• Periodontal (gum) disease can destroy the bone and tissues surrounding the teeth, and in advanced cases, these teeth need to be extracted.
• Some people have extra teeth that block other teeth from coming in.
• People getting braces may need teeth extracted to create room for the teeth that are being moved into place.
• People receiving radiation to the head and neck may need to have teeth in the field of radiation extracted.
• People receiving cancer drugs may develop infected teeth. These drugs weaken the immune system, increasing the risk of infection. Infected teeth may need to be extracted.
• People receiving an organ transplant may need some teeth extracted if the teeth could become sources of infection after the transplant. People with organ transplants have a high risk of infection because they must take drugs that decrease or suppress the immune system.
• Wisdom teeth, also called third molars, are often extracted either before or after they come in. They commonly come in during the late teens or early 20s. These teeth often get stuck in the jaw (impacted) and do not come in. They need to be removed if they are decayed or cause pain. Some wisdom teeth are blocked by other teeth or may not have enough room to come in completely. This can irritate the gum, causing pain and swelling. In this case, the tooth must be removed.

We will ask you about your medical and dental histories and then take an X-ray of the area to help plan the best way to remove the tooth.

If you are having your wisdom teeth removed by an oral surgeon, we will have a panoramic X-ray taken. This X-ray shows all of your teeth and surrounding anatomy at once. It can show several things that help to guide an extraction:

• The relationship of your wisdom teeth to your other teeth
• The upper teeth's relationship to your sinuses
• The lower teeth's relationship to a nerve in the jawbone that gives feeling to your lower jaw, lower teeth, lower lip and chin. This nerve is called the inferior alveolar nerve.
• Any infections, tumors or bone disease that may be present

• You have infection at the time of surgery
• You have a weakened immune system
• You will have a long or complicated surgery
• You have specific medical condition(s)

There are two types of extractions:

• A simple extraction is performed on a tooth that can be seen in the mouth. Dr. Heubner routinely does simple extractions. Most of these can be done using just an injection (a local anesthetic), with or without anti-anxiety drugs. In a simple extraction, Dr. Heubner will use a series of instruments called elevators, which fit between the tooth and gums, to loosen the tooth. Then, he will grasp the tooth with a forceps and gently move it back and forth until it is removed from the socket.
• A surgical extraction involves teeth that cannot be seen easily in the mouth. They may have broken off at the gum line or they may not have come in yet. To see and remove the tooth, Dr. Heubner must cut and pull back the gums. Pulling back the gum "flap" provides access to remove bone and/or a piece of the tooth. When this is done, it is much easier to remove the entire tooth.

Some surgical extractions, due to their complexity, are done by an oral surgeon. Dr. Heubner, however, has had advanced training in oral surgery and can perform routine surgery. Patients with special medical conditions and young children may be sent to an oral surgeon to be given general anesthesia.

If you need all four wisdom teeth removed, they are usually taken out at the same time by an oral surgeon. The top teeth are usually easier to remove than the lower ones.

Here are the types of wisdom teeth, in order from easiest to remove to most complex to remove:

• Erupted (already in the mouth)
• Soft-tissue impacted (just under the gum)
• Partial-bony impacted (partially stuck in the jaw)
• Full-bony impacted (completely stuck in the jaw)

Also, if your wisdom teeth are tilted sideways, they can be harder to remove than if they are vertical.

Most simple extractions do not cause much discomfort after the procedure. You may take an over-the-counter nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (e.g., Advil, Motrin or other brand names) for several days. However, you may not need any pain medicine at all.

Because surgical extractions are more complicated, they generally cause more pain after the procedure. The level of discomfort and how long it lasts will depend on the difficulty of the extraction. Dr. Heubner or the oral surgeon may prescribe pain medicine for a few days, and then suggest an NSAID. Most pain disappears after a couple of days.

A cut in the mouth tends to bleed more than a cut on the skin because it cannot dry out and form a scab. After an extraction, you will be asked to bite on a piece of gauze for about 30 minutes. This will put pressure on the area and allow the blood to clot. It still may bleed a small amount for the next 24 hours or so and then taper off after that. Do not disturb the clot that forms on the wound.

You can put ice packs on your face to reduce swelling after any oral surgery is performed. If your jaw is sore and stiff after the swelling goes away, try warm compresses. Eat soft and cool foods for a few days. Then try other foods as you feel comfortable. A gentle rinse with warm salt water, started 24 hours after the surgery, can help to keep the area clean. Use one-half teaspoon of salt in a cup of water. Most of the swelling and bleeding will end within a day or two after surgery. Initial healing takes at least two weeks.

If you need stitches, they usually disappear (dissolve) on their own within one to two weeks. Rinsing with warm salt water will help the stitches to dissolve. Some stitches need to be removed by Dr. Heubner or the oral surgeon.

You should not smoke, use a straw or spit after surgery. These actions can pull the blood clot out of the hole where the tooth was. That causes more bleeding and can lead to a dry socket, which is a painful condition. Dry sockets occur 3% to 4 % of the time after simple extractions and 20% to 30% of the time after impacted wisdom are removed. It happens more often in smokers and women who take birth control pills. It is also more likely after difficult extractions.

Infection can set in after an extraction, although you probably will not get an infection if you have a healthy immune system.

A common complication called a dry socket occurs when a blood clot does not form in the hole or the blood clot breaks off or breaks down too early. In a dry socket, the underlying bone is exposed to air and food. This can be very painful and can cause a bad odor or taste. A dry socket needs to be treated with a medicated dressing to stop the pain and encourage the area to heal.

Other potential problems include:

• Accidental damage to teeth near the surgical site, such as fracture of fillings or teeth
• An incomplete extraction, in which a tooth root remains in the jaw – we will usually remove the root to prevent infection, but occasionally it is less risky to leave a small root tip in place.
• A fractured jaw caused by the pressure put on the jaw during extraction – this is very rare and occurs mostly in older people with osteoporosis (thinning) of the jaw.
• A hole in the sinus during removal of an upper back tooth (molar) – a small hole usually will close up by itself in a few weeks. If not, more surgery may be required.
• Soreness in the jaw muscles and/or jaw joint – it may be tough for you to open your mouth wide. This can happen because of the injections, keeping your mouth open and/or lots of pushing on your jaw.
• Long-lasting numbness in the lower lip and chin – this is caused by injury (trauma) to the inferior alveolar nerve during removal of the lower molar teeth, especially the wisdom teeth. Complete healing of the nerve may take three to six months. In rare cases, the numbness may be permanent.

Call our office or the oral surgeon who performed the surgery if the swelling gets worse instead of better. Also, call if you have fever, chills, redness, trouble swallowing or uncontrolled bleeding in the area. If you have an infection, we will usually prescribe antibiotics. If your tongue, chin or lip still feels numb after healing is complete, call our office.

Finally, call our office or the oral surgeon if the area of the extraction site becomes very painful 2 to 3 days after the procedure. This is a sign that you may have a dry socket. If the area continues to bleed after the first 24 hours, you will also want to notify us or your oral surgeon.