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Nasser Antonious, DDS, MAGD, FICOI
Master of the Academy of General Dentistry
Fellow of the International Congress of Oral Implantologists

Oral Surgery-Sunnyvale Dental Care
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Oral Surgery





Oral Surgery

Q: What are impacted teeth?
A: The teeth that most commonly become impacted are the third molars, also called wisdom teeth. These large teeth are the last to develop, beginning to form when a person is about nine years old, but not breaking through the gum tissue until the late teens or early twenties. By this time, the jaws have stopped growing and may be too small to accommodate these four additional teeth. As the wisdom teeth continue to move, one or more may become impacted, either by running into the teeth next to them or becoming blocked within the jawbone or gum tissue.

Q: What are extra Wisdom teeth?
A: Extra wisdom teeth are often smaller than normal third molars and may be misshapen and poorly aligned. They are present at the time the original wisdom teeth are removed, but may not be easily accessible. So the dentist may wait until the extra teeth move into position before deciding to remove them.

Q: What is a panoramic x-ray?
A: A Panorex image is an X-ray that depicts a panoramic view of your mouth, from one side to the other. This image can help the dentist understand the relationship between your teeth, jaws, and occlusion (bite, or how your top and bottom teeth fit together). A panoramic radiograph is necessary for wisdom teeth extraction surgery.

Q: What is Nitrous Oxide (laughing gas)?
A: In one form of conscious inhalation sedation, nitrous oxide gas (laughing gas) is used to induce a state of relaxation. A local anesthetic will be administered in combination with nitrous oxide sedation to eliminate pain. An escort after nitrous oxide sedation is recommended but not required.

Q: I do not feel any pain or suffering from any problems. Can we leave it alone?
A: Impacted wisdom teeth can be predictably removed with no discomfort. Our concern is that, on a regular basis, we do see the condition of the good tooth in front of an impacted wisdom tooth deteriorate due to the position of the wisdom tooth. If the wisdom tooth is deeply embedded, it may be possible to leave it and review with radiographs regularly. Occasionally, an asymptomatic deeply embedded wisdom tooth may turn into a cyst. That will require a bigger surgery to remove the tooth.

It is very common to see an impacted wisdom tooth with no significant symptoms. It is impossible to predict when an impacted tooth may flare up and cause trouble. It is likely that it will cause trouble some point.

When it becomes symptomatic, the treatment will be more complicated. There are times that your medical condition may complicate treatment too. For example, a normal course of pregnancy will make caring for an infected wisdom tooth more problematic.

Q: I am in my late 20s and have yet to extract my wisdom teeth, which have all grown. I would like to know if extraction of wisdom teeth is necessary? I do not face any problems, but there are times where I feel that the wisdom teeth are shifting and affecting the neighboring teeth. What should I do?
A: The first step is to visit a dentist for a dental X-ray and thorough examination. Dr Antonious will then be able to advise whether the wisdom teeth need to be removed. The risks and benefits of wisdom teeth removal will be explained and discussed. Current scientific research tells us that there is no correlation between wisdom teeth and crowding of the teeth in front of them. There is a natural tendency for teeth to crowd toward the front with time. It happens with age, as a result of jaw growth rotations and soft tissue pressures, as well as forward-directed chewing forces, and not because of the presence of wisdom teeth.

Q:When should I have the impacted tooth removed?
A: Experts recommend wisdom teeth to be removed during teenage years or in the early 20s. People in this age group recover faster. You will never miss those problematic wisdom teeth!

There are other food reasons for removing wisdom teeth. Impacted wisdom teeth can become food traps and result in bone and gum impactions and dental decay. These can also affect the good molar neighboring the wisdom teeth. Some wisdom teeth are also non-functional, i. e. they do not bite properly. Thus, removing them will not affect your chewing abilities at all.

It is generally recommended that you remove wisdom teeth when they are impacted or are difficult to clean and maintain, before problems set in. Dr Antonious has seen many situations where the molars in front of the wisdom teeth (that were not taken out on time) were affected and required expensive and difficult treatments.

Q:Why do I need to come back for a re-consultation before surgery?
A: If Dr Antonious has requested to see you again for a consultation before your surgery, it is usually because there has been a significant period of time between your initial consult and the time which you wish to schedule surgery. In some cases there may be circumstances (shifted teeth, etc.) that may affect the surgical procedure. It is imperative that Dr Antonious knows the exact position of the tooth and the surrounding structures before the start of the surgical procedure.

Q:How long does the procedure take?
A: Most of our procedures last anywhere from 1-2 hours.

Q: What is the typical recovery time?
A: Normally you will be able to return to school/work 48 hours after your surgery, as long as you have not experienced any complications. In fact, you can even return to taking part in athletic activities within 7-14 days.

Q:Will I have stitches?
A: In most cases, our patients do have stitches after their surgery. Dr Antonious often uses absorbable stitches that will dissolve on their own. Occasionally Non-absorbable types of stitches are used. Dr Antonious will remove these stitches for you at the time of your follow-up appointment.

Q: What will I be able to eat?
A: For about two (2) to seven (7) days following extraction, we recommend liquids and soft foods only. This might include yogurt, soup, applesauce, oatmeal, pudding, etc. You may gradually start on a normal diet when you feel that your surgical area is healed enough to handle the type of food being consumed. Immediately following the surgery if your lip or tongue is numb, do not try to chew, you may bite yourself and not know it.

Q: Will I be able to chew after my wisdom teeth are out?
A: Modern human beings retain most of our teeth. As a result, wisdom teeth are usually non-functional. You will not suffering from lack of chewing ability because of wisdom teeth removal.

Q: If I'm not in pain, why do I need to come in for a follow-up?
A: We don't expect our patients to have complications after an oral surgery procedure; however, a follow-up visit will ensure that healing is proceeding in the right direction. Also, if you have any stitches this would be the time to remove them.

Q:What are some typical complications to watch for?
A: There are two relatively minor complications to watch for. First, some patients experience what's known as 'dry socket' in the area of the extraction. Dry socket is characterized by a dull to severe throbbing pain in the socket area, radiating toward the entire jaw, ear, and/or neck region. Advil or other over the counter analgesics will not relieve the pain. In such cases, we urge you to call our office for a no-charge visit, so that we can pack the socket with a special medication. This provides immediate pain relief. We will need to see you again 2-3 days after to remove the dry socket dressing and see how you're healing. The second potential complication is abnormal bleeding. You will be given some gauze to bite down on. Drugstores also sell these gauzes. It is normal for there to be oozing from the wounds for up to 24 hours. If in doubt please call the office for help. After hours, feel free to call our 24 hour answering service. Due to the location of the wisdom teeth, a rare complication is numbness of the tongue, lip or chin. This happens very rarely and when it does, it is usually temporary. Dr Antonious always does his best to perform procedures in a safe manner.

Q:What is a dry socket?
A: A dry socket can occur when the blood clot at the extraction site is lost prematurely. This causes the bone to become exposed and can be very painful. If you are experiencing any pain, please call us for an appointment so we can treat it as soon as possible. It is very important to not rinse your mouth for 48 hours and to use the gauze as instructed. Smokers have a significantly higher incidence of dry sockets than non-smokers.

Q:What should I do after my oral surgery (e.g. dental extraction or implant surgery)?
A: Right after the procedure, bite down on a gauze over the surgical site for one hour. Even though the bleeding has stopped when you are discharged, it is normal to taste blood.

Do not spit out or rinse your mouth for 24 hours. Rinsing and spitting may dislodge the blood clot and bleeding may start again.

The surgical site usually stays numb for approximately two hours. Food and hot drinks should not be consumed until the sensation has recovered. After that, eat a soft to liquid diet chewing away from the surgical site. It is crucial to take all the medication as prescribed and keep your follow-up appointment to ensure uneventful healing.

You may contact our office during office hours or contact our answering service office after office hours.

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Nasser Antonious DDS is licensed as a general dentist in California. Sunnyvale Dental Care established since 1995
Sunnyvale dentist, Nasser Antonious DDS welcomes new patients from all areas including Sunnyvale, Mountain View, Santa Clara, Cupertino, Campbell, San Jose, Saratoga, Los Altos, and Los Gatos
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