Oral Surgery

What is Dry Socket?

Dry socket is a common term describing the painful condition after the tooth extraction.  It happens when the blood clot is dislodged from the extraction site, thus exposing the underlying bone and tissue to external environment.  The exposed bone and tissue will be more sensitive to external stimulus such as cold, hot and air.  Also the area is more prone to infections.

One way to avoid dry socket is to have the patient bite down on the cotton gauze for a couple of hours until the bleeding stops.  The pressure from biting down on the cotton gauze will help stop the bleeding.  Also it will help keep the blood clot stays within the extraction site under the gauze, thus help promoting blood clot and wound healing.  Also if there is saliva or trace of blood, patient is encouraged to open the mouth and allow it to flow out from the mouth, instead of forcefully spitting it out.  Spitting out saliva would dislodge the blood clot.

If dry socket occurs, patient will know by having painful symptoms at the extraction site.  It may follow by swelling.  The way to treat dry socket is to put medicament into the wound site.  Usually over-counter medicament cannot treat the dry socket.  It is best to go to your dentist to have it looked at and treated.

 

Written by Daniel Tee, DDS, MS

Cosmetic Dental Office in Tempe AZ — White Tooth-Colored Fillings, Porcelain Crowns, Veneers, Inlays, Onlays

Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona. Practicing General Dentist

New Digital Panoramic Xray Machine Installed In Our Dental Office

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Recently I have introduced a new full-featured digital panoramic xray machine into my dental office.  It gives off exceptional digital xray images enabling viewing of the entire dentition.  It takes the xray images in lesser time and in lesser radiation dosage.  It has the advanced image-reconstruction technology that enables recalculation of the x-ray data after the initial scanning is completed thus helps to minimize any retake.

I am using it for diagnosing and treatment planning for oral surgery procedures such as third molar extractions, and in the future implant placement surgery.  Also, the panoramic image allows me to view the general relationship of each teeth to each other within the same arch and also how the upper and lower teeth relates to each other.  It is a win-win situation for the dentist and the patients.  I as the dentist can better design treatment for the patient and the patient will receive the best dental care.

 

Digital Panoramic Xray Machine Closeup Digital Panoramic Xray Machine Digital Panoramic Xray Radiograph

 

 

Written by Daniel Tee, DDS, MS

Practicing General Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Dental Office in Tempe AZ

 

Cleft Lips and Cleft Palate

Cleft Lips and Cleft Palate is a neonatal developmental defect that causes splitting of the lips and upper palate.  It occurs in one out of 700 new born babies.  This condition is hereditary and currently our knowledge about this hereditary condition is not complete.  Luckily, the defective lips and palate can be surgically repaired with modern cosmetic surgery techniques.  The outcome of the plastic surgery depends on the severity of the defects.  If the defect only affects the lips, surgery can successfully repair the lips.  However, if the defect affects the upper palate, this can affect the child’s dental development and also may affect the speech learning.  In some rare instances, this clefting condition may affect the hearing.

To properly manage the clefting condition, a team of specialists from many medical specialties, including a dentist, will be working together to help the child.

 

Written by Daniel Tee, DDS, MS

Practicing General Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Dental Office in Tempe AZ

 

 

Fosamax Can Cause Osteonecrosis to the Jaw Bone

Fosamax is a common drug used to treat osteoporosis and also Paget’s disease. In some rare cases, people may develop dental complications after dental extractions when they are taking fosamax. The jaw bone may never heal and osteonecrosis of the jaw bone may occur. There may or may not be infections. It may be asymptomatic for a couple of weeks until the exposed bone appears in the affected site.

There are other drugs that may cause osteonecrosis. They are bisphosphonate-category of drugs used to commonly treat cancers.

One way to minimize the chance of side effect is to have the physician to prescribe an alternative medication for the targeted medical illness.

So if you are taking fosamax, please be sure to discuss this with the dentist upon dental visit.

Written by Daniel Tee, DDS, MS

Practicing General Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Why does Wisdom Tooth Hurt? Pericoronitis

Typically, adult has four wisdom teeth and they don’t come in until a person’s late twenty years old.  Often, people will complain about pain caused by the wisdom tooth.  There are many reasons why wisdom tooth causes pain.

Just like other tooth, wisdom tooth would have to push through the gum tissue when it is coming in.  During the process of eruption, the eruption movement of the wisdom tooth causes pressure to the adjacent tooth and the gum tissue, so as the result, it might cause discomfort and perhaps pain.

In addition, the wisdom tooth might grow side way (or horizontally impacted.)   It can be totally submerged under the gum tissue or it may be half way showing through the gum tissue.  If it is impacted and is unable to break through the gum tissue completely, the food is more lilely to be jammed in between the wisdom tooth and the adjacent tooth.  Bacteria will feed off from the jammed food debris and infection will occur.  The bacteria infection will cause inflammation of the gum tissue around the wisdom tooth.  The technical term of this inflammation is called pericoronitis.  The gum tissue around the wisdom tooth might appear reddish in color (in comparison to the pinkish color of normal gum tissue) and might be swollen.

The treatment would be antibiotics for short term control of the infection but it is generally recommended to have the wisdom tooth removed for prevention purpose.  Failure to remove the wisdom tooth might cause many major dental problems.  See my previous article for more information.

 

Written by Daniel Tee, DDS, MS

Practicing General Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Impacted Wisdom Tooth Can Causes Major Dental Problems

In this article, I would talk about the necessity of removing impacted wisdom tooth and I will show one of my recent cases relating to the impacted wisdom tooth.

Typical adult has 32 teeth and four of them are wisdom teeth located at the most posterior area of the dental arch.  Often these wisdom teeth don’t come in until a person’s late twenty years old.  Even though they don’t seem to cause any pain, it is recommended to have the wisdom teeth extracted for preventive purpose.

It is generally difficult to clean the wisdom teeth because it is located at the most posterior region of the mouth.  Sometimes, the wisdom teeth can grow sideways.  Detanlly we called them impacted wisdom teeth.  If the wisdom teeth are impacted, food and bacteria can accumulate around the wisdom teeth because food is more likely to get caught in between the wisdom tooth and the tooth in front of it.  If left ignore, continual jamming of food will allow bacteria to grow and causes tooth decay, on the wisdom tooth and also on the tooth in front of the wisdom tooth.

Xray Image of Impacted Wisdom Tooth Causing Dental Decay, Pull Wisdom Tooth extraction, Pull Third Molar, Wisdom Teeth extraction

Xray Image of Impacted Wisdom Tooth Causing Dental Decay

I have this patient come in with the toothache.  Upon examination of Xray, we can see that the impacted wisdom tooth causes severe decay on the tooth in front of it.  The decay has already progressed onto the nerve chamber of the tooth.

So in order to treat her dental problems, I would perform surgical removal of the wisdom tooth and for the damaged tooth, I would remove all decay, perform root canal therapy, buildup the tooth and follow by the crown.

The main reason why the decay has progressed is because the patient does not have the habit of going to see the dentist for routine checkup, and also follow through the previous dentist’s recommendation of extracting the wisdom teeth.

Often the type of dental problem created by the wisdom tooth can be difficult to address because the decay can be very deep and dental restoration may not be able to be placed to restore the tooth.  Luckily, in the above case, the decay has not compromise the structural integrity of the tooth and I was able to restore the tooth.

 

Written by Daniel Tee, DDS, MS

Practicing General Dentist Serving the city of Tempe, Chandler, Phoenix, Gilbert, and Mesa in Arizona.

Extraction of Wisdom Tooth Prevents Long Term Problems

Today, I have completed extraction of two impacted wisdom teeth.  I would need to perform surgery to take those two teeth out.  At the end of the procedure, I was exhausted but I believe it is worth it.  Generally, impacted wisdom teeth would often have developed problems in the long term.  By removing it in time, this will prevent any potential big problems in the future.

In some occasion, the wisdom tooth was grown  in the bad position in relation to the other tooth.  It could be growing side way or horizontally impacted  Then the wisdom tooth would often push against the the toot anterior to it and causes the rest of the teeth in the jaw to shift.  Crowding would result and this in turn would cause the food impaction in between the teeth.

Bacteria grows off the food debris jammed in between the wisdom tooth and the adjacent tooth, and causes infection and inflammation to the gum tissue around the wisdom tooth.  This infection is called pericoronitis and will cause severe pain and discomfort if left untreated.

Due to the most posterior location of wisdom tooth, it is not easy to gain access for the toothbrush to clean the area adequately.  In addition, if the wisdom tooth is impacted, food impaction is the most severely in between the wisdom tooth and the tooth adjacent to it.  This promotes increased likelihood of tooth cavity.  If the wisdom tooth is impacted, the tooth cavity develops at the root area of the tooth.  This is the area very difficult to get access to and to do the filling.

If the tooth cavity is deep, then the tooth would develop painful response and may become infected.  Then root canal therapy would be needed to treat the infection.

More frequentlly, the impacted wisdom tooth would cause tooth cavity to the tooth adjacent to it.  Some people think wisdom tooth is not functional and can be disposable, thus they tend to ignore the wisdom tooth.  However, wisdom tooth can cause severe problem to the other tooth.  For this reason, I generally recommend removal of wisdom tooth if the wisdom tooth is not growing in the good position.

 

Written by Daniel Tee, DDS, MS
Practicing General Dentist Serving Tempe, Chandler, Phoenix, Mesa, and Gilbert Arizona

Atraumtic Extraction of Teeth — Oral Surgery

Atraumtic extraction of teeth is a surgical extraction technique in which the teeth are extracted with minimal amount of damage to the surrounding bone and tissue structure.

As a dentist, I always focus to deliver optimal dental care to patient.  With all extraction, I take special care to minimize discomfort to patient and to efficiently perform the surgery.  With the new development of surgery instruments and increased popularity of implants, I am able to perform the surgery of extraction in the most atraumatic ways than it has always been in the past.

In the past, usually the two most common types of instruments are elevators and forceps.  The elevators is used to loosen the tooth in the socket by applying torquing pressure on the tooth against the bone socket or the surrounding tissue.  After the tooth has become loosen, a forcep is used to further grab the tooth out of the bone socket.

Most of the time, this traditional extraction technique requires a lot of blunt forces in the process of loosening the tooth.  Sometimes, the surround bone, especially the buccal bone,might become fractured inevitably in the process.

However, with the increased popularity of dental implants, dentists have become more aware of the importance of preserving the bone.  A good natural bone is desirable for optimal implant placement and osseointegration.  Thus, a newer generation of surgery instruments are developed.

The newer generation of surgery instruments are periotomes and luxators.  Even though they were first used by dentist more than a decade ago, these instruments have recently been reintroduced to the dental offices by popular demand due to their ability to allow dentists to perform atraumatic extraction and surgery.

Atraumatic Dental Extraction, Periotome, Periodontal Ligaments, Tempe Dentist, Tempe, Chandler, Mesa, Phoenix, Gilbert, Arizona

During extraction, periotome is iinserted into the gum pocket to sever the periodontal ligaments in order to loosening the tooth.

The periotome instrument is a small surgical knife-like instrument that is inserted into the pocket between the tooth and the alveolar bone.  In there, there are ligaments and fibers extending from root surface of the tooth to the surrounding alveolar bone.   The periotome instrument is inserted and is able to cut through these fibers/ligaments.  In essence, the periotome is performing microsurgery to sever the periodontal ligaments.  Once the fibers are cut, the tooth will be loosened.

Next, luxator is a small instrument with a thin blade at its tip.  The thin blade is further inserted into the space created by the periotome.  With a couple of small twist, the tooth will become completely loose and a forcep can be used to grab the tooth out of the bone socket.

Disclaimer: this surgery technique is not applicable to all situation.  And even though it was inteneded to perform surgery atraumatically, some unexpected situation may arise and dentist would need to perform additional steps to complete the surgery.  Not all tissue or bone can be preserved atraumatically as intended.

 

 

Written by Daniel Tee, DDS, MS
Practicing Emergency Dentist Serving Tempe, Chandler, Phoenix, Mesa, and Gilbert Arizona