Wisdom teeth extractions- By Dr Amir Mostofi DDS, Dip. MSc

Overview

The four permanent adult teeth known as wisdom teeth are placed at the top and bottom back corners of your mouth. A wisdom tooth extraction is a surgical procedure to remove one or more of these teeth.

You'll probably need to have a wisdom tooth removed if it is impacted, causing you pain, an infection, or other dental issues. An oral surgeon or a dentist can remove a wisdom tooth.

Even if impacted teeth aren't currently causing issues, some dentists and oral surgeons advise wisdom tooth extraction to avoid potential future issues.

How did it get done?

The final permanent teeth to erupt in the mouth are the wisdom teeth, sometimes known as third molars. Between the ages of 17 and 25, these teeth typically erupt. Some individuals never get wisdom teeth. Others do not experience any issues when their wisdom teeth erupt naturally, just like their other molars did.

Wisdom teeth that don't have enough room to erupt into the mouth or develop normally are known as “impacted” wisdom teeth. Impacted wisdom teeth may partially or completely fail to emerge.

A wisdom tooth that is impacted can:

• Toward the following tooth, grow at an angle (second molar)

• Grow at an angle with your mouth's roof.

• Grow at a right angle to the neighbouring teeth, appearing to "lye down" in the jawbone.

• Like other teeth, they can grow straight up or down, but they cannot come out of the jawbone.

Impacted wisdom teeth issues

If your impacted wisdom tooth causes issues like these, you'll probably need to have it extracted:

1. Pain

2. food and debris becoming stuck behind the wisdom tooth

3. Infections or gum disease (periodontal disease)

4. tooth decay in a wisdom tooth that has partially erupted damage to the tooth next to it or the surrounding bone

5. creation of a cyst (cyst) around the wisdom tooth that is filled with fluid

6. problems with the orthodontic procedures used to straighten other teeth

Avoiding future dental issues

Dental experts disagree on the benefits of removing impacted wisdom teeth when they are not causing issues (asymptomatic).

With impacted wisdom teeth, future issues are impossible to forecast. Here is the justification for pre-emptive extraction, though:

• Even wisdom teeth without symptoms could be diseased.

• It's frequently challenging to reach the tooth and give it the required cleaning if there isn't enough room for it to erupt.

• In younger adults, severe wisdom tooth issues are less common.

• Surgery-related problems and difficulty for older patients are also possible.

Risks

The majority of wisdom tooth extractions don't cause long-term issues. However, sometimes a surgical procedure that involves making an incision in the gum tissue and bone excision is necessary to remove an impacted wisdom tooth. Rare problems may arise from:

• When the post-operative blood clot is lost from the site of the surgical wound, a painful dry socket or exposed bone results (socket)

• bacterial or food-particle-trapped infection in the socket

• damage to the bones, sinuses, nerves, or teeth close

  How you get ready

The procedure might be carried out in the dental office. However, your dentist could advise seeing an oral surgeon if your tooth is severely impacted or if the extraction calls for a complex surgical procedure. Your surgeon may advise sedation in addition to local anesthesia to numb the area and make you more comfortable throughout the treatment.

Issues to raise

You might wish to ask your oral surgeon or dentist the following questions:

• What number of wisdom teeth must be extracted?

• What kind of anaesthetic am I going to get?

• How difficult do you anticipate the process to be?

• How long will the process probably take?

• Have the other teeth been harmed by the impacted wisdom teeth?

• Is there a chance I could sustain nerve damage?

• What other dental procedures might I require in the future?

• How long does it take to fully recover and resume daily activities?

Getting ready for surgery

Almost always, wisdom tooth extractions are done as outpatient procedures. You will therefore return home that day. The staff at the hospital or your dentist will give you information on what to do the day before and after your scheduled procedure. Query these things:

• Is it necessary for me to plan for a ride home following the procedure?

• Do I need to fast and refrain from eating, drinking, or both? If yes, when should I start?

• Can I take my prescribed drugs before the procedure? If so, when can I start taking a dose before the procedure?

• Is there anything I should stay away from taking before the operation?

What to anticipate?

Throughout the process

Depending on how comfortable you are and how complicated the removal of your wisdom teeth is predicted to be, your dentist or oral surgeon may choose one of three types of anesthesia.

Options consist of:

A local anesthetic

Each extraction location receives one or more injections of local anaesthetic from your dentist or oral surgeon. Your dentist or surgeon will probably numb your gums with a chemical before administering an injection. During the tooth extraction, you are awake. You won't feel any discomfort, although feeling some pressure and movement.

Anesthesia and sedation.

Through an intravenous (IV) line in your arm, your oral surgeon or dentist administers sedative anesthesia to you. During the surgery, a sedation anaesthetic subdues your consciousness. You won't remember much of the process and won't experience any pain. Additionally, you'll need local anesthesia to make your gums numb.

General sedation

You might be given general anaesthesia in certain circumstances. You might either have an IV line in your arm or inhale medication through your nose. You subsequently go unconscious. Your medicines, breathing, temperature, hydration intake, and blood pressure are all continuously monitored by your surgical team. You won't feel any pain and won't remember the process. Additionally, local anaesthetic is administered to ease discomfort following surgery.

Surgical procedure

When removing wisdom teeth, your dentist or oral surgeon will:

• Creates a cut in the gingival tissue to reveal the tooth and bone

• bone that prevents access to the dental root is removed

• if it's easier to remove the tooth in sections, divide it.

• takes out the tooth, removes any dental or bone debris from the area where the tooth was removed.

• Closure of the wound with stitches is done to aid in healing, albeit it is not always necessary.

• Apply gauze to the extraction site to stop bleeding and promote the formation of a blood clot

Following the procedure

After the procedure, you are transferred to a recovery room if you underwent general or sedation anaesthesia. If you had local anaesthetic, you would probably spend the short recovery period in the dental chair.

Follow the advice from your dentist as you recover from your procedure.

Bleeding.

Blood may ooze on the first day following wisdom teeth removal. Spitting excessively should be avoided to prevent removing the blood clot from the socket. As instructed by your dentist or oral surgeon, replace the gauze over the extraction site.

Management of pain.

An over-the-counter pain treatment like Paracetamol or Ibuprofen or a prescription painkiller from your dentist or oral surgeon may help you manage pain. If bone was removed during the treatment, prescription pain medication might be especially beneficial. A cold compress applied to your jaw may help provide pain relief.

Bruising and swelling.

As advised by your dentist or surgeon, use an ice pack. Your cheek swelling often goes down in two to three days. It can take a few more days for bruises to heal.

Activity.

Plan to rest for the rest of the day after your procedure. The following day, return to your regular routine, but refrain from any strenuous exercise for at least a week to prevent losing the blood clot from the socket.

Beverages.

Water is important to drink after surgery. In the first 24 hours, refrain from consuming any alcoholic, caffeinated, carbonated, or hot beverages. For at least a week, refrain from drinking using a straw since the sucking motion could push the blood clot out of the socket.

Food.

For the first 24 hours, stick to soft foods such as yogurt or applesauce. Once you can tolerate soft meals, start eating them. Avoid things that can stick in the socket or irritate the wound by avoiding hard, chewy, hot, or spicy foods.

Smoking

Smoking should be avoided for at least 72 hours following surgery, and ideally for longer. Don't chew tobacco for at least a week if you do. After oral surgery, using tobacco products might hinder recovery and raise the possibility of problems.

Stitches.

You might not have any stitches at all or have stitches that fall out in a few weeks. Make an appointment to have your stitches removed if they need to be taken out.

When to call a surgeon or dentist?

If you suffer any of the following warning signs or symptoms, which could point to an infection, nerve damage, or other severe problem, call your dentist or oral surgeon right away:

• Breathing or swallowing challenges

• A lot of blood

• Fever

• Severe pain that is not alleviated by painkillers as prescribed

• Swelling that gets worse two or three days later

• A foul taste in your tongue that saltwater rinsing cannot cure

• Pus in the socket or leaking from it

• Enduring numbness or a loss of sensation

• Nasal discharge with blood or pus

If problems arise, speak with your dentist or oral surgeon..

What is orthodontic Treatment?- By Dr Amir Mostofi DDS, Dip. MSc

Orthodontics involves realigning and straightening the teeth and jaw to improve one's smile and oral health.

Treatments are available to repair gaps between teeth, straighten crooked teeth, and fix an uneven bite. In order to complete this process, braces are used. These are attached to the inside of the mouth for a predetermined amount of time. Retainers are then worn following the end of treatment.

Although orthodontic procedures are frequently carried out for cosmetic purposes, they can also enhance tooth health over the long run. Fixing misaligned teeth that do not fit together is crucial because they are more difficult to keep clean and are consequently more prone to gum disease or tooth decay.

Fixed metal braces and removable clear aligners are just two of the many variations of braces. Here is a summary of the various orthodontic procedures that are offered:

Invisible braces

Modern technology has made it possible to create almost undetectable braces, allowing patients to straighten their teeth more covertly.

There are several varieties of these very undetectable braces:

Invisalign

Your teeth will be gradually straightened using a series of almost unnoticeable, removable custom aligners. Before the next is fitted, a patient wears the previous aligner for roughly two weeks, 20 to 22 hours per day.

There are various variations, including versions specifically made for teenagers. These versions contain "wear indications" that change colour from blue to clear to make sure you're using the brace frequently. Invisalign i7 is a treatment for modest crowding that uses a set of transparent, removeable aligners to straighten teeth in just three months.

Lingual brackets (Lingual orthdontics)

In order to correct your teeth, lingual braces are discreetly positioned against the inside surfaces of your teeth. There are several kinds based on your requirements. Some of them are made specifically to align just your front six to eight teeth. Only your orthodontist can remove these braces when the course of treatment is complete.

Ceramic (white coloured) brackets

These, also referred to as ceramic braces, have a more discrete appearance than standard metal braces thanks to the use of clear or tooth-colored brackets. Clear braces straighten teeth in about 18 to 24 months, just as conventional orthodontic therapy.

Cosmetic adjusting

Contrary to braces, treatment just straightens the front six to eight teeth that are most noticeable. Cosmetic straightening, which takes a more focused approach, uses procedures that are significantly more covert than metal braces to provide results in as little as six months. In fact, a large number of the selections are hardly visible.

The conventional fixed bracing

Due to their effectiveness and dependability, fixed metal braces continue to be a common choice for straightening teeth, especially among teens, although many adults also use fixed braces. With the help of a wire connecting the brackets on the braces, which are glued to the teeth, the teeth are gradually pulled into alignment.

braces that self-ligate

These resemble standard metal braces in appearance, but they use spring clips to attach the wire rather than elastic bands, which decreases friction between the bracket and the wire. Because they are simpler to maintain and permit more tooth movement, these braces are less likely to discolour and may cause less discomfort.

A retainer is what?

Although technically not an orthodontic procedure, retainers are an essential component of the maintenance required to properly achieve straighter teeth. After your braces have done their magic, you will need to wear a retainer to prevent your teeth from trying to return to their unattractive shape.

It takes some time for the gum's elastic fibres to realign themselves around each tooth's new position and cease tugging them out of alignment. Retainers are crucial up until the point that the teeth have stabilized for this reason. In reality, retainers should be worn permanently to ensure that teeth stay in place.

Removable retainer

These have the appearance of a thin, transparent gum shield that is moulded to your teeth to keep them in alignment and for comfort. Patients will need to wear retainers for varying amounts of time, but for the majority, only at night.

Fixed retainer

In these, the retainer is held in place by a stainless-steel wire that is bonded behind the front teeth. You just need to be cautious when brushing your teeth while wearing them because they are incredibly discreet and simple to completely forget about.

The best thing to do is to talk to your dentist if you're curious to learn more about braces and orthodontic therapy.

If you are interested in knowing about your orthodontic treatment options, please do not hesitate to contact the Clinic for Implant & Orthodontic Dentistry on 01903 821822.

What to do following a surgical tooth extraction?- By Dr Amir Mostofi DDS, Dip. MSc

Post operative instructions following surgical tooth extraction.

In order to minimize the risk for infection, pain, swelling and to aid healing please follow the advice provided here.

Following the surgery you may have minor discomfort. However, if you feel that it is too much then contact your dental practice. Do not disturb the surgical side—this refers to playing with the area using your tongue. If you feel the need, take painkillers and refer to our advice regarding how to take them.

Smoking:

Smoking is prohibited following an extraction as it reduces the blood flow to the area, increases the risk for infection and delays healing.

Sutures:

If you have dissolvable sutures (your dentist would have informed you of this) then they should dissolve on their own within 3-4 weeks. However, sometimes if you are taking antibiotics they may not dissolve on their own. If they are bothering you go your dentist practice after around 2 weeks and the dentist will remove them for you.
If you have non-dissolvable sutures then you will need to come back in 2-3 weeks to have them removed by the dentist.

PAINKILLERS

There are two types of painkillers (over the counter) that can be taken following a tooth extraction. If it is required, they can both be taken up to their maximum doses together. They can be taken together due to the fact that they are two completely different types of drugs. You must take what you would usually take for a headache and consult the leaflet, a GP or pharmacist for any interference with your current medication.

Ibuprofen:

You can take up to 1600mg of ibuprofen per day. This works out to be 2 x 200mg tablets being taken 4 times a day, and this can be done for up to a week.

Paracetamol:

You can take up to 2500mg per day. This works out to be 1 x 500mg tablet 5 times a day for a week.

You must wait between 4 to 6 hours between doses on both medications. If you stagger the medication, then you may find it more effective.

You should notice a noticeable improvement after a week. If you feel that you are still in a lot of pain after a week, contact your dentist.

Antibiotics:

If you have been given antibiotics, read the following advice.

Do not stop taking the antibiotics until the end of the course or unless a professional tells you to stop. You should notify the dentist if you are allergic to any of these medications before you begin taking them.

Amoxicillin is to be taken once every eight hours.

Metronidazole is to be taken once every eight hours. Contact your dentist if you are taking warfarin regarding this drug.

Erythromycin is to be taken once every 6 hours . To reduce side effects, it is recommended to have natural, live yoghurt.

Brushing:

Brushing should be done as usual, but try to avoid the surgical side for the next few days. If there are sutures, please be careful not to damage the sutures.

Mouthwash:

It is recommended that for the first week following extraction, you rinse with a disinfectant mouth wash. Any antibacterial mouth wash is OK, but there are two main ones that we recommend. Do not rinse too violently as it will disturb the healing

Corsodyl is best used for 10 seconds twice a day. Do not use it for longer than one week. If used for longer than one week, it is likely to cause discoloration of the teeth.

Listerine is best used for 10 seconds twice a day.

Bleeding:

Following a tooth extraction, patients should expect some bleeding. Expect a little bit more bleeding if you use blood thinners or if you have more complicated procedures like implants or surgical extractions.

However, you should not have excessive bleeding . If you experience excessive bleeding, then roll a tissue or gauze in the shape of a sausage and then bite on it gently for 20 minutes. If you have sutures, DO NOT do this, as it can irritate the area more. Contact your practice ASAP.

Bruising:

Following more extensive surgeries like implants or surgical extractions, bruising and swelling may appear. This should start to disappear within a week or 10 days. Anti-inflammatory painkillers such as ibuprofen will aid a faster recovery. This bruising and swelling may last slightly longer in some patients.

What is an overdenture?- By Dr Amir Mostofi DDS, Dip. MSc

An overdenture is a cheaper removable substitute for a full jaw fixed implant treatment. A denture with one or more teeth, prepared roots, or implants covered at the base is known as an overdenture. Any removable dental prosthesis known as an overdenture is one that covers and rests on one or more natural teeth that are still present, their roots, and/or dental implants. Overdentures can be implant- or conventionally tooth-supported. Alveolar bone is found to be preserved and the process of total edentulism is postponed. For senior individuals who have lost some teeth but not all, making them qualified for a set of full dentures, an overdenture is typically employed. The overdenture is detachable and not fixed in the mouth. Overdentures have the advantage over complete dentures in that the roots that are still in the maxilla (upper jaw) or mandible (lower jaw) protect the top or lower jaw's bone, reducing bone resorption.

Implants may support an upper or lower overdenture. The most frequent number of implants used to stabilise an upper denture is 4, despite the fact that there is little evidence to conclusively demonstrate the appropriate number of implants for stabilising an upper overdenture. Support for a mandibular overdenture was improved when two implants were present rather than just one implant.
The patients could also chew much better and was overall more pleased with the overdenture. Sometimes a metal bar connecting implants will enhance retention of an overdenture. The patient's overall satisfaction with the overdenture increased along with how much better they could chew. Initially chewing abilities are decreased, however when the overdenture has been fitted for a year, the chewing cycle improves.

Very Important advice for all implant patients. By Dr Amir Mostofi DDS, Dip. MSc

Following your implant surgery, ask for a written copy of your implant details. It should include brand, model and specific details like diameter and implant connection type. Keep these details somewhere safe for a very long time. The reason for that is it makes it much more easier for another dentist 10-20 years later to unscrew the prosthesis above the implant and use the implant base (in jaw bone) for something else. Do not trust that the clinic will always retain a copy of your implant details as accidents happen, dental practices shut down and clinical notes could become lost and sometimes clinical notes are not very clear. It is very difficult and almost impossible for a new dentist to guess what specific type of implant has been used in your mouth.

When not to have full jaw implants?- By Dr Amir Mostofi DDS, Dip. MSc

The reasons that follow are the most common, however each case should be considered by a qualified implant dentist.

• Heavy smokers.
• Patients with severe bruxism (grinding teeth).
• Individuals taking bone loss prohibitory medications (like bisphosphonates for osteoporosis).
• Patients unable to perform routine brushing procedure.
• Patients with severe and long term systemic illness like diabetes, which might affect the healing following surgery.
• Radiation (to the jaws) & chemo therapy.
• Patients with cognitive decline (memory, speech, motoric, judgment and thinking).
• Very advanced age.
• Bleeding disorders.
• Bone disease.
• Severe psychiatric disorder.

How long to wait following an extraction for a implant placement?- By Dr Amir Mostofi DDS, Dip. MSc

How long following an extraction should you wait before having an implant placement to fill the gap? In reality on the same visit you can have an implant inserted, but such approach is not always possible. The reason could be because there are not enough bone in the extraction socket to support a new implant, or severe infection in the site. However, if you wait too long following an extraction, the jaw bone in extraction socket will start shrinking and you have less bone in extraction site. Numerous studies have been carried out to find out the optimum waiting time prior to an implant placement in an extraction site. It appears that optimum time is between 8 to 12 weeks following extraction for a new implant placement.

Root canal or implant , which one is better?- By Dr Amir Mostofi DDS, Dip. MSc

Many people some times come to a point when they should choose between an option of root canal treatment or perhaps option of extraction of a tooth and later replacing the missing tooth by an implant. The question is which one is a better, more long lasting, less trouble some and cheaper option? Like many times in life there is no straight forward and easy answer to this, however, I try to out line the main differences in here.

First point that a lot patients ask me, is how long each one lost? The life span of an implant depends on many different factors but the most important factor is place in the mouth where an implant is inserted. Usually implants at upper or lower front part of a mouth last longest and implants at upper molar region last less. There are several studies that shows 85% - 95% of implants survive up to 15 years. The survival rate for root canals is also dependent on a tooth position in mouth. Front teeth as they have less number of roots are more successful than molar teeth. On average 90% of root canal treatments are successful in a 15 year period.

From a cost point of view a root canal with a restoration at the top , cost less in comparative to an extraction plus implant and a crown at the top of implant.

Time wise a root canal with restoration is completed in much shorter time compare to extraction , waiting for healing period, implant insertion, waiting for implant integration with bone and later fitting a crown at the top of implant.

As a general rule my first recommendation to our patients is a root canal. However, there are cases where performing a root canal is not a good option and considering for an implant becomes a better choice.

Making Dentistry Affordable - Payment Plans

Want high quality dental treatment but are worried about the costs?

If so then look no further because we have payment plans to help suit you! We have interest free finance for those one offs either over 6 or 10 months. We also have a denplan payment plan which is a monthly payment plan for longer term planning.

Our plans are easy to sign up for and our higly trained nurses/recepton can tell you more information and guide you through the application process.

No more NHS dental treatment. You can finally afford that high quality private treatment you've always wanted. We can finance all of our treatments such as the following.

• Implants
• Dentures
• Fillings
• Crowns
• Bridges
• Teeth Whitening
• Home Visits
• Extractions
• Root Canal Treatments

Invisalign - Clear braces

What is Invisalign/clear aligners?

Aligners are thin clear flexible plastic ‘mouthguards’ which fit closely over the teeth. A series of aligners are used to move the teeth incrementally according to a treatment plan developed by the orthodontist. Aligner appliances are ideally suited to adult patients whose life-style or work commitments make it difficult for them to wear more visible conventional fixed appliances.

When can Invisalign/aligners be used?

Aligners are most commonly used in cases needing alignment of teeth without extractions. Routine aligner treatments include:

• Mild-moderate dental irregularity
• Crowding which can be corrected with mild-moderate expansion of the dental arch
• Crowding which can be corrected with reductions in tooth width (Inter-proximal reduction or slenderising)
• Mild spacing

Do I need aligners for both top and bottom teeth if I only want one straightened?

Changes in teeth crowding and spacing affect your bite, so to make sure your bite isn’t affected, our dentist likes to assess both arches and more often than not treat both arches at the same time to achieve the perfect results for your perfect smile.

How long does the treatment take?

The typical treatment length for aligners is around 5 months. The typical person will receive a series of 5 invisible aligners that need to be changed every 3 weeks or so. Some patients will receive slightly more or less aligners. This depends on the degree of teeth straightening required.

Payment Plans

We do have interest free payment plans avaliable in order to spread the cost.

In order to get urther information please visit our page for Invsalign here.

Dementia Awareness - Dementia Friendly Dental Practice

Dementia awareness among dentistry is becoming increasingly important. Therefore, we as a surgery have decided to take the necessary steps to work towards being a dementia friendly practice.

We are doing this by:

• Joining the Alzheimers Societies Dementia Awareness programme - Meaning we are Dementia Friends
• We have conducted an audit to look for any shortcomings in the way we run our practice
• We have an action plan to move foward
• We are looking into joining Worthings Dementia Action Alliance
• We have had recent training in how dementia affects people
• We will continue to update on how we have improved our practice to aid people with dementia and their carers/family members feel more comfortable while they are with us.

Implant Procedure - Final Step - Fitting the Crown

This is the final step of the procedure.

A few weeks after the impressions usually about 2 weeks you will be asked to come back to have the final fit of the crown. During this appointment the clinician will try in the crown or bridge that has been sent back from the laboratory. They will initially just try it in and ensure it doesn't need any major changes. If they are happy with that then they will proceed to either cement retain the crown or to screw it in to permenantly place it.

The clinician will then check the bite and ensure that you are fully happy with it. Once everyone is satisfied you will be then finished.

GDPR

As many of you are probably aware. The new GDPR regulation came into affect as of today. It means that it will affect the way that we can process any data that we have of patients. Please have a read of our Cookie Policy, Privacy Policy and Fair Processing Notice before you coninue on our website.

Thank you for you co-operation.

Implant Procedure - Step 3 - Taking Impressions

This is the stage that will begin the procedure for making the crown to finish the implant.

Firstly, the implantologist will select an impression tray that matches your personal mouth size so it is the most comfortable.

Following this, the implantologist will place a special abutment into the implant which the impression will go round and show the laboratory exactly how the implant has been placed and give them a good idea on how to make the crown.

Then, they will have their nurse mix the impression material and place it into the tray. The nurse will then pass that to the implantologist and place it into your mouth. This is uncomfortable for many patients but the best thing to do is just breathe through your nose and focus on your breathing and not whats going on.

After this, they will unscrew the abutment so that the impression comes out. They will then send this to a laboratory where they will make the crown to fit on your implant.

Implant Procedure Step 2 - Placing the implant - Part 2

Once the pilot hole has been made then the implantologist will use drill pieces of increasing sizes to slowly made the hole bigger. This allows the implantologist to slowly increase the length and width until they are happy with the size.

During the increasing sizes a thread will be made in the bone so that the implant will be able to be screwed in easily. Some implants can be self-tapping which means that they create there own space to fit.

Once the implantologist is happy they will often place a direction indicator in the pre-made hole this is just to assess what direction that the implant will be. They may also take x-rays with drill pieces in the hole as they are going along this is to make sure that everything is going as best it can and so that they can measure accurately.

Once they are happy with the size they will then screw in the implant. The implantologist here prefers to use a little wrench a do it by hand as he feels he gets the best results that way. However, some implantologists will use a machine that measures everthing for them.