OST Blog

We’re used to seeing athletes wearing mouthguards at practice or play, because dental trauma is one of the most common (and predictable) sports injuries. But it’s not just athletes who are at risk, and there are some events in our daily lives that we just can’t predict. Car accidents, falls, workplace injuries, even innocent playground structures can take their toll on our smiles.

A major chip or a crack in your tooth is upsetting enough, and should be seen by a dentist as soon as possible. It’s even more unnerving when a tooth is knocked out completely. The technical term for a tooth which has been knocked out is an avulsed tooth, and it is a true dental emergency.

If you should suffer a partially or completely dislodged tooth, there is a possibility that your tooth can be reimplanted—if the damage isn’t too severe and if you get to your oral surgeon or dentist immediately.

How can a lost tooth be saved? This is possible because of the complex biological engineering that anchors our teeth within the jaw. The root of a tooth is surrounded by the periodontal ligament. This connective tissue attaches the tooth to the alveolar bone of the jaw. When a tooth is knocked out, this ligament splits apart, leaving some tissue on the tooth root and some within the tooth’s socket.

To successfully reimplant a tooth, the connective tissue cells around the root of the tooth need to be vital, so that they can begin to reattach to the connective tissue left in the socket. Over time, this reattachment is complete, and the tooth becomes firmly anchored to the bone again.

It’s important to protect your tooth before you see Dr. Ford and Dr. Guter to make sure there will be enough healthy tissue for reattachment. First of all,

• Don’t panic! If you or a friend or family member lose a tooth, call your oral surgeon, your dentist, or your emergency health care provider as soon as possible. You will get specific instructions for your specific situation.

If you are unable to reach your health care provider immediately, there are some general rules for taking care of an avulsed tooth:

• Find the lost tooth. Don’t touch the root—use the crown, or top part of the tooth, to pick it up. You are trying to preserve and protect the connective tissue on the root surface.

• If the tooth is dirty, gently rinse it in milk, saliva, or water. Don’t wipe it off, though. You could damage those connective tissue cells mentioned above.

• Place the tooth back in the socket, if possible. Gently hold it in place with your fingers or bite down (again, gently). You can also place the tooth in your mouth next to your cheek.

• If returning the tooth to the socket is not an option, or if you are worried about a child possibly swallowing the tooth, keep the tooth moist. Whole milk or solutions sold just for the purpose of preserving an avulsed tooth are better choices than water, which damage the tissue cells on the root. And never wrap the tooth tightly—this can also damage the connective tissue.

Above all,

• Don’t delay! The faster a tooth is reimplanted in its socket, the greater chance you have of keeping it. Really, every minute counts. Reimplantations are more successful if they take place within 30 minutes. After an hour out of the mouth, your tooth’s chances of successful reintegration are lower—but still worth pursuing!

What will your oral surgeon do?

• Evaluate the avulsed tooth.

There are variables which can affect whether or not a lost tooth is a good candidate for reimplantation. Trying to replace a baby tooth, for example, could interfere with the formation of the adult tooth. An adult tooth that is broken will probably require a different type of treatment.

• Prevent infection.

You might be given antibiotics and a referral to your doctor for a tetanus booster if needed.

• Clean the site.

The socket will be gently irrigated to clean the area and to remove any clots that may have formed which can interfere with the tooth’s placement.

• Recommend or perform a root canal.

Nerves and blood vessels within the tooth’s pulp generally don’t recover after a serious traumatic injury, so a root canal procedure could be necessary to preserve the health of your tooth. This procedure might be done immediately, or might be recommended for a later date.

• Stabilize your tooth.

The tooth must be stabilized after being reimplanted, so Dr. Ford and Dr. Guter will use a splint to anchor the tooth to the teeth next to it. The splint can be flexible or rigid, depending on the condition of the alveolar bone. Splinting generally takes from two to eight weeks, and you will be given detailed instructions for taking care of the area while you heal.

Dr. Ford and Dr. Guter can offer you your best options for successful treatment because oral and maxillofacial surgeons are experienced in treating not only avulsed teeth, but dental trauma in the surrounding area as well. Losing a tooth is an alarming experience. But with prompt action, and a trip to our Virginia Beach, VA office, it might be possible to make that loss only a temporary one.

Happily, a root canal is usually all that you need to treat an infection in your inner tooth. But when inflammation or infection returns at the tip of the root, or in the bone surrounding the tip, your dentist may recommend that you see an oral and maxillofacial surgeon like Dr. Ford and Dr. Guter for further diagnosis and treatment.

And often when pain, inflammation, or infection recur after a root canal, we may suggest an apicoectomy—a procedure that can save your natural tooth and prevent further infection or damage to the neighboring bone and teeth.

• Just what is an apicoectomy?

The tip of a root is also called its “apex.” An apicoectomy means the surgical removal (“ectomy”) of the apex (“apico”) of a tooth’s root.

• How does the procedure work?

Often local anesthesia is all that is needed. (But if you have concerns, talk to us about your anesthesia and sedation options. We are expert in all forms of anesthesia.)

After the area is numb, an incision is made in the gum tissue to allow access to the root and any affected bone tissue.

Dr. Ford and Dr. Guter will carefully remove the tip of the root and any damaged or infected tissue from the bone surrounding it. The root end will then be cleaned and sealed.

Stitches or sutures will be used to close the incision, which will either dissolve on their own or which will be removed on a follow-up visit. We will let you know just how to take care of the site after surgery.

In general, any pain or sensitivity after the procedure can be treated with over-the-counter anti-inflammatory pain relief such as ibuprofen. Patients should follow post-op instructions carefully to reduce any swelling, and be sure to follow any dietary suggestions and restrictions.

• Why choose an oral and maxillofacial surgeon for your apicoectomy?

An oral and maxillofacial surgeon has the training and skill to perform this specialized procedure. After dental school, oral surgeons pursue four to six years of additional advanced medical studies at a residency-based hospital.

They train with medical residents in the fields of anesthesiology, general surgery, internal medicine, and other surgical areas, concentrating on the bone, skin, and muscle of the face and jaw. They are uniquely qualified to diagnose and treat oral conditions that require a surgical solution, and routinely perform procedures such as apicoectomies.

Happily, a root canal is usually all that you need to treat an infection in your inner tooth. But if you have recurring or new pain or infection after a root canal, and if you want to preserve your natural tooth, an apicoectomy at our Virginia Beach, VA office is an option well worth investigating.

A dry socket isn’t a common post-surgery complication, but it happens occasionally. A dry socket, technically known as alveolar osteitis, can occur after an adult tooth is extracted from the mouth. It occurs if the blood clot at the place the tooth was extracted gets lost.

Without a small, protective blood clot where the tooth was removed, nothing will stop the exposed bone and nerves from becoming infected. It’s easy to treat a dry socket, and care is recommended if noticeable pain develops in the area where the tooth came out.

You may have a dry socket if you experience severe pain, bad breath, or an unpleasant taste in the mouth. Dry sockets can happen right after a tooth is extracted, or may develop several days later due to bacterial contamination or trauma.

There is a higher risk of having a dry socket if you smoke, take oral contraceptives, perform poor oral hygiene, or have pre-existing infections in your mouth. Make sure you pay close attention to the state of your mouth after a tooth extraction if you have one or more of these higher risks for developing a dry socket.

If this condition does occur after surgery, Dr. Ford and Dr. Guter can help by cleaning any debris that may have settled in the area. We can also provide a medicated gauze that should be changed regularly to help speed the healing process.

Antibiotics may be prescribed, depending on the infection, but Ibuprofen or acetaminophen can usually be sufficient to ease any pain.

If you think you might have a dry socket following oral surgery, please contact our Virginia Beach, VA office and let us know which symptoms you’re experiencing so we can assist you. To avoid getting a dry socket, make sure to get plenty of rest after surgery, drink lots of water, eat soft foods, and clean your mouth thoroughly.

We hope you never experience a dry socket, but if the situation does arise, you should be ready now!

Patients have a variety of options in dental providers, and it can be tricky to know which type of dental professional is best for your current needs. Understanding the differences between general dentists and oral surgeons, like Dr. Ford and Dr. Guter, can help you make an informed choice for dental care.

Education

Both general dentists and oral surgeons must complete dental school after receiving a bachelor’s degree. In dental school, which typically takes four years of full-time study, students take coursework in anatomy, physiology, pharmacology, pathology, and oral surgery. Dental students also complete clinical practicum experiences, gaining hands-on training in how to diagnose and treat dental problems.

After completing dental school and earning the Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DMD) degree, a general dentist must complete a licensure exam to practice in a particular area. In contrast, oral surgeons (often called oral and maxillofacial surgeons) complete a four to six year surgical residency. The residency program must be accepted by the Commission on Dental Accreditation, ensuring that each resident receives the training in oral pathology, anesthesia, oral surgery, and other areas needed to competently practice. Following the surgical residency, a person completes a board certification examination.

Scope of Clinical Practice

General dentists serve as primary care providers for dental medicine. At the general dentist’s office, you will receive teeth cleaning, X-rays, and a comprehensive screening for dental problems. General dentists most often provide gum care, dental fillings, root canals, veneers, bridges, and crowns. They also make recommendations for how to prevent common dental problems. Although a general dentist may perform simple tooth extractions, more complex surgeries may be outside of the scope of a general dentist’s competence.

Oral and maxillofacial surgeons receive specialized training to treat a variety of conditions affecting the face, mouth, and jaw. Patients are typically referred to an oral surgeon when a problem is beyond the scope of a general dentist’s expertise. Oral surgeons perform simple and complex tooth extractions, including wisdom tooth extraction. They also provide care to accident victims who need reconstructive dental surgery. Oral surgeons may also perform soft tissue biopsies, tumor removal, jaw realignment surgery, soft tissue repair, or positioning of implants.

It can be difficult to determine what dental professional best fits your needs. Contact our Virginia Beach, VA office to determine if an oral surgeon can best meet your needs.