To control bleeding directly place gauze over the sockets where the wisdom teeth were removed. Bite firmly on the gauze for 20 to 30 minutes. Constant pressure will help stop any bleeding. Do not chew on the gauze and talking should be kept to a minimum if possible. The tooth socket can ooze for 1-2 days after the procedure. A small amount of blood and a large amount of saliva can appear to be a large amount of blood. If the bleeding is more than a slight ooze, fold a piece of gauze in half and place over the tooth socket. Close your mouth for at least 30 minutes to apply pressure over the area.
Here are things that can cause bleeding
2) sucking on a straw when drinking. This can create a negative pressure that dislodges the blood clot in the tooth socket
3) avoid spitting for 1 week. Spitting can also cause negative pressure which can disrupt the blood clot. If you have to expel saliva or water from your mouth, tilt your head forward and open your mouth over a sink. Wipe the remaining fluid from your mouth using a napkin. Avoid spitting.
4) Strenuous activity or exercise. Avoid strenuous activity and/or exercising for a week. Such activity can significantly increase your blood pressure which can cause bleeding from the tooth sockets.
Sometimes oozing may occur during the night and blood mixed with saliva may be found on the pillow.
Bruising can occur on the cheeks or underneath the jaw line. Bruising is not dangerous and does not increase pain or infection. Bruising can be seen as early as the second day and can last as long as 2-3 weeks. The discoloration will turn from a brown/blue appearance to yellow over a 1-2 week period. The bruising will drift slowly down the neck area.
Swelling usually reaches a maximum after 3 days. The first day after the procedure, there may not be significant swelling but it may show up soon after. Application of ice packs to the areas where the wisdom teeth were removed can help minimize swelling. Ice should not be placed directly on the skin but rather should have a layer of dry cloth between the ice container and the tissue to prevent superficial tissue skin damage. An ice pack from your oral surgeon usually have a outside protective layer to prevent this. The ice pack should be kept on the local area for 20 mintues and then left off for 20-30 mintues. Ice pack application should be maintained for about 24 hours.
Patients who have had extractions may avoid eating because of local pain or fear of pain when eating. A high calorie, high volume liquid diet is recommended for the first 24 hours. Fluids can include water, juices, jello, smoothies and clear soups. The diet can be advanced after 1 day to thicker liquids like soups and shakes. For the rest of the week, a soft diet (i.e. mashed potatoes, scrambled eggs, macaroni) is tolerated well. Avoid spicy or hot foods. NOTE: Patients with diabetes must stay on an ADA diet that is approved by their primary care physician. After 1 week, most patients return back to a regular diet.
Patients can gently brush their teeth the day of the procedure. However, avoid brushing the teeth immediately adjacent to the extraction sites to avoid bleeding and/or pain. Gently rinsing is acceptable with warm salt water. A saline solution can be prepared by dissolving ½ teaspoon of salt in an 8 ounce glass of warm water. Normal hygiene daily routine can be resumed on the 3rd or 4th day.
Shifting of teeth – the pressure from erupting wisdom teeth can cause shifting of teeth eventually disrupting the natural alignment of your smile. What if you had orthorthodontic treatment (which is $$$$) and you now have the perfect smile? Your teeth are perfectly aligned and white. You definitely do not want your wisdom teeth to compromise all the hard work and money you have put into braces.
Wisdom teeth can cause shifting of other teeth.
Can you believe that this patient had perfectly straight teeth at one time! She got her braces off 2 years ago but never had her wisdom teeth removed. Her wisdom teeth unfortunately caused shifting of her teeth. Look at how misaligned her front teeth are. This patient went back into braces for the 2nd time to realign her teeth. Having the wisdom teeth removed earlier could have prevented this.
The number of wisdom teeth that are present in your mouth can range from none to multiple. However, the average number of wisdom teeth present is 4. Guess how many wisdom teeth is in this patient (see xray below)?
Many wisdom teeth.
If you look carefully, there are actually 8 wisdom teeth. Yes 8! There are 3 on the top left side, 2 on the bottom left jaw, 2 on the top right jaw and 1 on the lower right jaw. If you have 4 wisdom teeth, consider yourself lucky.
Your dentist probably have been telling you for a while to have your wisdom teeth removed. However, this is a surgical procedure and it can be frightening and scary. Consider going to an oral surgeon to have your wisdom teeth removed. Oral surgeons specialize in wisdom teeth removal and are very proficient at this type of surgical procedure. Hence, the process often will be very quick, smooth and easy. Who would you rather go to, to have an invasive procedure? There are risks in having wisdom teeth remove such as lower lip numbness. An oral surgeon understands and knows how to avoid such risks. Sedation is provided for your comfort and this makes the procedure feel like a split second.
Watch this video below to see the experience of a patient from the consultation appointment to the surgery day to 1 week after surgery. See how smooth and simple having wisdom teeth removed can be.
Dr. Ronald Achong is a Board Certified Oral & Maxillofacial Surgeon serving the Clermont and Orlando area. 352-243-5599. www.oralsurgicalarts.com
Now that your wisdom teeth are removed, what to expect?
The removal of wisdom teeth is a common and routine procedure. Many family or cosmetic dentists can perform this procedure. Oral surgeons are specialized in the removal of wisdom teeth or any teeth in the mouth. So now that your wisdom teeth are removed what should you expect? Here are some questions you may have. How much pain will I be in? What am I able to eat? How many days do I take off work or school? Here are some helpful tips and answers.
This picture shows Dr. Achong with a tooth removed. This is not meant to be serious.
Immediately after the procedure, patients are usually sleepy or drowsy. This is due to the effects of the sedation (anesthesia). Often, patients may sleep the rest of the day. Once the anesthesia has worked itself out of the body, patients become fully alert and will beginning returning to normal activity.
In the event that nausea or vomiting occurs, contact your doctor for advice. The nausea can be due to the effects of the sedation (anesthesia) or due to the prescribed narcotic pain medication. Consider switching the pain medication to a different type or contact your doctor for a medication for the nausea. Usually nausea will pass after the first day.
On the day of the procedure, discomfort and swelling will occur. The pain may progressively worsen but usually the prescribed narcotic pain medication will manage the pain. Discomfort or pain can last from one to several days depending on the patient. Maximum swelling occurs 2-3 days after the procedure. Ice to the face where the wisdom teeth were removed will minimize the amount of swelling.
There may be intermittent bleeding from the extraction sites. Placement of gauze over the site(s) with constant pressure for 20-30 minutes often will significantly reduce or stop the bleeding. If there are any concerns or questions, contact your doctor.
It is important to drink ample amounts of fluids for rehydration. Remember, you had an empty stomach for quite a number of hours before the procedure. Start with clear liquids like water, Gatorade or clear juices to start the rehydration process. If these liquids are tolerated without any nausea, then the diet can be advanced to thicker liquids and soups. Usually patients can tolerate clear soups on the day after the procedure. If soups are tolerated well, then consider soft foods and then eventually solids. Avoid, spicy and chewy foods. Every patient’s diet will advance at various rates. It is not a race to get to a solid diet. Once, there is adequate nutrition intake the recovery will be smooth. After 1 week, most patients will have started a solid diet.
It is common for food to become stuck in the lower teeth extraction sites. Gently rinse with warm, salt water to dislodge the food. However, do not spit for the first 3 days as this can cause a dry socket and cause bleeding. If food continues to get stuck in the extraction sockets after 1 week, your oral surgeon or dentist can provide a small syringe to irrigate the sockets. The extraction sockets can take 3-4 weeks to completely close.
It is highly recommended that all prescribed medications by your oral surgeon or dentist is taken as directed. Smoking after is not recommended. Some patients are able to return to work after 3-4 days of recovery. We hope that your recovery is smooth. Good luck!
Should you be sedated for your wisdom tooth or teeth removal?
Your wisdom tooth or teeth may need to be removed for many reasons: presence of a infection, presence of a cavity, cracked, orthodontic reasons, pathologic reasons, gum disease, crowding of your teeth, compromise of the adjacent teeth or preventative reasons. Your dentist probably explained why you needed to have your wisdom teeth removed for some of these reasons. One of your main concerns is “Will the procedure hurt?” You have the option of sedation (asleep) or local anesthesia (numbing dental shots). Which one do you choose? What will your dentist or oral surgeon recommend?
Your dentist or oral surgeon will offer both options but will provided recommendations. However, how would you decide if to be asleep for the procedure or to be fully awake? Sedation anesthesia will put you into an induced state of a deep sleep where you will be comfortable and often unable to recall the events that transpired during the procedure. The local anesthesia (dental shots) option, you will be fully awake and aware of everything that occurs during the procedure. Of course, dental offices will make the experience as pleasant as possible.
Here are some factors that your doctor may consider to decide if sedation may be the better option.
1) If the wisdom teeth are infected. Often with an infection present around the wisdom teeth, the dental shots alone may not provide the complete local anesthesia (numbing) to complete the procedure. Sedation probably will be recommended.
2) Level of anxiety. Often patients are very apprehensive about having any type of procedures, especially surgical procedures in their own mouths. For comfort and better compliance during the procedure sedation may be a great option.
3) The position of the teeth. Wisdom teeth can be located deep in the jaw bones (where drilling is required to facilitate removal) or may be in close proximity to vital structures such as nerves and blood vessels. The dentist or oral surgeon may recommend sedation if this is the case.
Your doctor must be specifically trained in sedation and must have special anesthesia equipment present in the office. The recovery from sedation usually takes less than a day. Sedation is a separate cost from the teeth removal procedure and often dental insurances often cover sedation.
A local anesthetic injection (dental shot) will only cause you to lose sensation in that one specific area where the tooth is located. This is usually recommended when only one or two wisdom teeth require removal and are fully exposed in the mouth on a compliant patient. This option is less expensive and has a shorter recovery time. You will remember the procedure but should not experience any during the procedure.
Which dentist do you choose to have your wisdom teeth removed?
Have you ever been to the dentist and was told “You should have your wisdom teeth out!” So now that your wisdom teeth need to be removed which dentist do I go to? A general dentist (family or cosmetic)? A periodontist? Or an oral surgeon? All 3 options are good options. A periodontist and an oral surgeon are specialized dentists. So which dentist do you go to? The answer to this question will probably depend on both the patient and the dentist involved.
What procedures can a general dentist perform? General dentist can perform all procedures offered by dentistry including the removal of teeth. So what is an oral surgeon? Removal of teeth (including wisdom teeth) is one of the specialized job descriptions of an oral surgeon. Oral surgeons obtain formal training in a residency hospital based program after completing dental school for 4-6 additional years to master the skill of removing teeth and sedation. Hence, the most difficult teeth that need to be removed are mostly done by oral surgeons. Furthermore, oral surgeons are formally trained to manage complications from the extraction of teeth. These can include, infection, maxillary sinus issues, bleeding and nerve injury. Removal of teeth can be performed by many dentist. However, if there are complications from the procedure an oral surgeon is trained to handle such complications.
Which option do you go with? It can become confusing. Sometimes your general or family dentist will refer you to a dental specialist such as an oral surgeon or a periodontist to have teeth (including wisdom teeth) removed. Other times your dentist will remove the teeth. Most general dentist are competent at removing teeth.
Here are some factors to consider to help you decide.
1) What type of health issues do you have? Are these health issues significant? If so, some patients may choose a dental specialist like an oral surgeon for the extraction of teeth.
2) How involved is your treatment? Are the wisdom teeth abscessed? Are they bony impacted (deep in the jaw bone)?
3) Level of anxiety? Some patients may require sedation for the procedures. All oral surgeons provide the option of sedation so that the procedure can be smooth and easy.
What to look for to help determine the expertise of the dentist.
1) How many wisdom teeth extractions have the dentist performed?
2) How often does the dentist remove wisdom teeth?
3) Has your family or friends had teeth removed by that dentist with a satisfactory result?
4) Are there any video testimonials of wisdom teeth patients treated by the dentist?
5) Are their any reviews on the internet that patients have written? Google, facebook etc.
6) What type of dental training did the dentist receive?
Dr. Ronald Achong is a Board Certified Oral & Maxillofacial Surgeon. Offices serve the Clermont and Orlando area. For more information on wisdom teeth, visit www.nomorewisdomtooth.com Or contact us at 352-243-5599.
This picture was taken from nobel biocare (www.nobelbiocare.com)
You may have a missing tooth or several missing teeth. So what? There are many other teeth in your mouth. What is the big deal?
Missing Teeth = Loss of Jaw Bone = LOOKING OLDER
When a tooth is removed, the jaw bone in this area slowly resorb or “melt” away. Sometimes more teeth may need to be removed. Several missing teeth will cause even more jaw bone to “melt” away. Because teeth are missing, the jaw bone in these areas are no longer in use. This leads to the resorption of the bone. ”If you don’t use it you loose it? For example, when a cast is removed after a broken leg has been treated, the leg appears “skinny”. This is because the leg has not been in use for many weeks so the muscle mass diminishes. The same applies to the jaw bones.
Over many months and years the jaw bone will resorb. Looking at the above picture, the face on the left shows a face that is young, full and healthy due to a full set of natural teeth. However, if all the teeth were removed, the jaw bone “melts” away. This eventually will lead to a sunken in appearing lower face as depicted on the picture right side. Furthermore, the wrinkles around the mouth become significantly prominent. The chin appears to be larger and more protrusive. The facial structure of the face collapse making the face look older.
Dental implants are a great treatment option to replace missing teeth. Once the dental implants are placed in the jaw bones, the jaw bone volume in these areas are maintained. No bone loss occurs and the facial support is maintain leading to a young, full and healthy appearance. Missing teeth can cause many problems.
Dental Implant Patient Experience with Dentures and then Dental Implants.
“Now I have dentures and the biggest problem is the embarrassment. You can’t eat, laugh the way you want, you can’t speak. When you got dentures you don’t know when they will come out. You got to keep you tongue pushing the top part of the dentures and that is terrible. You can’t bite into things as you would like to, meats, poultry are hard to eat. Corn on the cob, forget about it! Having dentures and meeting people you got to be brief. It is not fun anymore. You do more listening with dentures……….. I have been living with dentures for 5 years and I met Dr. Achong and he suggested dental implants.
It has been 3 months now that since I had the implants, I won’t trade it for the world. They are exactly what I should have done years ago and I am very happy. I am happy, I feel great, I can smile, I can eat what I want.”
For more information, visit www.oralsurgicalarts.com
Dr. Ronald Achong is a Board Certified Oral & Maxillofacial Surgeon that provides dental implant treatment.
Mini dental implants are a minimally invasive treatment that can immediately stabilize loose dentures, eliminating the need for messy denture adhesives.
Why MDI Mini Dental Implants?
Even the best denture adhesives can’t compare to the denture stability achieved with mini dental implants. 3M™ MDI mini dental implants are designed to help denture wearers laugh, talk and live with comfort and confidence.
As the most popular small diameter implant system in America, 3M™ MDI mini dental implants were developed to provide greater denture stability for those who:
"Wonderful!!! This was a surprising experience for me. I was very nervous and everyone there was so kind. My surgery was over before I even thought they had started! It was wonderfully painless with no problems! Thanks to Dr Achong, and the whole staff for being so helpful."
- denar, SORRENTO, FL
"Friendly, Professional and Caring! A wonderful experience they were helpful in getting appt. set up and they bill the Ins. company. Dr. Achong and all of your staff… Thank you!"
- anthonyr, HAINES CITY, FL
"Needed inplant put in.Very perfessional!!!!!!! Explained every thing real well. Treated me like family. Inplant went Smoooooooooooth I recommend them 100%"
- josephz, CLERMONT, FL
"I had my wisdom teeth taken out by a different Clermont oral surgeon. That oral surgeon "broke" one of my permanent molars in the process of removing the wisdom teeth. Bad infection, loss of tooth. I was very upset about it. Dr. Achong removed my broken tooth, stitched the area perfectly, and reassured me while giving me my options. I wish that I had gone to him to begin with. The other oral surgeon was-nervous and not very confident. It is no wonder he messed up. It seemed like my procedure was a simple process for Dr. Achong. You would think he could do it blindfolded. I recommend him all of the time. Best Oral Surgeon in Clermont-hands down."
- Laura J Lydon
"Thanks to Dr. Achong my smile makes me proud again. I hate anything that has to do with Dentist/oral stuff. Dr. Achong made me feel very comfortable. His expertise in this field shows. His bedside manner was great. Now my son has had his wisdom teeth out by Dr. Achong and I will recommend him to everyone I know. Thanks!"
- Paige Summers
"I had to get all 4 of my wisdom teeth removed at the same time. My Doctor for the procedure was Dr. Achong, he told me exactly needed to be done an he could do it right away. The next time I went in simple procedures just signing some papers an before I knew it i was already asleep. After the surgery of course I felt pain but after a day or so I did not even need to use the pain killers. My experience was amazing there, nothing but kind an helpfull people same with the doctor."
- Christopher Antompietri