Extractions « The Cosmetic Dentistry Blog

November 6, 2009

A broken piece of tooth left in my jaw

Filed under: Wisdom teeth — iowasmiles @ 5:34 pm

Dr. Hall, I was searching online with the statement “wisdom teeth piece left in gumline” and I found a post of yours. You stated that the dentist makes a choice of whether or not he should leave the piece left in the gum. What are the actions that can occur if something does go wrong later on. I am asking because I had this happen to me and I am trying to figure out what I should do. I have seen two other dentists and they said they will not do the surgery to go in and remove the piece because they are scared of nerve damage in my face. Is there any legal responsibilites by my old dentist? I appreciate you time and any information you can give me.
- Chris from Virginia

Chris,
You didn’t say whether or not you are having trouble with this piece of tooth left in your jaw. If you aren’t having any trouble, then that is the end of the issue.

Even if you are, though, I don’t think the dentist is responsible for anything. And here is the reason: It seems to me that if you have two other dentists who are afraid to go after this piece for fear they will damage your nerve, then the dentist was reasonable to leave it in. If the piece is bothering you a great deal, then you can make a decision that you will take the risk of damage to your nerve, absolve the dentist or oral surgeon of any responsibility, and have it taken care of. But you will need to sign away your rights to complain later.

If your inferior alveolar nerve is severed in the process of getting this piece out, then your lower lip on that side will be permanently numb. While it feels weird for several months, eventually people get used to this and forget that it’s numb. You do have to be forever careful, though, because you can’t feel it if you bite your lip or burn it. I think you need to decide whether or not you want to take that risk.

Dr. Hall

Related links:
Read about the post-operative complications possible with wisdom tooth removal.

We thank our advertisers who help fund this site.

Comments Off

August 26, 2009

The tooth next to my recently extracted tooth hurts.

Filed under: Extractions — iowasmiles @ 6:13 pm

I just had a lower 2nd molar removed last week. Not as straightforward as I would have hoped – it took about 2 hours and came out in pieces. As the swelling and general pain subsides, I’ve noticed pain is much more localized on the neighboring 1st molar. It hurts to tap on it and responds to heat and cold. This was perfectly fine before. Is this normal?

Thanks,
- Eric from Ontario

Eric,
Many dentists have difficulty from time to time with extractions they thought were going to be routine. Unfortunately, you’re the one that suffers the trauma when this occurs.

Experiencing pain on the neighboring tooth after a tooth extraction isn’t unusual, especially when there was difficulty with the extraction. Apparently, in the course of the extraction, the dentist needed to leverage against this other tooth. This would cause the symptoms you’re experiencing – tenderness to touch and sensitivity to cold. This pain should gradually subside over the next week or so.
- Dr. Hall

We thank our advertisers who help fund this site.

Comments Off

March 4, 2009

Should I have an oral surgeon do this extraction?

Filed under: Extractions, Sedation dentistry — iowasmiles @ 6:26 pm

Dr. Hall,
A couple of years ago, a filling came out of my tooth, and the tooth later broke. When the pain finally became too much to bear, I went to a dentist and ended up having a root canal done, although I’m not sure it was successful. I’m ashamed to admit that my apprehension about dentists has kept me from proper routine check ups and maintenance. The dentist that did the root canal failed to follow up with me and I was in no rush to have more work done, as the pain was gone for the most part, so I did not follow up either and I did not have a cap put on. The temporary filling ultimately fell out, the tooth is about half gone as well and is now infected.

I’ve seen a new dentist that was recommended by a friend, he confirmed the infection, and has advised that the tooth needs to be extracted. He explained that it would be quite invasive due to the condition of the tooth, cutting gum and bone, and that I could have it done by an oral surgeon under anesthesia, or by him with a local. Because of cost considerations, I’ve elected to NOT use an oral surgeon/anesthesia.

I guess my question is this—Due to the invasive nature of the procedure, would it be advisable to use the oral surgeon, or is it safe to assume that a ‘regular’ dentist is qualified to handle to job safely and effectively?
- Amy in New Jersey

Amy,
Giving patients options like this can leave them in a quandary. You leave them with the impression that they might not be safe taking the cheaper route. I would suggest asking more questions to help get at the answer.

It’s possible that the extraction you’re dealing with is beyond the comfort level of your dentist and the dentist could end up in trouble during the appointment. And it’s possible that this appointment could be a traumatic experience for you. Those are the two issues.

Dental anxiety can be very expensive, as you are finding out. If you had the filling replaced when it first came out, you wouldn’t have needed a root canal treatment. If you had the crown done right after the root canal (which sounds like it was done properly), you wouldn’t need the tooth extracted and now a much more expensive tooth replacement to keep your bite from collapsing. So I wouldn’t dismiss the idea of having this appointment with the best anesthesia possible, to keep you from having a bad experience and the resulting lifetime of serious dental anxiety. The end result would be that your mouth would gradually fall apart.

So I would try to pin your dentist down with some specific questions about just how comfortable he feels with this appointment, if he has done extractions like this in the past, if there is nitrous oxide sedation available for you that would help it be more comfortable, and if it is likely to be traumatic for you. Are the roots straight and tapered, or are they twisted with knobs on the end?

Having answers to these questions would help. It sounds like your dentist is trying to be fair and honest with you, so I would give his expressed opinions considerable weight. My tendency would be to encourage you to see the oral surgeon if that option is being offered—it indicates a degree of discomfort on the part of your dentist.

- Dr. Hall

Related links:
Read about dental crowns and why they are needed. In particular, you may want to find out about porcelain fused to metal crowns.
Read more about sedation dentistry here.

We thank our advertisers who help fund this site.

Comments Off

February 23, 2009

Why should I have my upper wisdom teeth removed?

Filed under: Braces, Wisdom teeth — iowasmiles @ 6:56 am

Hi Dr. Hall,
First I would like to say, “Thank You” for putting up this site. I was looking for more advice online and came upon your site. I am hoping you can help me.

I am 22 years old and my cosmetic dentist says that I should get my upper wisdom teeth extracted, both at the same time, in order to put braces on me.

I need braces because I have a missing right incisor so my canine is taking up the space in the middle between my front teeth and the molar; an unerupted left canine, and a baby incisor also on the left.

I am apprehensive (about the extractions) because my wisdom teeth don’t bother me and they are not crooked or impacted. They have just erupted about a month or so ago though. I also have my bottom wisdom teeth, but my dentist says that they can stay in. How come my upper ones have to go and the bottom ones can stay? I need some advice in order to make my decision before signing the consent form. I am very apprehensive about the procedure.

Thank you again.
Have a good day,
Jasmine from Wisconsin

Dear Jasmine,
First, I’m not going to call your dentist a cosmetic dentist automatically, because only a fraction of the dentists who claim to be cosmetic dentists actually are, in my opinion. They have to be a true artist, not just a good dentist, for me to call them a cosmetic dentist.

About your case. I’m assuming from what you’ve told me that the dentist is wanting to use the braces to make space for the unerupted canine and your missing permanent incisors, though I don’t know this is the case. I hope he or she is not going to put your canine teeth right next to the central incisors and then try to make the canines look like lateral incisors. That is very, very difficult to pull off without looking funny, because the canines are simply too big.

But I would have the wisdom teeth removal done, if that is what your dentist recommends. If they are already erupted, these tooth extractions will be very simple, and it seems reasonable that something has to give in order to make some space for moving the other teeth.

Having said that, I’m leery about having a general dentist do braces for your case. It sounds a little tricky. Maybe your dentist is truly expert with braces, but maybe not. I would lean toward having this done by an orthodontist who has had all that extra schooling. If your dentist truly knows what he or she is doing, then I apologize for raising this question.

Dr. Hall

Comments Off

October 28, 2008

A problem with an infected wisdom tooth

Filed under: Infected teeth, Wisdom teeth — iowasmiles @ 12:38 pm

I am a 25 year old female. I had a terrible toothache with slight swelling of the gums roughly 4 weeks ago. I went to the dentist who said I had an infection in my upper wisdom tooth and that it should be refered to a specialist and be removed. He gave me antibiotics and anti-imflamatory pain pills. The pain pills didnt work and I got stronger ones from the pharmacist. I went to the specialist just after the antibiotics had finished and the pain had gone away. He said to make an appoinment to have all my Wisdom teeth out. I have made the appointment but the earliest date I could get is the 10th of November. Over the last 3-4 days there has been a dull ache in that tooth and the tooth in front of it. It is not exactly painful just sensitive if I bite on that side.

My questions are these. Do you think it is another infection? Will the dentist refuse to operate if there is an infection? Must I see the dentist before my operation to remove the teeth to maybe get more antibiotics? I really cant afford this but I will not be able to afford more time off work if he refuses to operate because there is an infection? Please help I am hopelessly lost and confused as what to do.
- Jennifer from South Africa

Dear Jennifer,
It’s not essential, but it’s a good idea for the infection to be under control when the tooth is extracted. Some dentists will want the infection to be under control before the extraction. But more important is that this infection could get really nasty if it’s allowed to come back. Yes, your infection is coming back and you need to get back on the antibiotics and take them from now until you’re done with the extractions.

You should be able to call your dentist that gave you the prescription and tell him that you ran out and you need more, and that you need enough to get you to the time of your appointment and four or five days past. And he should be able to just phone that in without your needing another office visit. But if he won’t do that, you should go to the specialist and get that done. And I would do that as soon as you can.

These infections in your back teeth can travel to your brain or down your neck, and can cause swelling that cuts off your breathing. I wouldn’t trifle with them. And antibiotics alone will only control them – they never eliminate an infection when it comes from a tooth - you have to eliminate the cause or you still have the infection, even if the symptoms aren’t active.
- Dr. Hall

Related links:
Read more about tooth infection
Read more about wisdom teeth removal
More information about dental implants

We thank our advertisers who help fund this site.

Comments Off

October 21, 2008

Problems with kissing after wisdom teeth removal

Filed under: Wisdom teeth — iowasmiles @ 3:55 pm

Dr. Hall,
My name is Kim. About a year ago I had my wisdon teeth pulled on the right side.

I had it done by a military dentist who did a terrible job. Afterward, my entire mouth was in a large amount of pain for months. I thought the pain would never go away. It slowly did but now I have a constant irritating feeling on the lower right side of my lip and the right side of my chin. When I push down on it, it tingles and gives an irritating tender feeling. Everytime I kiss my husband I flinch and pull away because it does’nt feel good. That’s one of the reason it botters me so much. I want to be able to kiss my husband without issues.

After almost a year is this damage considered permanent? What is wrong with it? Will it ever go away? Is there something I can do to make it better? Please help me so that I can kiss my husband again.
- Kim in Virginia

Dear Kim,
When you had your wisdom teeth out, the nerve that goes by the roots of your lower right wisdom tooth was apparently damaged.

Because you are having strange sensations and your lip is not completely numb, it will probably fully recover in time. The strange sensations indicate that the nerve was damaged but not severed. Nerve tissue is very slow-growing and takes a number of months to fully recover. Usually it recovers in a year, but it can take longer.

There’s nothing we know of that you can really do to make it get better any faster.
- Dr. Hall

We thank our advertisers who help fund this site.

Comments Off

October 3, 2008

Should I wait the three weeks to get my tooth extracted?

Filed under: Extractions, Infected teeth — iowasmiles @ 11:25 am

Dr. Hall,
One specialist tells me I have a fractured root on a 3-year old root canal on my lower left molar (#19). There is an abscess/burst/bad taste/mild throbbing, sensitivity, and generally, I feel tired and foggy-brained since this started swelling 3 weeks ago. I’m scheduled for an extraction and implant later, but must wait over 3 more weeks for the extraction. It feels urgent to have this tooth out and to start feeling better. I’ve asked the specialist to get me in sooner, but it looks like I will have to wait. Should I find another specialist to remove the tooth? What are the consequences of waiting for the extraction/infection growing? Thanks for your advice on this.
- Jeanne in Arizona

Jeanne,
Unless they’ve given you some clinical reason that you should wait to have this tooth extraction done, I’d find someone who can get this done faster. You’re not saying what specialist you’re dealing with – I’ll assume it’s an oral surgeon as that would be the normal situation. You don’t necessarily need an oral surgeon to take out tooth #19. I doubt it would be that complicated. I’d tell your dentist who referred you to this specialist that this is unacceptable to you and you want him or her to refer you to someone who can get you in faster. Or you can go out and find someone on your own. You can call oral surgeons’ offices, or you can call general dentists. Unless there’s something unusual about this tooth #19 besides the fractured root, a good general dentist who does a lot of extractions would ordinarily be able to take it out.

In the meantime, before you get it out, this infection can grow, and it can become more entrenched. It PROBABLY won’t cause any serious complications to wait, but it could, and there’s apparently no reason to wait except that you have to deal with the schedule of the specialist. The biggest reason is that you’re uncomfortable. It also makes you more vulnerable to other ailments, while you’re battling this infection.

Good luck,
Dr. Hall

We thank our advertisers who help fund this site.

Comments Off

July 22, 2008

The oral surgeon wants to take out the wisdom tooth, too.

Filed under: Wisdom teeth — iowasmiles @ 5:35 pm

Dr. Hall,
Thank you for this service. I am a male age 63 male, and need my upper second molar (#15) extracted, which concerns me. I have a 2 1/2 year history of taking Fosamax, though I haven’t taken any the past six months. The oral surgeon insists that he should also remove the neighboring wisdom tooth, because it is a “vertical impaction” that is resting against the side of the #15 tooth and should also be removed to lesson the risk of infection. The wisdom tooth has never caused me problems and more jaw bone work increases my fosamax-related concerns. I’m thinking if a problem develops from there I can later deal with that. Please respond ASAP.

Thanks,
Larry from Missouri

Dear Larry,
I’d have the oral surgeon take out the wisdom tooth also.

If #15 didn’t have to come out, then I’d leave the wisdom tooth alone. But with #15 being extracted, that is going to open up a passageway from your mouth directly to the wisdom tooth, and the chance of getting infection in your wisdom tooth could be pretty high. And waiting until it bothers you would be a bad idea. Once it’s infected, it could be very difficult to get you numb for the extraction, plus extracting an infected wisdom tooth could cause a general septicemia. Plus, with the socket open after the extraction of #15, the wisdom tooth will be much, much easier to take out. Like maybe five times easier.

While you are taking Fosamax, you have increased chances of osteonecrosis after an extraction, or from any tooth infection. This risk, in my opinion, is only an additional reason for getting the wisdom tooth out. In other words, I believe you are at greater risk in taking out just #15 than if you did as your oral surgeon recommends and have both teeth out.

Bottom line – save yourself some misery and just get the wisdom tooth out at the same time. Less chance of infection, less chance of osteonecrosis, less pain, fewer appointments, happier patient. I don’t see any downside.

Dr. Hall

We thank our advertisers who help fund this site.

Comments Off

May 16, 2008

Am I too old to have my wisdom teeth out?

Filed under: Wisdom teeth — iowasmiles @ 7:39 pm

Dr. Hall,
I am a 31-year-old woman and my lower right wisdom tooth started to bother me a few days ago. I made an appointment with an oral surgeon for a consult. I was wondering what are the risk of extraction surgery for my age? Can my jaw bone get damaged or even break? I had my upper left wisdom tooth removed in emergency about 4 years ago but i was never told that the others needed to be removed. I hope I am not ” too old ” to get this done. And my last questions is can they remove all 3 remaining teeth at the same time? Thanks in advance for your help
Fran in Virginia

Fran,
No, I wouldn’t say you’re too old at all to have the rest of your wisdom teeth out. And, if the wisdom tooth is bothering you, that means it’s probably infected, and you don’t have much choice anyway. An infected wisdom tooth can become life-threatening if it isn’t taken care of, so I wouldn’t put off getting it taken care of.

Yes, it would have been better to have had them out at age 18-25, but the chances for complications still aren’t a lot. I didn’t start to get concerned until people were over 40. You’re very unlikely to have your jawbone get damaged or break. Now they will give you a scary consent form to sign with a list of absolutely every possible thing that could go wrong, but this is because they have to protect themselves in today’s legal climate. The chances of any of these bad things happening are pretty remote.

And yes, I would have the rest of them all out at the same time. It’s so much easier that way, and then you have them done. Don’t wait any longer–it doesn’t get any easier. The next time one of these bothers you, you may be over 40 and then the chances for complications will be that much worse.

Dr. Hall

We thank our advertisers who help fund this site.

Comments Off

February 5, 2008

How soon can you place the bridge after the extraction?

Filed under: Dental bridges, Extractions — iowasmiles @ 7:05 am

Dear Dr. Hall,
I had a tooth extraction of an upper molar and immediatley after my dentist set a bridge on top of the extraction without the allowed time for the site to have pressure applied and make sure the blood clot does form. Is this a normal way of practice or was the procedure rushed?

Thank you!
- Kelly from Texas

Dear Kelly,
It’s hard for me to tell without having seen this, but it sounds like everything turned out okay, and if it did your dentist probably did the right thing.

You didn’t say whether the dental bridge your dentist placed was a temporary bridge or a permanent one, but in either case, the bridge could have put some pressure on the site. However, the pressure may not have been necessary. Sometimes it doesn’t take long for the bleeding to stop–maybe five minutes is all. And there are other ways besides using pressure to make it happen more quickly, such as placing gelfoam, placing an astringent, or using electrocautery. And sometimes the bleeding stops fairly quickly without any pressure or other aids. Pressure is just an easy and convenient way to help insure that it stops if the dentist isn’t right there watching it.

The thing that is nice about what he or she did is that, when a tooth is extracted, the teeth on either side tend to move, and movement can disrupt your bite or lead to other problems. Placing the bridge immediately would prevent any movement of adjacent teeth.

Dr. Hall

We thank our advertisers who help fund this site.

Comments Off

Older Posts »