Impacted wisdom teeth are the 3rd molars at the back of our mouth. They are the last adult teeth that emerge and when they do, they do not get enough space to emerge and grow normally. Typically people have 4 wisdom teeth at the back of their mouth – 2 are on the on top at either side, while 2 on the bottom. When they get impacted, they can be very painful, damage other teeth and cause other dental problems. Sometimes, they may not cause any immediate or apparent problems. However, since they are difficult to clean, they are more vulnerable to decay and the adjoining gum can get diseased too.

These teeth are more prone to decay and damage. Since an impacted tooth can lead to pain and cause dental complications, dentists recommend that they be extracted. Oral surgeons and dentists also suggest that some other impacted teeth that do not cause any symptoms should also be removed to prevent any problems in the future.

The Cause for Infection

Impacted teeth are enclosed in the soft tissue and the jaw bone. They emerge only partially from the gum. The opening that is created is more than enough for bacteria to enter the area around the teeth. Since this area is not easily accessible, cleaning this tooth and the surrounding gums becomes very difficult. Over a period of time, this leads to an infection which results in jaw stiffness, pain, swelling and oral sensitivity. In some cases general illness may also follow. Brushing and flossing is very difficult.

You will have to ask your dentist about the positioning of the wisdom tooth.

Evaluating Alignment

An x-ray may be taken periodically and the dentist will evaluate the alignment and presence of the wisdom teeth. If they notice an impacted wisdom tooth, he/she will suggest that it be extracted. This will help prevent any future problems. It is easier to do extractions in younger people. This is due to the fact that the roots are not fully developed at this point of time and the bone is also less dense. The recovery period tends to be longer in older people.

Before the impacted wisdom tooth is extracted, the gum area and the tissue that surrounds the tooth will be numbed. A local anesthetic is used for this procedure. In the event that any anxiety controlling medication is administered, you will need to have someone drive you home after the dental procedure.

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All dentists work on teeth, but not all dentists, or dental clinics are created equal. You have dental clinics that specialize in family dentistry and you have dental clinics that specialize in pediatrics, orthodontics, geriatrics, and cosmetic corrections.

Most family dentistry clinics fall into the category of general dentistry. In general dentistry the clinic takes care of the most commonly occurring dental problems. The following procedures can be gotten when you see a dentist practicing in general dentistry.

• Tooth extractions

• Tooth fillings

• Tooth cleaning

• Dental check ups

• Oral hygiene instruction for children

• Root canals

• Caps on teeth

Having a dental clinic that specializes in family dentistry will allow you to have a first line of defense against dental complications. You will have someone that knows what preventative measures you need to take, and someone that can recommend the experts that can fix any problem that your family develops.

In order to find a clinic that specializes in family dentistry that suits the needs of your particular family you have to look into advertisements for local dentists. You will be able to determine if the dental clinic will treat everyone in your family from their advertisements.

You cannot select the dental clinic on the advertisement alone. You will need to visit the clinic and meet the staff there. See if they give guided tours of their facilities, and speak to all of the staff members to find out how they handle children, emergencies, and the many problems that your family will face over the next few years.

Remember that you are selecting an establishment that you will have a relationship with for many years to come. You want to feel comfortable with the members of the staff, with the rules of the clinic, and with the dentist that does the work.

You must have trust in your dentist if you are going to accept their judgment concerning your teeth, the teeth of your children, and the treatments that you will all require. If you do not trust the dentist then you will feel reluctant to have procedures done without getting second opinions. Second opinions will cost you time and money, so it is better to find a dental clinic that you have faith in and see them first.

Go see the dentist for a minor care procedure like a tooth cleaning before you decide to switch your entire family to their practice. While you are there you will be able to see how the dentist deals with their patients, and what methods of pain relief they provide. This can help you to choose the right dentist for your needs.

Before you make a final decision on who to use as your primary care dentist make an appointment for your children and see how the children respond to the doctor. You want the children to be comfortable, to respect the opinion of the doctor, and to want to follow the instructions of the doctor. If they do not feel this way then keep looking until you have a dentist they do feel this way about.

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Local anesthetics work by blocking nerve impulses. Nerve impulses are electric signals that carry both stimulus to a muscle to have it function and sensation, including pain, from tissues to the brain. At a cellular level this occurs by blocking sodium channels in the nerve membranes. When sodium is blocked in this way, the nerve cannot conduct an impulse and therefore no sensation can be transmitted. Different local anesthetic drugs differ in their side effects, dosages and duration of action.

In a dental context there are two types of anaesthetic injections. In Canada we call such an injection, ‘freezing’, in the USA it is called a shot. Not sure if that is a geographical or political distinction. In a lower anaesthetic usually the a half of the mandible is anaesthetized. This involves a block of the entire inferior alveolar nerve. This nerve blocks sensation to the lower teeth, lower lip, chin and tongue on the half of the lower jaw that is injected. To achieve the anesthesia the dentist injects into the area behind the last lower molar. A ‘landmark’ is used to properly inject the anesthesia into the site where the nerve exit’s the inside of the jaw. But, in some cases the block may not occur as the anatomy may vary between patients. In such cases the dentist will place another carpule of anesthesia into the area. A branch of the ‘mandibular’ nerve is the mental nerve. It exit’s the jaw area near the lower bicuspids. It supplies innervation to half of the lower lip and the chin. This is why the dentist will ask if the lip is “frozen”. If a patient’s lower lip and chin are numb it means we can proceed with treatment. In some cases a dentist may place some anesthesia near the tooth or teeth being treated, this helps numb supplementary innervation.

The upper teeth are usually anesthetized with anesthesia placed directly beside the tooth or teeth in question. This is called an infiltration procedure in that the anaesthesia will penetrate the thin bone surrounding the tooth. In most cases where a filling is being provided this will allow painless treatment. In other cases such as a dental extraction, the anesthesia may be introduced to several areas around the upper teeth / tooth. This can include an anesthesia to the palate, which can be sensitive.

In most applications of local anesthesia a gel containing some anesthesia is placed on the injection site. It is in fact more of a psychological aid because it only anesthetizes the surface. Once the needle penetrates the soft tissues the effect of the topical gel disappears. But if a dentist slowly injects a few drops as he / she proceeds the discomfort is minimalized. Anesthesia usually lasts about thirty minutes. But in some cases where a longer duration is desired, an anaesthesia with adrenalin (Epinephrine) in the concentration of one in 100,000 is used to constrict the blood vessels near the nerve, this reduces the time it takes for the anesthesia to be removed from the site. After it is circulated it is reduced by the liver to an inert material.

In rare instances a lower mandibular block can result in a numbing which can last for several weeks. This is due to an unavoidable situation where the needle may cause some injury to the nerve. A lip or tongue can remain slightly numb for several weeks.

It is also important that the patient and the dentist be aware of any medical problems which should be addressed before injecting an anesthesia. High blood pressure, heart problems, diabetes are a couple of situations the dental team should be appraised of.

Dr Michael Pilon DDS

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How is emergency dentistry different to normal dentistry?

Much the same as commonplace accidents or injuries, dental emergencies can happen anywhere and at any time, requiring immediate attention from a healthcare professional – something that a regular check-up won’t provide. Emergency dental clinics are open 24 hours a day, every day of the year – even Christmas Day in most cases, treating any problems with the teeth, mouth, and jaw. An emergency dental surgery is run in a different way to the normal dentists office you might be used to, that’s because it is designed to treat patients with much more pressing issues than a brace fitting or tooth whitening procedure. Emergency dentists won’t give appointments for a general dentistry consultation after 11pm and they are not going to assess you for orthodontic treatments at night, they only accept patients who are in pain and need help immediately.

Not only are these types of institutes becoming a necessity because of their prompt service, but they also take a great deal of pressure off nearby hospitals, who are less likely to be capable of dealing with specific dental problems such as root canals or extractions. It’s comforting to know that there is someone who can help within hours if you suffer an accident, any time, day or night.

When should I give the emergency dentist a call?

First of all, a mild tooth ache is no cause for alarm, it could just be a reaction to an extreme temperature, so don’t panic and think you should head to the emergency dentist right away – although you should certainly get it checked out if it persists. Temporary aches and pains are sometimes just a symptom of what we’re eating, the weather, our general health, etc, and will only last a few minutes or so, but ongoing discomfort, particularly regular bouts of throbbing toothache, should warrant a visit to your dentist. You can’t ignore niggling pain that won’t go away, your teeth are trying to tell you that something is wrong; it will only get worse if you dismiss it.

Emergency dental appointments are normally taken up with situations much worse than sensitive teeth, and if you are in need of immediate assistance you will almost certainly know about it. Many patients arriving at the emergency dentist have lost or broken a tooth in an accident and have to be seen by a dentist straight away, this can be quite traumatic and cause a lot of pain, it’s lucky that the majority of patients are referred for treatment within twenty-four hours of the injury occurring. If you experience a similar injury, make an appointment straight away, even if the pain dulls after a few hours, there could be significant damage that needs repairing.

How can the emergency dentist help with broken teeth?

Thanks to constantly advancing medical technology, there are lots of ways an emergency dentist can fix or replace broken teeth – if you’re lucky, they may be able to reattach the natural tooth before it dies. Rebuilding damaged teeth depends on a number of factors; primarily what state the tooth and its empty socket are in when the patient arrives at the surgery. A tooth that has been completely knocked out but is still in a relatively solid condition can be fixed back into the socket if there is enough time to salvage it, but if the tooth has been out of the mouth for more than an hour then the chances of reattaching it are slim, so the dentist may just repair the damage to the gum in preparation for further treatment after healing. Even in this situation there are still options available, such as implants or dental bridges, you don’t have to learn to live with a gap-toothed smile.

If, however, you have suffered gum disease or tooth decay before the breakage, the dentist may not attempt a reattachment, as it’s likely that more deterioration will occur without further treatment. Although superficial chips and cracks can be repaired with composite bonding, crumbling or fractured teeth that are in a state of decay are better off extracted, they will eventually fall out of their own accord if left to rot anyway.

Is there anything I can do to help myself while I wait for the emergency dentist to see me?

You can try to alleviate toothache pain whilst you are waiting to see the dentist by taking strong pain killers, but don’t attempt any kind or surgery on yourself, as this is invariably a terrible idea. Leave the extractions and fixtures to the professionals, unless you want to end up in more pain than you are already in. If you are experiencing severe pain, don’t wait around to be called into the surgery, get there as soon as you can.

For patients who have had whole or parts of their teeth knocked out, hold on to any broken pieces, carefully keep them in a cup of milk – this will keep the tooth alive until it can be reattached. Leave any remaining fragments in the socket, they may serve as a base for fixing the rest of the pieces back in place, or they may need to be removed under anesthetic. If you can, try and replace the tooth in the empty socket as gently as possible, this is the best way to encourage regrowth into the tissue and survival of the tooth, but it’s sometimes to painful to keep it there for any period of time without some type of pain relief.

Hopefully, you should be admitted to see a surgeon within hours of your emergency, but some patients can struggle with travel conditions – be it the weather, car trouble, transport issues – which can really cause problems with damage that needs to be dealt with immediately. If there is heavy bleeding, try pressing a small piece of gauze onto the area or biting down on a cotton wad to stem the flow – this is a common occurrence with broken and dislodged teeth. Where the bleeding is accompanied by severe pain, try taking some Ibuprofen to lessen the swelling and help with the discomfort, but be sure to let your dentist know if you have taken any medications.

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After an extraction, it’s important for a blood clot to form to stop the bleeding and begin the healing process. That’s why your dentist will ask you to bite on a gauze pad for 30 to 45 minutes after an extraction. If bleeding or oozing continues after you remove the gauze pad, place another gauze pad on the area and bite firmly for another 30 minutes. You may have to do this several times.

After the blood clot forms, it’s important to protect it, especially for the next 24 hours. It’s important to not:

o smoke and chew tobacco

o drinking alcohol

o suck through a straw

o rinse your mouth vigorously

o clean the teeth next to the extraction site

These activities could dislodge the clot and slow down healing.

Limit yourself to calm activities for the first 24 hours. This keeps your blood pressure lower, reduces bleeding, and helps the healing process.

After the tooth is extracted, you may feel some pain and have some swelling. You can use an ice bag (20 minutes on, 20 minutes off) to keep this to a minimum. The swelling usually starts to go down after 48 hours.

To control discomfort, take pain medication as recommended. Don’t take medication on an empty stomach or nausea may result. If antibiotics are prescribed, continue to take them for the indicated length of time, even if all symptoms and signs of infection are gone. Also:

o Drink lots of fluids.

o Eat only soft, nutritious foods on the day of the extraction.

o Don’t use alcoholic beverages.

o Avoid hot and spicy foods.

You can begin eating normally the next day, or if not by then, as soon as it’s comfortable. Gently rinse your mouth with warm salt water three times a day (put a teaspoon of salt in a cup of warm water, and then gently rinse, swish, and spit). Also, rinse gently after meals. This helps keep food out of the extraction site.

It’s very important to resume your normal dental routine after 24 hours. This should include brushing your teeth and tongue and flossing at least once a day. This will speed healing and help keep your breath and mouth fresh. Call your dental office right away if you have heavy bleeding, severe pain, continued swelling after two or three days, or a reaction to the medication. After a few days, you’ll be feeling fine and can resume your normal activities.

Dry socket is an infection in your tooth socket after a tooth is extracted. The condition usually develops when a blood clot fails to form in the socket, or if the blood clot comes loose. Dry socket occurs in approximately 5 percent of all tooth extractions.

Normally, the blood clot that forms after a tooth is removed promotes healing, laying the foundation for the growth of new bone tissue. When dry socket occurs, this blood clot is lost and the infected, inflamed socket appears empty – hence the name. Nerves are exposed, and sometimes the bone is visible in the empty socket.

You may not have symptoms until 3 to 5 days after the extraction. Then, the condition will manifest itself as severe pain that doesn’t subside, often accompanied by what feels like an earache. You may also have an unpleasant taste in your mouth, and bad breath. Call your dentist right away if you notice any symptoms of dry socket. Treatment for dry socket typically includes a gentle rinsing of the socket and dressing the socket with sedative medication.

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