Oral Surgery & Teeth Extraction
There may be a time when you need a wisdom or other tooth removed. The team at Parkview Dental have the expertise, experience, and equipment to make your tooth extraction as comfortable and pain-free as possible.
To learn more about what kinds of extractions we provide, please click the links below.
Oral Surgery
By age 18, most adults have 32 teeth – 16 on the top and 16 on the bottom. By design, an average mouth holds 28 teeth, often making it painful to fit all 32. The four extra teeth are your third molars or wisdom teeth. It’s not unusual for these teeth to become problematic.
Why Should I Have My Wisdom Teeth Removed?
Wisdom teeth are the last teeth to erupt through the gums. When they align properly, and the surrounding gum tissue is healthy, they don’t need to be removed. Unfortunately, this is the exception rather than the rule.
When wisdom teeth can’t erupt in a healthy way, extraction is necessary. Sometimes they grow sideways, emerge only partially, or remain trapped beneath the gum and bone. When teeth are impacted, they can exist in a variety of positions within the bone as they find a path to erupt successfully. This process can cause many problems.
Alternatively, the opening in the gum of a partially erupted tooth allows bacteria to grow, eventually resulting in infection, which can include swelling, stiffness, pain, and even illness. The associated pressure may cause the surrounding teeth to move and potentially disrupt the natural or orthodontic alignment of other teeth.
The most serious issue occurs when cysts or tumours form around the impacted wisdom teeth. The result can be the destruction of the jawbone and healthy teeth. Removing the offending teeth tend to resolve or prevent these problems. We recommend early removal to avoid future complications and decrease the surgical risk involved with the extraction procedure.
Common dental problems encountered with wisdom teeth include:
Periodontal disease (gum disease)
Recurrent pericoronitis (multiple episodes of gum infection)
Abscess, cellulitis or osteomyelitis (an infection spread from wisdom tooth into surrounding tissues)
Untreatable pulpal and/or periapical pathology
Inability to treat a cavity in a tooth without removal of the wisdom tooth
A disease of follicles, i.e. a cyst (a sac filled with fluid) or tumour
Wisdom tooth root, bone or crown breakdown
Fracture to a wisdom tooth or neighbouring teeth
In the event of one of the above issues, the following may develop:
Pain or tenderness in the gums or jawbone
Bad breath
Redness or swelling in the gums
An unpleasant taste in the mouth
Headaches or jaw ache
Wisdom Tooth Extraction
If we feel a wisdom tooth extraction is in your best interest, for your convenience, we will schedule an additional consultation with our oral surgeon. This is an opportunity to discuss your options, ask questions, and learn about any potential surgical risks.
Post Tooth Extraction
Removing impacted teeth is a serious surgical procedure. Post-operative care is critical.
Following instructions carefully will help you avoid any unnecessary pain and possible complications of infection and swelling.
Directions immediately following surgery:
For about an hour, bite down on the gauze pad covering the surgical site. After this time, remove and discard the gauze pad. Replace with another. Refer to the section on BLEEDING for more details.
Avoid touching the wound area or vigorous mouth rinsing after surgery. This can initiate bleeding by dislodging the blood clot that has formed to facilitate healing.
Place ice packs on the surgery side of your face to help minimize any swelling. Refer to the section on SWELLING for a more thorough explanation.
Begin prescribed pain medications as soon as you can. Start medications as soon as possible so as to digest them before the local anaesthetic wears off. Have something of substance in your stomach to coat the stomach and help minimize nausea from the pain medications. Refer to the section on PAIN for specific details.
Restrict your activities on the day of surgery. If you are active on the day of surgery, your heart rate is elevated and can cause excessive bleeding and throbbing from the wound. You can resume normal activity when you feel comfortable.
NO SMOKING UNDER ANY CIRCUMSTANCES
Bleeding
You can expect a certain amount of bleeding following surgery. Typically, on dry skin, it takes about 10 minutes for bleeding to clot. In the mouth, however, where it’s a wet environment, it takes about 6-8 hours for clots to form and bleeding to subside. It’s common to experience slight bleeding or oozing, visible in the saliva.
The gauze will always appear red when it is removed. Even after bleeding from the sockets has stopped, saliva washes over the blood clots and leaves the gauze red.
To control excessive bleeding, GENTLY rinse or wipe old clots from your mouth, place a gauze pad over the area and bite firmly for sixty minutes. Repeat as necessary.
If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps encourage clotting by contracting bleeding vessels. You can repeat several times.
Minimize further bleeding by sitting upright, keeping calm, maintaining constant pressure on the gauze (no talking or chewing) and avoiding exercise.
If bleeding does not subside after 6-8 hours, call our office for further instructions (416-368-2855).
Swelling
It is normal to experience swelling of the cheek(s) after the removal of impacted wisdom teeth. You can expect the swelling not to become apparent until the day after surgery. And it may not reach maximum swelling until 2-3 days post-operation.
The immediate use of ice packs can help minimize swelling. Apply a sealed plastic bag of ice or frozen veggies (peas or corn are best) wrapped in a washcloth and applied to the side of the face where surgery was performed.
Apply ice packs alternating on and off every 20 minutes for the afternoon and evening immediately following your extraction. After 24 hours, ice has no beneficial effect.
36 hours after surgery, applying moist heat, such as a warm, damp cloth to the side of the face, can help reduce swelling.
Don’t be alarmed if swelling or jaw stiffness persists for several days. Soft, puffy swelling that you can indent with your finger is very normal after oral surgery.
If swelling becomes hot to the touch, bright red and rock hard, which does not indent with finger pressure and enlarges, it may indicate infection. These symptoms typically develop around days 3-4 after surgery. If this occurs, call our office for support.
Temperature
It is normal to run a low-grade temperature (99°-100°F) for 7-10 days following oral surgery. You may even experience a higher temperature (over 101°F) for 6-8 hours after surgery. It should decrease after that time. Two Tylenol or 2-3 200mg Ibuprofen (Motrin/Advil) every 4-6 hours will help to moderate high temperature.
A temperature above 101°F several days after surgery – especially when accompanied by redness, hard swelling and increased pain – is often indicative of infection. Call our office for instructions if this occurs.
Bruising
Sometimes the procedure involves smoothing bone to fit a denture. Some bruising is likely to appear on the surface skin over the surgery area. It commonly occurs over the upper-eye teeth (on the cheek and below the eye).
You might find that bruising isn’t obvious for a day or two. By the time it reaches the surface, it may have already turned from purple to green to yellow in colour. Over several days, the yellow colour can extend down the neck to near the nipple line on the chest before it disappears.
Pain
You can expect moderate discomfort or pain following surgery to last as long as 4-5 days. It’s not unusual for the third and fourth days to require more pain medicine than the first and second days. Pain should consistently subside following the fourth day.
Many pain medications can cause nausea or vomiting. We recommend you have something of substance in the stomach (ice cream, yoghurt, pudding or apple sauce for instance) before taking prescription pain medicines or over-the-counter pain medicines (especially aspirin or ibuprofen). Pepto Bismol or Milk of Magnesia can also help to prevent or minimize nausea.
For moderate pain, you can take one or two tablets of Tylenol or Extra Strength Tylenol every three to four hours. Ibuprofen (Motrin or Advil) two-three 200 mg tablets may be taken every 4-6 hours.
For severe pain, take the prescribed pain tablets as directed every 4 hours in addition to the Tylenol or Ibuprofen. Expect the prescribed pain medicine to make you groggy and slow down your reflexes. Please do not:
Drive an automobile or work around or operate heavy machinery if you are taking prescription pain medicine.
Drink alcohol. Alcohol and prescription pain medicines do not mix!
If you require prescription pain medications for longer than 4 days, further treatment may be required. Please call the office and discuss your situation with us.
Antibiotics
We don’t routinely prescribe antibiotics after oral surgery. The overuse of antibiotics leading to the development of resistant bacteria is well documented. We give careful consideration to each circumstance when deciding whether antibiotics are necessary. Only in specific circumstances will we prescribe antibiotics to help prevent infection or treat an existing infection.
If you have been prescribed antibiotics, take the tablets or liquid as directed. You should take them on schedule until they are completely gone.
In the event of a rash or other unfavourable reaction, discontinue antibiotic use and contact our office to report any such finding.
Diet
It’s important to stay hydrated. Drink 5-6 glasses of water on the first day. DO NOT use a straw – the sucking motion can dislodge the blood clot that naturally forms in the wound and delay healing.
Avoid hot liquids or food until any numbness wears off.
You can eat soft food and liquids on the day of surgery. Avoid chewing hard or sharp food items for several days so as not to disturb the surgical site.
Return to a normal diet as soon as you are able unless otherwise directed. For the first few days, many people find eating multiple small meals a day is easier than three large meals.
Oral Hygiene
Good oral hygiene is essential post wisdom teeth removal. You can brush your teeth the night of surgery but rinse very gently.
The day after surgery, rinse your mouth with salt water (one cup of warm water mixed with a teaspoon of salt) at least 5-6 times a day, especially after eating.
Mouthwash has an alcohol base, so it can cause an unpleasant sensation when it comes in contact with fresh oral wounds. Resist using mouthwash until three days after surgery and dilute it by half with tap water. Gradually build up to full-strength mouthwash as the wound becomes less sensitive.
Smoking
Do not smoke for at least 48 hours following surgery. Smoking retards healing dramatically. Constricting blood vessels significantly, nicotine slows the formation and expansion of the healing blood clot in the socket. This leads to a painful complication called dry socket.
If, by 48 hours after surgery, you need even one Tylenol or Aspirin to control pain, avoid smoking. This usually indicates that the clot has not grown enough to cover all the exposed bone in the socket. The exposed bone is filled with raw nerve endings, and until they’re covered with a healthy blood clot, it will cause pain. Smoking will slow this process significantly, worsening the pain.
Activity
For 6-12 hours after surgery, keep all physical activity to a minimum. If you exercise 12 hours after surgery and still experience throbbing or bleeding, you should discontinue all physical activity.
Nausea and Vomiting
If nausea or vomiting persists for more than 12 hours, please call the office for advice.
If you experience nausea and/or vomiting following surgery, do not consume anything – including prescribed medicine – for at least one hour. After this period, sip slowly on coke, tea or ginger ale. Avoid milk products.
Coating the stomach with Pepto Bismol or Milk of Magnesia may help nausea to subside.
Other Complications
If you experience numbness of the lip, chin or tongue, there is no cause for alarm. This is usually a temporary symptom.
Sometimes, patients can feel hard projections in the mouth with their tongue. These are not the roots of the tooth; they are the walls of the tooth socket. These projections usually become smooth naturally within days or weeks after surgery. If the rough edges bother your tongue or cheeks, Dr. Afif or Dr. Poulos can evaluate the area and smooth them down for you.
Corners of the mouth can get stretched during surgery resulting in drying and cracking. Keep them moist post-surgery with an ointment like Vaseline.
It’s not uncommon to experience sore throat and pain when swallowing. It should subside within 2-3 days.
Commonly, patients experience stiffness of the jaw muscles, making it difficult to open their mouth, for anywhere from 7-10 days after surgery. Eating, chewing, talking, and yawning help ease the stiffness over time.
Pull out all the Stops
Pulling a tooth is referred to as an extraction. There are various reasons a tooth needs to be extracted rather than repaired:
Decay or a break in a way that makes repair difficult or impossible
Gum disease
If a tooth’s position in the mouth causes problems with other teeth (an impacted wisdom tooth causing inflammation of the gums allowing tartar and plaque to build up, for example)
In preparation for orthodontic treatment
We understand how extractions can cause anxiety. Please rest assured, we take every precaution to ensure that your experience, from your initial diagnosis through to successful tooth extraction, is as pain- and stress-free as possible.
We encourage you to share your feelings of anxiety and stress about the procedure with us. We will take all steps necessary to alleviate your discomfort.