We perform certain extractions at Harmony Dental on a case by case basis, with wisdom teeth and some other cases being referred to an Oral & Maxillofacial Surgeon. This is determined by placement of the teeth near adjacent anatomical structures, the patient’s health and medication history, or our doctors’ preference.

Most often, extractions are necessary because the tooth is too damaged from either decay, bone loss, or cracks to be saved, or an attempt to save the tooth would be unpredictable in the long term.

Dental extractions can often be performed with only forceps (i.e. no gum incision or bone removal necessary). Occasionally, a small incision in the gums and sectioning of the tooth or bone removal is necessary to remove the tooth, especially if it is difficult to remove. This is known as a surgical extraction. If this is the case, dissolvable sutures will be placed.

Anesthesia Options

It is normal to feel nervous about having a surgical procedure performed (no matter how big or small).  A clear understanding of your anesthetic options and knowing what to expect is an important way to help you feel better as a patient.

Harmony dental offers two different anesthetic options for your procedure. We do not offer sedation, but if you would like to have this, we can refer you to an Oral & Maxillofacial Surgeon who is trained in sedation and general anesthesia. Below is a brief description of each option that we offer.

Option 1: Local anesthesia only:
Local anesthesia is when patients get a shot for numbing. It involves giving a local anesthetic to the area through an injection in the gums. Local anesthesia is likely what you would commonly think of when going to the dentist because it is the same anesthesia given for restorative treatment like fillings. By using a topical anesthetic jelly first, the discomfort of an injection is commonly decreased. A local anesthetic injection does not eliminate the feeling of pressure or vibration during the procedure, but it removes the feeling of sharpness and causes minimal discomfort.

Option 2: Local anesthesia with Nitrous oxide:
Nitrous oxide (commonly known as “laughing gas”) is a very effective way to decrease patient anxiety. Nitrous oxide is a gas that is inhaled through your nose along with oxygen through a mask. It will not put you to sleep, but it will help you to relax for injections and the procedure. We begin administration of nitrous oxide before the local anesthetic injections to decrease discomfort with the injection.

FAQ

Unfortunately, no. You will be referred to a specialist with more anesthesia options.

The peak of pain and/or swelling can often be 3-4 days after the procedure, then should continue to improve after that time. After approximately a week, most patients feel much better and can return to their normal eating. However, the body continues to undergo a healing process. The gums will typically heal completely within 6 weeks, and the bone will continue to change for months after the extraction.

The exact time varies depending on the person and material used, but typically the stitches will dissolve or fall out on their own within 1-2 weeks.

Yes. Brush your teeth normally, but do not spit forcefully for about a week. You will want to avoid brushing over the extraction site(s) due to the healing gums. Continuing excellent oral hygiene will help prevent infection after extraction, help your healing, and hopefully help prevent from requiring further extractions.

After an extraction, some bleeding is normal, and the blood has factors in it to help the area heal. A clot forms naturally, and if this dissolves or comes out, it leaves an empty socket of bone. This condition is called Alveolar Osteitis, or a dry socket. A dry socket causes soreness in the area since the bone is unable to heal properly, but it is not an infection; the exact reasons this occurs are not known. Treatment involves causing the site to bleed again and/or medicated rinses. The problem usually resolves within 1 week.

This is a complication that can possibly occur after having an upper tooth extracted.  The ends of the teeth are called roots, and upper teeth roots can be positioned very close to (or within) your maxillary sinus. The sinuses are air-filled spaces that everyone has near their cheek bones on each side of their face.  If the roots of the tooth extended into this space, there could be a hole left between your mouth and the sinus after the tooth is extracted. This is a very rare event, and typically heals without any additional surgery necessary if it occurs. If our doctors believe it would require an additional procedure if it were to occur, we will give you a referral to an Oral & Maxillofacial surgeon. If you had this occur, please complete the prescribed antibiotics, and follow the sinus exposure protocol that was given.

Yes.  Smoking causes multiple adverse effects in the mouth. Smoking is a known cause of delayed healing. Also, smoking before an extraction or within 1 month after the extraction causes an increased risk for dry socket and infection.

Post-Op Instructions

Post op instructions are typically discussed verbally and handed to each patient, but the following can serve as a recap:

After any surgical procedure, one can expect some discomfort, swelling, and bleeding. Those occurrences will be minimized if these instructions are followed carefully. Sometimes patients do extremely well, so not all instructions may apply. You know your body best, so please be sure to listen to it, your intuition, and use common sense. However, if you have questions, follow these guidelines or call our office.

Immediately after the procedure:
Bite on folded gauze for at least 60 minutes with firm pressure, or until bleeding has stopped. You will be given extra gauze to change out as necessary. If there is still active bleeding after that time, continue to bite on gauze or a tea bag for another 30-60 min. Please keep in mind that some blood-tinged saliva can be normal for 1-2 days after the procedure.

You are safe to drive after receiving local anesthesia or nitrous oxide. Try to take any pain medication before your anesthetic or numbing wears off.

You may apply ice packs to the outside of your face near the extraction site the first day. Alternate 20 minutes on and 10 minutes off. This can decrease swelling and help with discomfort.

Beginning 24 hours after the procedure:
After the first 24 hours, you may begin gently rinsing your mouth with salt water or the prescribed rinse (chlorhexidine) 3 times per day. Brush teeth carefully, avoiding surgical areas.

For 7 days after the procedure:

  • You should avoid strenuous activity and sports for 5 days after the procedure
  • Do not use a straw
  • Do not spit or suck
  • Do not smoke
  • Do not drink soda or carbonated beverages
  • Do not use hydrogen peroxide or other mouthwash
  • These all have the potential to pull the blood clot out of the socket and lead to a dry socket
  • Remember to not drive or operate heavy machinery while taking narcotic pain medication

Diet:
You may begin eating after numbing wears off and you have removed the gauze. Some soft foods include soup (not too hot), mashed potatoes, Jell-O, applesauce, yogurt, pudding, ice cream, protein shakes (no straws), etc.

You should eat a soft diet with nothing hard, crunchy, or chewy for at least 2 days after the procedure. Make sure to stay nourished; you will feel better if you do not skip meals. Over the next several days, you can progress to other foods at your own pace.

Avoid straws and very hot foods or drinks (increases swelling and can play a part in dry sockets)

Sharp Edges:

It is possible to feel hard or sharp edges in the extraction site. This is likely the bony walls and edges which supported the tooth that was extracted. Occasionally, small slivers of bone may work themselves through the gums during the following couple weeks which can be uncomfortable. If this causes a concern, please call the office.

Conclusion of what to expect:

  • Soreness for at least 4 days
  • Swelling around surgical site
  • Bleeding day of procedure, and to see diluted blood in your mouth for a few days
  • Tightness and stiffness of the jaws/limited mouth opening

If your pain gets worse after 5-7 days, please notify our office

Medications

Most often, it is recommended to take an NSAID such as Ibuprofen to best manage pain and swelling after an oral surgery procedure unless a medical professional has discussed other pain management with you. NSAID stands for non-steroidal anti-inflammatory drug, which also helps with swelling (unlike narcotics). You should begin doses of Ibuprofen immediately after your extractions (600 mg every 6 hours or 800 mg every 8 hours for an adult), ideally before the numbness wears off. Stay on top of the medication regimen to control the pain. You may alternate with Acetaminophen if needed.

  • Do not take NSAIDs or Tylenol if you are allergic, or your medical doctor has advised against it.
  • Do not exceed 3200 mg of Ibuprofen, or 3000 mg of Acetaminophen per day for adults. For children, please refer to instructions on the bottle for dosing based on weight and age.
  • Taking pain medication with food will help prevent stomach pains or nausea.
  • If you were prescribed a narcotic (ie Norco, Tylenol #3), it often has Acetaminophen already in it. Do not take additional Acetaminophen. Please note that narcotic pain medications can have side effects such as upset stomach, drowsiness, addiction, and constipation.
  • You may not drive or operate heavy machinery while taking narcotic pain medication.
  • Most cases do not require antibiotics but take as directed if you were prescribed an antibiotic.

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