Oral Surgery

What is cleft lip and palate?

Clefts of the lip and palate are a very common occurrence. They are congenital deformities meaning defective developments seen at the time of birth. Cleft lip is seen as a clefting of the lip - usually the upper. This produces bad facial appearance. Cleft palate is seen as a cleft or furrow in the palate producing sometimes a communication between the nose and the mouth. This causes difficulty in nursing the child and may later pose problems of speech.

Why do clefts occur?

The clefts of the lip and palate occur due to a verity of reasons the most important being genetic. The other causes include the intake of certain teratogenic drugs or chemicals during pregnancy, which cause a defect in the development.

How are clefts treated?

Clefts pose numerous problems. They are treated by a multidisciplinary approach by involvement of the pediatrician, orthodontist, pediatric dentist, plastic surgeon, prosthodontist etc.

When are teeth extracted?

Teeth extractions are done for a variety of reasons. Below are some examples.

  1. Very large cavity/ caries that cannot be restored with cements.
  2. Mobile tooth or infected tooth (abscess)
  3. Fractured or broken teeth 
  4. Teeth that fail to erupt or are unable to erupt into the mouth and are deep inside the bone. They are called impacted teeth and may have to be removed. 
  5. Teeth that are abnormal in development i.e., structure, shape, size, etc. 
  6. Teeth that are involved in cysts or tumors.
  7. Ectopic teeth that have erupted in a wrong place. 
  8. Sometimes the orthodontist may remove some teeth to correct crooked teeth.

Does it pain while removing a tooth?

Dental extractions are done after administration of local anesthesia that makes the tooth and the surrounding tissues numb. Thus extractions need not be painful. But a feeling of pressure may be experience by the patient during the procedure. This is often coupled with fear and anxiety which makes the patient feel some sort of pain

What care should be taken after Dental extraction?

The following care should be taken after extraction: a) Bite on a gauze pack for 15-20 minutes. b) Take rest and avoid physical activities. c) Avoid eating till the numbness of the anesthesia persists. d) Avoid warm food as it can result in bleeding. In addition soft food is advised. e) The dentist may advise cold fomentation for some patients to reduce the inflammation and swelling. f) After 24 hours warm saline mouthwash helps in keeping the wound clean. g) Avoid biting the lips/cheeks.

What are sutures and why are they given?

Sutures are stitches which maybe given after an extraction. These stitches help in approximating the gums close together and therefore restrict the size of the wound. Sutures also help in controlling the bleeding.

Should sutures be removed?

Sutures are of two types: absorbable and non-absorbable. The absorbable sutures are broken down by the enzymes in the human body. So they just dissolve in a few days and need not be removed. The non-absorbable sutures need to be removed after 7-10 days.

Why does it bleed after extraction?

Once the tooth is extracted a wound is created and therefore bleeding occurs. The bleeding stops once a stable clot forms. But in some patients minor seeping of blood may be seen for a day or two after extraction and their saliva may be tinged with blood. This need not be a cause for worry to the patient. However profuse bleeding must be brought to the notice of your dentist.

Do we always have to remove wisdom teeth?

They may not erupt or emerge from your gums until your late teens or early twenties - if they erupt at all. Most often they are impacted or trapped in the jaw-bone and gums, usually because there is not enough room for them in your mouth. In fact, wisdom teeth often do more harm than good, and in-case of any problems related to them, your dentist would suggest removing them.

There are 5 possible ways in which wisdom teeth may cause problems:-

Gum disease: Most people are aware of the pain experienced during the eruption of these teeth. This generally happens because these partly erupted teeth are difficult to keep clean, and the accumulated food particles cause the gums around the tooth to get infected. Such an infection is felt as swelling and pain around the area. Sometimes the tooth is trying to erupt, but has not yet broken through the gums. When the upper tooth bites down onto this gum, pain can be caused.

Impacted:It sometimes happens that there is not enough space in the mouth for these teeth to erupt. In such cases they may try to erupt in an abnormal direction, or may get locked into the jaw. This locking is known as impaction.

Decay:A wisdom tooth may decay unnoticed, as they are the most difficult teeth to keep clean, being so far back into the mouth. Most importantly decay is caused in healthy neighboring teeth because of food stagnation and plaque accumulation.

Crowding: An impacted or erupting wisdom tooth can push on adjacent teeth, causing them to become crooked or even damaging them structurally.

Cyst: If the sac that holds the crown of the wisdom tooth remains in the bone, it can fill with fluid, forming a cyst that can destroy surrounding bone.

Why is the wisdom tooth removed so often?

The wisdom teeth are the third molars, which are the last teeth in the dental arch. The teeth usually erupt between 18 and 25 years of age. In many individuals, the wisdom teeth remain in the bone as they may not have adequate space in the dental arch to emerge out. This condition is called impaction. In addition the third molar may erupt in abnormal inclination thus affecting the health of the adjacent teeth. So the wisdom teeth need to be removed often.

Why is it difficult to remove the wisdom tooth?

The wisdom teeth are often inside the bone and therefore cannot be removed easily by using the forceps. In addition their position and angulation may be abnormal. They often require surgical extraction by cutting open the overlying gums and cutting the bone around the teeth.

Why does a swelling appear after extraction?

Some extractions are followed by appearance of swelling. This is nothing to worry about, as it is a part of the normal healing process. In reaction to the extraction, the tissues show an inflammatory reaction to heal the wound created by the removal of the tooth. Swelling is a part of the normal inflammatory process. However the dentist may advice you to have cold fomentation over the area to reduce the swelling.

What is dry socket?

Dry socket is a condition characterized by onset of pain and foul odor a few days after the extraction. This occurs due to lysis or dislodgment of the clot that forms after the extraction leaving behind the bony socket that is very sensitive and tender. The socket may also get infected. This is one of the rare complications of extraction.

Why does the tooth break sometimes during the extraction?

Teeth are embedded in bone. The principal behind extraction is that the tooth is held by forceps and rocked from side to side to allow the bony socket to expand. In patients who are aged, the bone is very hard and mature and does not easily expand. In addition the teeth also become brittle with age or may have been weakened due to dental decay. The two factors, namely weakened teeth and brittle bone may result in breaking of the tooth during extraction. The small piece of tooth left behind can be removed by appropriate root forceps or may require surgical opening of the gums and cutting of the bone to remove the broken fragment.

Should the gums be cut while extracting some teeth?

Those teeth that cannot be gripped by a forceps or are embedded inside the bone may require cutting of the gums and the overlying bone to remove the teeth. This is called surgical method of extraction.

Can extractions be done on a patient having medical problems?

The dentist must be informed of any medical problems that you may have or had in the past. There are certain systemic problems, which may require certain precautions during the dental treatment so as to avoid complications. In some cases the dentist may require consent from your physician before he can extract.

Can extraction be done on a heart patient?

Usually extractions may not pose any problems for heart patients. However the dentist may require your physician's consent. If the patient is on anticoagulants, the drug has to stopped 4 days before extraction. In addition prophylactic antibiotics may be prescribed prior to the extraction as a precautionary measure. Some sedative may also be prescribed prior to the extraction.

Can extraction be done on a diabetic patient?

Patients who have their diabetes under control by diet and medication can undergo extraction. However the dentist may give you a prophylactic antibiotic prior to the procedure. He would also advice you to have normal food and medicine before the appointment. Sedative may also be prescribed.

How do oral cancers present?

Most oral cancers may appear as a swelling or painless ulcer. Sometimes a patch of whitish tissue or red tinged tissue may be seen. Pain is usually a feature in the late stages due to infection of the lesion. The cancer can spread to nearby and far tissues.

How are oral cancers treated?

Oral cancer is treated by one or more of the following: 1. Chemotherapy: This means the tumors are treated by drugs or chemicals that kill the tumor cells. These drugs are usually very toxic to the body. 2. Radiation therapy: The tumor is exposed to radiation, which is found to cure certain tumors. 3. Surgical removal: The entire tumor is removed along with a border of normal tissue. In case the tumor has spread to nearby lymph glands, they may also be removed surgically.

Do teeth get decayed after radiation therapy?

Radiation therapy for treatment of oral cancer is usually followed by reduced salivary quantity due to atrophy of the oral glands. So the cleaning action of the saliva on the teeth is reduced resulting in increased dental decay. Thus patients who have had radiation therapy need to maintain good oral hygiene and may also require professional fluoride application to offer resistance to caries.

Are teeth extracted prior to radiation therapy?

Extraction and other minor oral surgical procedures are usually completed prior to radiation therapy. Soon after the radiation therapy it has been found that the blood supply to the radiated zone is reduced. This predisposes the tissues to infection. So surgical procedures and extractions are avoided after radiation therapy.

What is biopsy?

Biopsy is surgical removal of a small sample of tissue from a lesion such as a tumor. This tissue is studied under the microscope to determine what type of lesion it is so that appropriate treatment can be planned.

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