Posts Tagged ‘emergency dentist’

What You Need to Know About Wisdom Teeth Extractions

Posted on: January 10th, 2012 by Nicholas Geller, DDS No Comments

Third molars, commonly referred to as wisdom teeth, are usually the last four of 32 teeth to erupt (surface) in the mouth, generally making their appearance between the ages of 17 to 25. They are located at the back of the mouth (top and bottom), near the entrance to the throat. The term “wisdom” stems from the idea that the molars surface at a time typically associated with increased maturity or “wisdom”.

In most cases, inadequate space in the mouth does not allow the wisdom teeth to erupt properly and become fully functional. When this happens, the tooth can become impacted (stuck) in an undesirable or potentially harmful position. If left untreated, impacted wisdom teeth can contribute to infection, damage to other teeth, and possibly cysts or tumors.

There are several types, or degrees, of impaction based on the actual depth of the teeth within the jaw:

Soft Tissue Impaction

The upper portion of the tooth (the crown) has penetrated through the bone, but the gingiva (gum) is covering part or all of the tooth’s crown and has not positioned properly around the tooth. Because it is difficult to keep the area clean, food can become trapped below the gum and cause an infection and/or tooth decay, resulting in pain and swelling.

Partial Bony Impaction

The tooth has partially erupted, but a portion of the crown remains submerged below the gum and surrounding jawbone. Again, because it is difficult to keep the area clean, infection will commonly occur.

Complete Bony Impaction

The tooth is completely encased by jawbone. This will require more complex removal techniques.

Reasons to Remove Wisdom Teeth

While not all wisdom teeth require removal, wisdom teeth extractions are most often performed because of an active problem such as pain, swelling, decay or infection, or as a preventative measure to avoid serious problems in the future. If impaction of one or more wisdom teeth is present, and left untreated, a number of potentially harmful outcomes can occur, including:

  • Damage to nearby teeth: Second molars (the teeth directly in front of the wisdom teeth) can be adversely affected by impacted wisdom teeth, resulting in tooth decay (cavities), periodontal disease (gum disease) and possible bone loss.
  • Disease: Although uncommon, cysts and tumors can occur in the areas surrounding impacted wisdom teeth.
  • Infection: Bacteria and food can become trapped under the gum tissue, resulting in an infection. The infection can cause considerable pain and danger.
  • Tooth Crowding: It has been theorized that impacted wisdom teeth can put pressure on other teeth and cause them to become misaligned (crowded or twisted). This theory isn’t universally accepted by all dental professionals, and it has never been validated by any scientific studies.

Wisdom Teeth Examination

As with any dental procedure, your dentist will want to initially conduct a thorough examination of the wisdom and surrounding teeth. Panoramic or digital x-rays will be taken in order for your dentist to evaluate the position of the wisdom teeth and determine if a current problem exists, or the likelihood of any potential future problems. The x-rays can also expose additional risk factors, such as deterioration or decay of nearby teeth. Early evaluation and treatment (typically in the mid-teen years) is recommended in order to identify potential problems and to improve the results for patients requiring wisdom teeth extractions. Only after a thorough examination can your dentist provide you with the best options for your particular case.

What does the removal of wisdom teeth involve?

Wisdom teeth removal is a common procedure, generally performed under local anesthesia, intravenous (IV) sedation, or general anesthesia by a specially trained dentist in an office surgery suite. The surgery does not require an overnight stay, and you will be released with post-operative instructions and medication (if necessary), to help manage any swelling or discomfort.

What You Can Do For A Tooth Abscess

Posted on: September 21st, 2011 by Nicholas Geller, DDS No Comments

Peer Reviewed By: Columbia University College of Dental Medicine

When the inside of your mouth gets hurt or irritated, bacteria may enter and cause an infection. Sometimes you will see a painful swelling filled with pus (a thick, yellowish fluid). If the pus can’t drain out, the area will get more swollen and painful. This is known as an abscess. The abscess forms a barrier around the infection. This is one way that your body tries to keep a bacterial infection from spreading.

Abscesses can form very quickly. Sometimes they form only one or two days after the infection starts. There are two types of abscesses:

  • A gum abscess (also called a periodontal abscess) usually is caused by an infection in the space between the tooth and gum. The infection may occur after food gets trapped between the gum and tooth. In people with severe periodontal disease, bacteria can build up under the gum and in the bone.
  • A tooth-related abscess (also called a periapical abscess) occurs inside the tooth. This happens when the tooth’s nerve is dead or dying. This type of abscess shows up at the tip of the tooth’s root. Then it spreads to the surrounding bone.

Most abscesses are painful, so people usually seek treatment right away. Sometimes, the infection causes little or no pain. If an abscess is not treated, the infection can last for months or even years. It will not go away on its own, so it’s important not to ignore the symptoms.

If the infection is not treated, it can damage the surrounding bone and teeth. A hollow tunnel sometimes forms through the bone and skin to allow pus to drain. This tunnel is called a fistula or “sinus tract.” You might see or feel this opening inside your mouth. It looks like a pimple. If you have pus draining through a fistula, you might notice a strange taste in your mouth.

The buildup of pressure causes the pain of an abscess. Draining the abscess through a fistula reduces the pressure. The pain will disappear. However, the infection still needs to be treated.

Sometimes, an abscess that isn’t treated can form a fluid-filled bubble (cyst) in the jaw-bone. If the tooth is severely broken down and can’t be saved, the cyst may come out when the tooth is extracted. If the tooth can be saved, you will need a root canal to remove the infected nerve. If this treatment does not heal the cyst, you may need surgery to remove it.

In rare cases, the infection that causes an abscess may spread and lead to serious health problems.

What You Can Do

Abscesses are always serious because the infection may spread to other parts of the body. Call Dr. Geller for an appointment.

If you can see or feel a pimple-like swelling on your gum, rinse your mouth several times a day with a mild salt-water solution. Use 1/2 teaspoon of salt in 8 ounces of water. This may help draw the pus out and relieve pressure. Even if the rinse seems to help, you still need to see Dr. Geller as soon as possible.

What Now Care Dental Will Do

Most gum abscesses will heal quickly after three things happen:

  • The area is cleaned thoroughly.
  • The trapped pus is allowed to escape.
  • The infection is treated.

If a fistula has formed, Dr. Geller will trace it back to the source of the infection. Dr. Geller will insert a flexible, thin piece of material into the fistula. This will appear on an X-ray and show Dr. Geller where the fistula leads. Once Dr. Geller cleans out the infection, the fistula usually will close on its own.

If the infection started inside a tooth, Dr. Geller will make a small hole in the tooth. This allows the abscess to drain. The tooth will need root canal treatment, followed by a filling or a crown.

If an abscess is very large or the tooth is badly damaged, you may need to have the tooth removed. A large abscess often will need to be drained. Dr. Geller makes a hole in the gum through the bone that provides an exit path for any fluid or pus. This will reduce the risk of further spread of the infection.

People with severe periodontal disease may have abscesses. Draining them helps the immediate problem. However, the periodontal disease needs to be treated to prevent another infection.

Dr. Geller may give you a prescription for antibiotics and painkillers. These drugs will help the abscess heal and keep the infection from spreading.