OST Blog

No one really looks forward to a wisdom tooth extraction, even a straightforward one. Fortunately, you can be confident that your oral and maxillofacial surgeon has the experience and the skill to make your extraction experience as safe and comfortable as possible.

But what happens when your situation is not quite so straightforward? Dr. Ford and Dr. Guter and our team have the experience and the skill to diagnose and treat these more complex extractions as well.

One of the potential complications with an impacted wisdom tooth is its close proximity to the Inferior Alveolar Nerve (IAN) of the jaw.  When the roots of the impacted tooth are fully developed, they can rest very close to, put pressure on, or, in rare cases, even wrap around this nerve.

Why is this a problem? Because these nerves supply feeling to the lower lip, gums, chin, and teeth. If a nerve is damaged during extraction, a patient might be left with pain or numbness in these areas, which can affect sensation, speech, and eating. While this nerve damage is usually temporary, in rare cases it can be permanent.

But an impacted tooth, left alone, can also have serious consequences—pain, infection, and damage to neighboring teeth and bone. So what’s the answer in this complicated case?

Talk to Dr. Ford and Dr. Guter. We have the training and skill to detect any potential nerve involvement when you need a wisdom tooth extraction, and we have a procedure to help prevent damage to the nerve if it lies too close to the roots. The coronectomy is a specialized surgery used only to treat impacted teeth when the nerves of the lower jaw might be compromised.

What is a coronectomy, exactly? The tooth can be thought of in two distinct segments—the crown, which is the part of the tooth that rises above the gum when the tooth erupts, and the roots below, which anchor each tooth in the jaw. A “coronectomy” means the removal (“ectomy”) of the crown (“corona”) of the tooth.

In this procedure, we will divide the tooth into two parts. After making a small incision to expose the tooth, the crown will be removed, and the root section left in the jaw. When the procedure is completed, the incision in the gums will be closed with sutures. Recovery is much like recovery for any other tooth extraction.

Once the coronectomy is completed, you might be asking, “What happens to those roots that were left behind?” Another good question!

• Very rarely, the roots become infected or cause irritation to surrounding tissue and will need to be removed.
• Occasionally, root fragments can start to emerge through the gums, just as a whole tooth would. But since they must move away from the nerve in order to erupt, they can be extracted without endangering the nerve.
• The most common result? The remaining root segment becomes permanently encased by bone tissue within the jawbone, never to cause problems again.

Are there times when, even though a wisdom tooth is bordering on a nerve, this procedure might not be advisable? Yes. Infection and decay in the tooth, tooth mobility, periodontal disease near the tooth, a horizontal tooth (where sectioning the tooth could damage the nerve), and other conditions might mean that a coronectomy is not possible. In that case, Dr. Ford and Dr. Guter can discuss further options with you.

No one really looks forward to wisdom tooth extraction. Fortunately, even in complicated situations, your oral and maxillofacial surgeon has the experience and the skill to provide the answers you need for an extraction experience that is as safe and comfortable as possible.

Any more questions? Contact our Virginia Beach, VA office to see if a coronectomy is the answer for you.

There are many understandable reasons why you might be feeling less than enthusiastic about your upcoming implant procedure, extraction, or any other dental surgery.  Perhaps anxiety is an issue, or your teeth are extremely sensitive. You may have a low pain threshold, an easily triggered gag reflex, or require longer or more complex work during your visit. These are also excellent reasons to consider sedation dentistry.

Of course, Dr. Ford and Dr. Guter will always try our best to make sure that every procedure is pain free. A local anesthetic will be provided to numb the surgical area completely. You might decide that this all that you need, especially for relatively simple procedures. But if you would prefer to remain completely aware, but feel less anxious, if you would like deep sedation throughout the entire procedure, or if you want something in between, talk to us about making sedation part of your treatment.

The most common methods of sedation include:

• Oral Sedation

Usually, oral medications that reduce anxiety are given in pill form. The level of sedation and how much you will be aware during your procedure will depend on the dosage, and you will need time to recover from the drug’s effects after we are done.

• Nitrous Oxide

Commonly referred to as “laughing gas,” this has been used since the 1800’s to relieve dental anxiety and reduce pain.  Today’s equipment is designed to provide a precise mixture of nitrous oxide and oxygen inhaled through a mask that you will wear throughout the procedure. Once the mask is removed, you will recover quickly.

• IV Sedation

Medication will be delivered through an intravenous line placed in a vein. This delivery system allows the sedative to take effect very quickly, unlike oral sedation, and adjustments to the sedation level can be made throughout the procedure. This method will also require recovery time when your work is complete.

Because your concerns and condition are unique, we will tailor your sedation to fit your specific needs, and our experience and training enable us to recommend the sedation that is best for you. We will take a careful health history to make sure that whichever medication is used won’t interact with your other medications or affect any pre-existing medical conditions.

Oral and maxillofacial surgeons are trained in a hospital-based residency program to administer and monitor every type of sedation. Because sedation in all its varieties is a regular part of our practice, we have the medical knowledge and skill to provide you with a safe and comfortable surgical experience. If you think sedation dentistry might be right for you, this procedure is something we are happy to discuss before your appointment at our Virginia Beach, VA office.

X-rays have been a function of dental healthcare for a long time. That in and of itself should be good news, because it means we've had plenty of time to improve them. While there is always some risk in exposure to radiation, dental X-ray exposure has decreased significantly due to all the advances in technology. So there’s risk, but X-rays are quite safe.

Think of X-rays as you would about a car. Automobiles these days have all kinds of technology to make them as safe as possible. There's still a chance that you’ll suffer an accident. Would you stop using a car because of that risk? When it comes to dental X-rays, Dr. Ford and Dr. Guter and our team believe the positives clearly outweigh the negatives.

X-rays can be done digitally or with film. For film, X-rays require different exposures at different speeds to produce the image. Digital X-rays have software that automatically adjusts the exposure and produces the X-ray in a digital file. Since they substantially reduce your exposure to radiation, digital X-rays are the current standard in dental offices.

In addition to digital X-rays, lead aprons are an essential piece of X-ray safety. They help protect internal organs from X-rays by acting as a shield. They usually come with a thyroid collar as well, since that is one of the most vulnerable areas to X-rays in the body. Lead aprons can absorb up to 95% of any scatter rays that result from an X-ray. Not bad, right?

Although dental X-rays involve some radiation exposure (not all of it can be eliminated), so does everyday life. Getting too much sun, for example, can be dangerous. The truth is, we accumulate radiation in our bodies over a lifetime, so it’s worthwhile to be aware and avoid as much unnecessary exposure as possible. When it comes to your dental health, though, getting an X-ray — especially when your doctor says you need it — offers more benefits than risks.

Ask us about the type of dental X-rays we use during your next visit to our Virginia Beach, VA office!

If you're scheduled to get a dental implant, it's only natural to have questions about it. The pain involved is usually on the mind of most patients. Of course, some discomfort is possible, as with any major dental procedure. Having a well-defined plan ahead of time, which is carried out by Dr. Ford and Dr. Guter, reduces the risk of complications or side effects post-surgery.

During the procedure you won't feel a thing, since it is performed under general or local anesthesia that totally numbs your mouth. It's more likely that you will feel some pain or discomfort after the anesthesia has worn off.

There are usually three things that will affect the length and intensity of any discomfort:

• The complexity of your surgery (for example if you need a bone graft or sinus lift beforehand)
• How well-trained the dental team which works on your case is (it may be multiple people, including a periodontist, oral surgeon, and/or general dentist)
• How quickly your body is able to heal itself post-surgery

The pain experienced from an untreated case will usually far outweigh that experienced from a dental implant. Good oral hygiene after your surgery is important to avoid infection. Salt water rinses are generally recommended 24 hours after your surgery. Brush your teeth gently around the implant.

It's also a good idea not to eat any food that is too hot, cold, or hard. Soft or pureed foods will help you to avoid chewing for the first few days after surgery and will help your mouth to heal faster. You'll typically be prescribed pain medication, but some patients find that ibuprofen or acetaminophen work well enough. Just remember, the most severe discomfort is usually experienced within the six hours after your anesthesia wears off.

Getting a dental implant is a big decision, and we want to make sure you get through it easily. Our Virginia Beach, VA team is here to help if you have any questions about the procedure or post-surgery care.