Oral Surgery encompasses all kinds of surgical extraction right from simple extraction to extensive management of Maxillofacial fractures such as fracture of maxilla or mandible.
It refers to the removal of the tooth that may be impossible to save by root canal treatment. There may be several reasons to extract the tooth. Some of them are mentioned as under:
1) Nonrestorable teeth due to decay 2) Orthodontic reasons: Usually premolars are extracted though there may need to extract other teeth also 3) Periodontal causes such as mobility of teeth 4) Supernumerary teeth or Extra teeth in the lower or upper arch 5) Teeth associated with large cysts such as dentigerous cyst 6) Teeth associated with tumors of jaw such as ameloblastoma 7) Unerupted or Impacted teeth
Extraction is usually done with local anaesthetics such as Lignocaine with or without adrenaline or other anaesthetics such as articaine, Mepivacaine, Bupivacaine, etc.
Local Anaesthetic solution is slowly injected into the tissue around the nerve, and associated teeth and mucosa get numb. Then the tooth is slowly and gently extracted as atraumatically as possible.
The tooth is elevated first using elevators and then extracted with forceps. Sometimes there may a need to section the tooth when there is Dilaceration (curve) of root so that tooth comes out easily so that patient do not feel any discomfort.
Surgical Extractions or Disimpactions:
Many times some teeth usually Third Molars fail to erupt into the oral cavity. The most common cause is that they don’t have space in the jaw for the eruption. Sometimes unerupted teeth are also associated with cysts and tumors. Sometimes even canine also fail to erupt because of lack of space and crowding of teeth and is out of the scope for orthodontic treatment.
Such embedded teeth are called impacted teeth. These teeth usually cause discomfort to the patient and cause severe pain. Such teeth may also push against adjacent teeth and cause their resorption. So the removal of such impacted teeth may be necessary.
The removal of impacted teeth is called disimpaction or surgical extraction. This is done by separating periosteum of the jaw bone and removing the overlying bone with osteotomy burs. The exposed tooth may be extracted as such or after sectioning. After extracting the extraction, socket is irrigated with betadine solution. Sutures or stiches are then given, and post-extraction instructions are given to the patient.
Post-extraction instructions to the patient Following are the instructions given to the patient after extraction of teeth 1) To remove the gauze after 45 mins 2) Not to have anything hard, hot or spicy 3) To have cold food preferably cold milk or ice cream 4) Not to spit and rinse or use straw for 24 hours 5) Not to have Hard or aerated drinks such as Colas 6) To visit us after 1 week to get the sutures removed
Post-extraction Instructions to the Patient:
Following are the instructions given to the patient after extraction of teeth 1) To remove the gauze after 45 mins 2) Not to have anything hard, hot or spicy 3) To have cold food preferably cold milk or ice cream 4) Not to spit and rinse or use straw for 24 hours 5) Not to have Hard or aerated drinks such as Colas 6) To visit us after 1 week to get the sutures removed
Management of Fractures:
Fracture of the jaw bones occur due to any kind of injury such as accidental injuries, Injury due to impact after some hard blunt or sharp object is encountered, injury due to falling, etc.
The first line of management after any trauma is to maintain airway. This is usually done in trauma centers. Fractures of Upper and Lower jaw may be of various kinds such as simple fractures, compound fractures or comminuted fractures. Greenstick fractures mainly occur in children due to less dense and soft bones. Fractures can occur in Maxilla and categorize into Le-Fort fractures and mandible.
These fractures are managed by closed reduction or open reduction. In closed reduction, we approximate the fractured fragments together by hand manipulation, and there is no need for surgery. Most of the time the fracture heals without complications. But sometimes there is mal-union of fracture associated with pain, and such problems need to be addressed to your doctor.
In open reduction the fracture site is surgically exposed, fractures are approximated and stabilized with metal mini-plates and screws, stainless steel pins and stabilizing rods. Sutures are then placed, and the fracture site gets healed.