractions, such as removing wisdom teeth or impacted teeth, the bone and gums around the tooth may need to be moved or partially removed. To ensure that the gums heal cleanly around the jaws and do not create a food trap, sutures are used to approximate natural soft tissue contours. Additionally, stitches are used to help in the formation of healthy blood clots and to help keep grafts and membranes in place during critical healing periods. 

For "simple" dental extractions, sutures are not always required. When there is minimal manipulation of the gums and bones AND the patient has a healthy immune system, it is reasonable to expect that the tooth site will heal with no sutures. For most patients, a "scab" will begin to form in the mouth before they leave the dental office, and nearly all bleeding will cease within 2 hours. Research shows that sutures will not help the gums or bones heal faster or assist in preventing post extraction infection. On the contrary, the most important determining factor in extraction outcomes is following the post operative instructions given to you by your dentist!

It is often hard to tell if a patient will need sutures until after the extraction procedure is finished. Sometimes, even the most simple-seeming teeth require more manipulation and work than they initially let on. As with every procedure, we do our best to inform you of changes to your treatment plan as they arise. If you would like to know more about tooth extractions, oral surgery or other dental procedures, please give our office a call!

Wisdom Tooth Extraction

Wisdom tooth extraction is the most common oral surgery procedure performed on high school and college aged patients. Depending on how the teeth grow in, they can be painful, irritating or harmful to the adjacent teeth. Read on to learn about wisdom teeth and what to expect at your extraction appointment!

Wisdom teeth (or "third molars" in technical terms) are the last molars on the upper and lower arches of teeth, typically coming in between the ages of 17 and 20. They are the most common congenitally missing teeth, with 10-45% of the population missing at least one. When they erupt, wisdom teeth often grow in at angles that limit their usefulness in the mouth. In fact, they can increase the risk of decay and bone loss around adjacent teeth, depending on their position. 

Most dentists will recommend extraction of wisdom teeth if there is any sign of positioning problems or pain. Even if the teeth are "questionable," extraction is usually recommended if the patient is young and healthy. If you choose to wait until the teeth become infected or painful, there could be more complications with the procedure or recovery. In many cases, wisdom teeth will be impacted, or stuck beneath the gums and/or bone. Because of this, and because they are positioned so far in the back of the mouth, wisdom teeth are usually removed by an Oral Surgeon. Surgeons have the skills and instruments to remove more complicated teeth more quickly and with less trauma to the surrounding tissue. 

When you have you wisdom teeth removed, you will likely be given the option of being sedated for the procedure. No matter what type of sedation or anesthesia the surgeon uses, you will need to have someone drive you to and from your appointment. Additionally, plan on missing work/school for the rest of that day and the following day for recovery (at a bare minimum). Your cheeks can be swollen for the first week after the procedure. Pain usually peaks at about two days after and begins feeling completely normal in about a week. As with any tooth extraction, keeping the socket clean and healthy for the first two weeks is crucial. No smoking, sucking on straws or spitting with force!

We refer all wisdom tooth extractions to our network of trusted oral surgeons. If you would like to discuss your referral or better understand the extraction process, feel free to give our office a call. We are always here to alleviate any dental concerns or fears!

Dental Questions: What can a dentist do for tooth pain

At some time in their lives, everyone has experienced unexpected dental pain. It probably didn't show up at a convenient time (it never does) and you were probably willing to do anything to stop the pain. Fortunately, dentists are highly skilled in diagnosing and treating tooth pain. Read on to learn what we can do for patients in distress. 

As a disclaimer, this article will focus mainly on pain originating from the tooth nerve. An entire spectrum of problems can present as tooth pain (sinus infections, muscle spasms, gum disease, etc.), and a thorough exam with x-rays is the only way to confirm the source of your discomfort. 

The nerve in your tooth may become irritated for a number of reasons, ranging from exposure to extreme temperatures to decay and even fractures. Usually, this irritation is reversible meaning the nerve will calm down on its own. However, in certain cases the tooth can cross a threshold and become irreversibly inflamed, meaning the pain will persist until the tooth nerve dies. At this point, the nerve has to be taken out of the mouth- either via root canal or by extracting the tooth. 

At an emergency visit, a dentist will evaluate what is causing the pain, the health of the tooth nerve and if the tooth is overall "fixable." If the pain is coming from a tooth with a cavity or fracture that extends down the root and beneath the gums, it may be best to extract it and consider replacement options in the future. However, if the offending problem is well isolated and treatable, you will probably want to opt for a root canal. At most emergency appointments, a dentist will not complete a full root canal. Rather, they perform a procedure called a pulpectomy, where the nerve is removed and the roots are sterilized and filled with a temporary material. This procedure ends the pain and provides short term protection against bacterial invasion of the tooth. A full root canal will be required to reliably seal the nerve space and minimize risk of re-infection. 

If you can't get to a dental office right away and need relief from pain, over the counter NSAID medications like ibuprofen are excellent at treating dental discomfort. You may be tempted to request a prescription pain reliever, but these will not treat the inflammatory component of your pain like an NSAID. Before taking any medication for the first time, please consult with your dentist. If you have further questions on tooth pain, gum pain or emergency appointments, please give our office a call!