4175 N Hanson Ct, Ste #200, Bowie, MD 20716 301-383-9883

Oral Surgeon bowie, MD

ORAL SURGERY SEDATION | IV SEDATION

Several methods of anesthesia are available. The method of anesthesia that is chosen for or by a patient depends upon the nature of the surgical procedure and the patient’s level of apprehension.

To administer general anesthesia in the office, an oral surgeon must have completed at least five months of hospital based anesthesia training. Qualified applicants will then undergo an in office evaluation by a state dental board appointed examiner. The examiner inspects all monitoring devices and emergency equipment and tests the doctor and the surgical staff on anesthesia related emergencies. If the examiner reports successful completion of the evaluation process, the state dental board will issue the doctor a license to perform general anesthesia. The license is renewable every 5 years if the doctor maintains the required amount of continuing education hours related to anesthesia.

Again, when it comes to anesthesia, our first priority is the patient’s comfort and safety. If you have any concerns regarding the type of anesthesia that will be administered during your oral surgery procedure, please do not hesitate to discuss your concerns with your doctor at the time of your consultation.

ORAL SEDATION

Dr. Egolum is trained to administer (oral conscious) sedation, commonly referred to as “Sleep Dentistry.”

Sedation Dentistry Advantages to Patients

  • Treatment is completed when you are in a more relaxed mood.
  • You will have less difficulty sitting through a lengthy procedure.
  • Multiple treatments and full mouth restorations can occur at during the same visit.
  • Less discomfort after treatment.

Anti-Anxiety Pills

The most commonly prescribed dental related drugs that treat anxiety belong to the “benzodiazepine” family. Drugs such as Valium, Halcion, Xanax, or Ativan. These drugs decrease anxiety by binding and toning down activity within “fear” receptors in the brain.

INTRAVENOUS SEDATION (“TWILIGHT SEDATION”)

Our office offers our patients the option of Intravenous Sedation or Dental Intravenous Anesthesia or to some it is referred to as “Twilight Sedation” for their dental treatment. Intravenous Sedation or “twilight sleep” helps you to be comfortable and calm when undergoing dental procedures. Your treatment can be completed under intravenous sedation. Intravenous sedation or “IV sedation” (twilight sedation) is designed to better enable you to undergo your dental procedures while you are very relaxed; it will enable you to tolerate as well as not remember those procedures that may be very uncomfortable for you. IV sedation will essentially help alleviate the anxiety associated with your treatment. You may not always be asleep but you will be comfortable, calm and relaxed, drifting in and out of sleep – a “twilight sleep”.

If you choose the option of intravenous sedation your IV sedation/anesthesia is administered and monitored by the doctor therefore eliminating the costly expense of having your treatment carried out in an operating room or same day surgical facility.

HOW IS THE IV SEDATION ADMINISTERED?

A thin needle will be introduced into a vein in your arm or hand. The needle will be attached to an intravenous tube through which medication will be given to help you relax and feel comfortable. At times a patient’s vein may not be maintainable, in these situations the medications will be administered and the needle retrieved – both scenarios will achieve the same desired level of conscious sedation. Once again some patients may be asleep while others will slip in and out of sleep. Some patients with medical conditions and/or on specific drug regimens may only be lightly sedated and may not sleep at all.

The goal of IV sedation is to use as little medication as possible to get the treatment completed. It is very safe, much safer than oral sedation. With IV sedation a constant “drip” is maintained via the intravenous tube. At any time an antidote can be administered to reverse the effects of the medications if necessary. Along with IV sedation there are also other different “levels” of sedation available to you in our office. There is nitrous oxide analgesia.

NITROUS OXIDE (LAUGHING GAS)

Nitrous Oxide is a sweet smelling, non irritating, colorless gas which you can breathe. Nitrous Oxide has been the primary means of sedation in dentistry for many years. Nitrous oxide is safe; the patient receives 50-70% oxygen with no less than 30% nitrous oxide. Patients are able to breathe on their own and remain in control of all bodily functions. The patient may experience mild amnesia and may fall asleep not remembering all of what happened during their appointment.

There are many advantages to using Nitrous Oxide

  • The depth of sedation can be altered at any time to increase or decrease sedation.
  • There is no after effect such as a “hangover”.
  • Inhalation sedation is generally safe with no side effects on your heart and lungs, etc.
  • Inhalation sedation is very effective in minimizing gagging.
  • It works rapidly as it reaches the brain within 20 seconds. In as few as 2-3 minutes its relaxation and pain killing properties develop.

REASONS TO NOT USE NITROUS OXIDE

You should avoid using nitrous oxide if you are pregnant, have COPD, history of ear infection, emphysema, exotic chest problems, M.S., a cold or other difficulties with breathing. You may want to ask for a “5 minute trial” to see how you feel with this type of sedation method before proceeding.

Oral surgeon bowie, md

An impacted tooth simply means that it is “stuck” and cannot erupt into function. Patients frequently develop problems with impacted third molar (wisdom) teeth. These teeth get “stuck” in the back of the jaw and can develop painful infections among a host of other problems. Since there is rarely a functional need for wisdom teeth, they are usually extracted if they develop problems. The maxillary cuspid (upper eyetooth) is the second most common tooth to become impacted. The cuspid tooth is a critical tooth in the dental arch and plays an important role in your “bite”. The cuspid teeth are very strong biting teeth and have the longest roots of any human teeth. They are designed to be the first teeth that touch when your jaws close together so they guide the rest of the teeth into the proper bite.

Normally, the maxillary cuspid teeth are the last of the “front” teeth to erupt into place. They usually come into place around age 13 and cause any space left between the upper front teeth to close tighter together. If a cuspid tooth gets impacted, every effort is made to get it to erupt into its proper position in the dental arch. The techniques involved to aid eruption can be applied to any impacted tooth in the upper or lower jaw, but most commonly they are applied to the maxillary cuspid (upper eye) teeth. The impacted teeth are surgically exposed via an incision in the gums at which point the tooth is gently loosed and a bracket and chain attached to aid orthodontic eruption. Sixty percent of these impacted eyeteeth are located on the palatal (roof of the mouth) side of the dental arch. The remaining impacted eyeteeth are found in the middle of the supporting bone but stuck in an elevated position above the roots of the adjacent teeth or out to the facial side of the dental arch.

oral surgeon bowie, md

THE RESTORATIVE PROPERTIES OF STEM CELLS:

Stem cells are unique because they drive the natural healing process throughout your life. Stem cells are different from other cells in the body because they regenerate and produce specialized cell types. They heal and restore skin, bones, cartilage, muscles, nerves and other tissues when injured.

As a result, amazing new medical treatments are being developed to treat a range of diseases contemporary medicine currently deems difficult or impossible to treat. Among them are:

  • Parkinson’s Disease
  • Brain Injuries
  • Heart Disease
  • Diabetes
  • Arthritis
  • Muscular dystrophy
  • Leukemia
  • Crohn’s disease
  • Multiple Sclerosis
  • Periodontal Disease
  • Sports Injuries
  • Cosmetic and Anti-aging Applications

While stem cells can be found in most tissues of the body, they are usually buried deep, are few in number and are similar in appearance to surrounding cells. With the discovery of stem cells in teeth, an accessible and available source of stem cells has been identified.

  • The tooth is nature’s “safe” for these valuable stem cells, and there is an abundance of these cells in baby teeth, wisdom teeth and permanent teeth. The stem cells contained within teeth are capable of replicating themselves and can be readily recovered at the time of a planned dental procedure. Living stem cells found within extracted teeth were routinely discarded every day, but now, with the knowledge from recent medical research, your Doctor provides you the opportunity to save these cells for future use in developing medical treatments for your family.
  • Aside from being the most convenient stem cells to access, dental stem cells have significant medical benefits in the development of new medical therapies. Using one’s own stem cells for medical treatment means a much lower risk of rejection by the body and decreases the need for powerful drugs that weaken the immune system, both of which are negative but typical realities that come into play when tissues or cells from a donor are used to treat patients.
  • Further, the stem cells from teeth have been observed in research studies to be among the most powerful stem cells in the human body. Stem cells from teeth replicate at a faster rate and for a longer period of time than do stem cells harvested from other tissues of the body.
  • Stem cells in the human body age over time and their regenerative abilities slow down later in life. The earlier in life that your family’s stem cells are secured, the more valuable they will be when they are needed most.

STEM CELL RECOVERY AND CRYOPRESERVATION FROM TEETH ALSO HAS MANY ADVANTAGES:

  • Accessible – The stem cells contained within teeth are recovered at the time of a planned procedure: Extraction of wisdom teeth, baby teeth or other healthy permanent teeth.
  • Affordable – when compared with other methods of acquiring and preserving life saving stem cells: Peripheral blood, Bone Marrow, Cord blood etc, recovering Stem Cells from teeth is the most affordable and least invasive.
  • Convenience – the recovery of stem cells from teeth can be performed in the doctor’s office anytime when a healthy tooth is being extracted.
  • Ease of Use – The recovery of stem cells from teeth does not add any additional time on to a planned procedure. Your doctor does not require any additional equipment or training.

FREQUENTLY ASKED QUESTIONS ABOUT STEM CELL RECOVERY AND CRYOPRESERVATION FROM TEETH

WHY SHOULD SOMEONE RECOVER AND CRYOPRESERVE THEIR OWN STEM CELLS FROM TEETH?

  • Healthy dental pulp contains stem cells that are among the most powerful stem cells in the body and replicate at a faster rate and for a longer period of time than other types of stem cells.Stem cells from teeth show great promise for future regenerative medical treatments of neurodegenerative diseases, heart disease, diabetes, bone diseases and brain and nerve injuries.

WHICH TEETH ARE CANDIDATES FOR STEM CELL RECOVERY AND CRYOPRESERVATION?

  • Any extracted tooth with a healthy pulp contains stem cells. Wisdom teeth, baby teeth and other permanent teeth i.e. healthy teeth that are fractured and teeth recommended for extraction for orthodontic purposes are all candidates for stem cell recovery and cryopreservation.

AT WHAT AGE AM I NO LONGER ELIGIBLE TO RECOVER AND PRESERVE STEM CELLS FROM TEETH?

  • Age does not seem to play a major factor. All extracted healthy teeth contain stem cells. The younger you are then the younger the cells and these may be more beneficial in future regenerative therapies.

IS ONE TOOTH ENOUGH OR SHOULD I TRY TO BANK AS MANY TEETH AS I CAN AS THE OPPORTUNITIES ARISE. I BANKED DECIDUOUS TEETH, SHOULD I BANK THIRD MOLARS?

  • Diseases of different severity or tissue defects of different size will undoubtedly require
    different amounts of stem cells to heal. Conceptually, the more teeth are banked, the
    greater the potential for sufficient stem cells to treat various diseases.

oral surgeon bowie, md

  • Bone morphogenetic protein is an isolated protein that induces specific cells in our body to form new cartilage and bone. During surgery, the BMP is soaked onto and binds with a collagen sponge. The sponge is then designed to resorb, or disappear, over time. As the sponge dissolves, the bone morphogenetic protein stimulates the cells to produce new bone. The BMP also goes away once it has completed its task of jump starting the normal bone
    healing process.
  • Since there is no need to harvest bone from the patient’s hip for BMP, recipients are spared donor site pain. Complications from the graft harvest site are also eliminated with the use of bone morphogenetic protein.
  • Dr. Egolum would be happy to discuss all grafting options with you at the time of your consultation.

oral surgeon bowie, md

OBSTRUCTIVE SLEEP APNEA | SNORING

  • People with obstructive sleep apnea (OSA) have disrupted sleep and low blood oxygen levels. When obstructive sleep apnea occurs, the tongue is sucked against the back of the throat. This blocks the upper airway and airflow stops. When the oxygen level in the brain becomes low enough, the sleeper partially awakens, the obstruction in the throat clears, and the flow of air starts again, usually with a loud gasp.
  • Repeated cycles of decreased oxygenation lead to very serious cardiovascular problems. Additionally, these individuals suffer from excessive daytime sleepiness, depression, and loss of concentration.
  • Some patients have obstructions that are less severe called Upper Airway Resistance Syndrome (UARS). In either case, the individuals suffer many of the same symptoms.
  • The first step in treatment resides in recognition of the symptoms and seeking appropriate consultation. Oral and maxillofacial surgeons offer consultation and treatment options.
  • In addition to a detailed history, the doctors will assess the anatomic relationships in the maxillofacial region. With cephalometic (skull x-ray) analysis, the doctors can ascertain the level of obstruction. Sometimes a naso-pharyngeal exam is done with a flexible fiber-optic camera. To confirm the amount of cardiovascular compromise and decreased oxygenation levels, a sleep study may be recommended to monitor an individual overnight.
  • There are several treatment options available. An initial treatment may consist of using a nasal CPAP machine that delivers pressurized oxygen through a nasal mask to limit obstruction at night. One of the surgical options is an uvulo-palato-pharyngo-plasty (UPPP), which is performed in the back of the soft palate and throat. A similar procedure is sometimes done with the assistance of a laser and is called a laser assisted uvulo-palato-plasty (LAUPP). In other cases, a radio-frequency probe is utilized to tighten the soft palate. These procedures are usually performed under light IV sedation in the office.
  • In more complex cases, the bones of the upper and lower jaw may be repositioned to increase the size of the airway (orthognathic surgery). This procedure is done in the hospital under general anesthesia and requires a one to two day overnight stay in the hospital.
  • OSA is a very serious condition that needs careful attention and treatment. Most major medical plans offer coverage for diagnosis and treatment.

Oral surgeon bowie, md

  • The preparation of your mouth before the placement of a prosthesis is referred to as pre-prosthetic surgery.
  • Some patients require minor oral surgical procedures before receiving a partial or complete denture, in order to ensure the maximum level of comfort. A denture sits on the bone ridge, so it is very important that the bone is the proper shape and size. If a tooth needs to be extracted, the underlying bone might be left sharp and uneven. For the best fit of a denture, the bone might need to be smoothed out or reshaped. Occasionally, excess bone would need to be removed prior to denture insertion.

One or more of the following procedures might need to be performed in order to prepare your mouth for a denture:

  • Bone smoothing and reshaping
  • Removal of excess bone
  • Bone ridge reduction
  • Removal of excess gum tissue
  • Exposure of impacted teeth

We will review your particular needs with you during your appointment.

oral surgeon bowie, MD

Tooth extractions are routine dental procedures used to remove decayed, damaged or otherwise problematic teeth. Dentists usually make every effort to preserve natural teeth, although sometimes an extraction is necessary. Although the procedure is performed in a dentist’s or oral surgeon’s office, it is considered surgery. Depending on which teeth are removed, they may be replaced with a dental implant or another oral prosthetic.

There are several reasons why you could need a tooth extraction.

The most common cause of tooth extractions is severe tooth decay and cavities. However, many patients also undergo extractions for impacted teeth – particularly wisdom teeth. Other causes for extraction include advanced periodontal disease, cracked teeth, and teeth that are severely malformed. Although many circumstances that require extraction are unavoidable, some could be prevented with regular visits to the dentist for exams and cleanings.

Frequently Asked Questions

Do I need a tooth extraction?

Only your dentist can tell you if you need a tooth extraction. However, you may be a candidate for the procedure if one or more of your teeth are decayed so severely that a filling or others restoration is not a possibility for treatment.

What should I expect during my tooth extraction appointment?

If you and your dentist decide to extract one or more teeth, you will be scheduled to return for oral surgery at a later date. You will be given a local anesthetic to prevent pain during the procedure, and you may be prescribed medications to help manage pain in the hours following your extraction. Depending on the nature of your extraction and other factors, such as whether your teeth are impacted, you may also be sedated or given general anesthesia during your procedure.

What type of post-treatment care will I need to follow?

Post-operative care following a tooth extraction is essential for healing and preventing complications. You will be instructed to avoid certain foods and also keep the surgical site clean at all times. If you are prescribed an antibiotic, it is important that you complete the course of treatment to prevent infection. Finally, you may be advised to avoid smoking or drinking through a straw, as doing so may delay the healing process and cause a condition known as ‘dry socket.’

Oral surgeon bowie, MD

The removal of impacted teeth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and swelling as well as the risk of infection and other unwarranted outcomes can be minimized if the instructions are followed carefully.

IMMEDIATELY FOLLOWING SURGERY

  • The gauze pad placed under pressure over the surgical areas should be kept in place for a 30- 60 minutes. During this time talking should be minimized. After the recommended time, the gauze pad should be removed and discarded.
  • Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
  • Take the prescribed pain medications preemptively, ideally you should attempt to take the first dose with some food within 1 hr of leaving the office. This allows the medication adequate time to become effective prior to the wearing off of the local anesthetic.
  • Restrict your activities the day of and 24 hrs following surgery. You may resume normal activity when you feel comfortable.
  • Place ice packs to the sides (outside) of your face where surgery was performed. Refer to the section on Swelling for an explanation.

BLEEDING

A certain amount of bleeding is to be expected and anticipated following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first gently wiping any old clots from your mouth, then placing a moistened gauze pad over the area and biting firmly for 30 minutes. Repeat if necessary. If bleeding persists, bite on a moistened tea bag for 30 minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. 

To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call our office immediately for further instructions. Avoid the use of straws for 2 – 3 days after surgery.

SWELLING

The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the body’s normal reaction to surgery and is to be expected. The swelling will not become apparent until the day following surgery and will not reach its maximum until two to three days after surgery. However, the swelling may be minimized by the immediate use of ice packs following surgery. 

Ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake for the first 24 hours following surgery. After 24 hours, ice has little beneficial effect at this point you may switch to using a warm compress or warm wet rag against the face to further minimize swelling. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm, it is common for swelling to last up to 5 days following surgery. 

This is a normal reaction to surgery. However, please call us at 301-383-9883 if persistent swelling is associated with fever, severe pain or purulent discharge from the surgical wounds.

PAIN

Take your pain medications as directed. Some prescription pain medicines can cause drowsiness and slow your reflexes. For this reason, you should not drive a car or operate heavy machinery while you are taking these medications. You should also avoid combining alcoholic beverages with these medicines.

The pain medicine given to you by the doctor can be supplemented with over-the-counter medicines. Tylenol can be taken as directed by the instructions on the bottle. Up to four 200mg tablets of ibuprofen (Motrin, Advil) can be taken at one time as needed for pain, but should be taken (6) six hours apart.

Please be aware that the prescription given to you by your doctor may already contain Tylenol or ibuprofen. Taking additional medicine could cause an overdose. If there are any questions about your medications please call our office at (301) 383-9883.

Do not take any of the above medications if you have an allergy or have been instructed by your oral surgeon or your physician not to take it. If your pain medicine does not seem to be working please call the office. Pain or discomfort from the surgery should subside gradually however pain will normally peak at 48hrs – 72hrs after surgery. If severe pain persists beyond 72 hrs, it may require attention and you should notify our office immediately.

DIET

Soft non-chew foods and liquids are recommended after most oral surgical procedures. Do not use straws for up to 3 days following surgery. The sucking forces can cause more bleeding by dislodging the blood clot or potentially lead to a dry socket. You may eat anything soft by chewing away from the surgical site(s). High calorie, high protein intake is very important for a speedy recovery. Try to maintain as close to normal a caloric intake as possible. 

You should prevent dehydration by drinking fluids regularly. Your food intake will be limited for the first few days due to discomfort and lack of appetite. You should compensate for this by increasing your fluid intake. At least five to six glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort, and heal faster if you continue to eat regularly.

CAUTION: If you suddenly sit up or stand from a lying position, you may become dizzy. If you are lying down following surgery, make sure you sit for 30 seconds to one minute before standing.

KEEP THE MOUTH CLEAN

No rinsing or brushing of any kind should be performed until the day following surgery. The day after surgery you should begin rinsing gently at least 3 times a day with a cup of warm water mixed with a teaspoon of salt especially after eating. You should also begin brushing gently with a soft bristle brush, taking care to avoid contact with the surgical sites.

DISCOLORATION

In some cases, discoloration of the skin of the face follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal postoperative occurrence, which may occur two to three days after surgery and resolves over the next few days. Moist heat applied to the area may s peed up resolution of the discoloration.

ANTIBIOTICS

Antibiotics are not always required following surgery but rather they are prescribed only when deemed necessary by your doctor to treat or prevent infection. If you have been placed on antibiotics, take the tablets or liquid as directed to completion. Discontinue antibiotic use in the event of a rash or other unfavorable reaction and call the office immediately.

NAUSEA & VOMITING

In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including prescribed medications. You should then sip on coke, tea, or ginger ale. You should sip slowly over a 15-minute period. When the nausea subsides, you can begin taking solid foods and the prescribed medicines. In the rare event that nausea/vomiting persists, call our office immediately.

OTHER COMPLICATIONS

  • If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, this is usually temporary in nature. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. So be careful. Call the office if you have any questions.
  • A slight elevation of temperature immediately following surgery is not uncommon. If the elevated temperature persists longer than 48 hrs, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
  • You should be careful going from the lying down position to standing as you may feel light headed/dizzy. Before standing up, you should sit up for 30 secs to one minute.
  • Occasionally, patients may feel hard or sharp projections in the mouth with their tongue. They are usually not tooth or remnants of teeth; they are the usually the bony walls that supported the extracted tooth. These projections usually smooth out spontaneously as healing occurs. If they cause severe discomfort or ulceration they can be surgically removed by the doctor.
  • If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as Vaseline.
  • Sore throats and pain when swallowing are not uncommon as the muscles may become swollen. The normal act of swallowing can then become painful. This will usually subside in two to three days.
  • Stiffness (trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event that will resolve with time. You should perform jaw stretching exercises as well as apply heat to the face to help improve symptoms of stiffness in the jaw muscles.

FINALLY

  • Sutures are sometimes placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged. This is no cause for alarm. Just remove the suture from your mouth and discard it. The sutures will normally dissolve 7- 10 days after surgery unless otherwise specified by the doctor.
  • The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur, call the office for instructions.
  • There will be a cavity or hole where the tooth was removed. The cavity will gradually fill in with new tissue over the next month. In the meantime, the area should be kept clean especially after meals with salt-water rinses or medicated mouth rinse which is sometimes prescribed.
  • If you are given sinus precaution instructions please adhere strictly to them.
  • Your case is individual. No two mouths are alike. Do not accept well-intended advice from friends. Discuss your problem with the persons best able to effectively help you: your oral surgeon and staff.
  • Brushing your teeth is okay beginning the day after surgery just be gentle at the surgical sites.
  • A dry socket is when the blood clot gets dislodged prematurely from the extraction socket. A dry socket manifests as symptoms of severe, exacerbating pain at the surgical site and even pain radiating to the ear may occur usually starting three days following surgery. Call the office if this occurs.
  • If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you or in some cases induce bleeding at the surgical sites. If you feel light headed, stop exercising.

In any case, you should avoid strenuous activities for two (2) days following surgery.

SMOKING

Smoking not only disturbs and delays the normal wound healing but it also increases risk of excessive post surgical bleeding as well as infection hence should be avoided for 3-4 days after surgery.

Oral Surgeon Bowie, MD

Impacted Wisdom Teeth Bowie, MD

What Are Wisdom Teeth?

Third molars are commonly referred to as wisdom teeth. They are usually the last teeth to develop and are located in the back of your mouth, behind your second molars. Their development is usually completed between the middle teenage years and early twenties, a time traditionally associated with the onset of maturity and the attainment of wisdom.

What is an Impacted Tooth?

Although most people develop and grow 32 permanent adult teeth, many times their jaws are too small to accommodate the four wisdom teeth. When inadequate space prevents the teeth from erupting they are called impacted. This indicates their inability to erupt into the proper position for chewing and cleaning.

Types of Impactions

We will need to see you for a consultation to determine if you will benefit from wisdom tooth removal. A special x-ray of your mouth and jaws (panorex) will be taken to determine if your wisdom teeth are impacted, if there is room for them to erupt, and how difficult it will be to have them removed.

  • Soft Tissue Impaction: There is not enough room to allow the gum tissue to retract for adequate cleaning of the tooth.
  • Partial Bony Impaction: There is enough space to allow the wisdom tooth to partially erupt. However, the tooth cannot function properly in the chewing process, and creates cleaning problems, among others.
  • Complete Bony Impaction: There is NO space for the tooth to erupt, usually because the jaw is too small or the teeth are toot large in size. It remains embedded in the jaw bone or if even partially visible requires complex surgical techniques for removal. The impacted wisdom tooth may also be in an unusual position and difficult to remove.

Oral Surgeon Bowie, MD

  • With an oral examination and x-rays of the mouth, Dr. Egolum can evaluate the position of the wisdom teeth and predict if there are present or future potential problems. Studies have shown that early evaluation and treatment result in a superior outcome for the patient. Patients are generally first evaluated in the mid-teenage years by their dentist, orthodontist, or by an oral surgeon.
  • All outpatient surgery is performed under appropriate anesthesia to maximize patient comfort. Our doctors are trained, licensed, and highly experienced in providing various types of anesthesia for patients.
  • To schedule a consultation for your wisdom teeth evaluation please call our office.

WHY SHOULD I HAVE MY WISDOM TEETH REMOVED?

Not all wisdom teeth require removal. If you do not have enough room in your mouth for your third molars (wisdom teeth) to fully erupt, a number of problems can occur. Impacted wisdom teeth should be removed before their root structure is fully developed. In some patients it is as early as age 12 or 13, and in others it may not be until the early twenties. Problems tend to occur with increasing frequency after the age of 30. Some of the possible problems related to not removing your wisdom teeth include:

Infection:

● The most frequent clinical problem we see is pericoronitis, (a localized gum infection). Without enough room for total eruption, the gum tissue around the wisdom tooth can become irritated and infected, resulting in recurrent pain, swelling, and problems with chewing and/or swallowing.

Cyst Formation:

● Non-infectious diseases may also arise in association with an impacted wisdom tooth. Cysts are fluid-filled “balloons” inside the jawbone that develop as a result of impacted teeth and slowly expand destroying adjacent jawbone and occasionally teeth. They can be very difficult to treat if your wisdom teeth are not removed in your teenage years. Although rare, tumors can be associated with the delayed removal of wisdom teeth.

Possible Crowding:

● Impacted wisdom teeth may contribute to crowding of your teeth. This is most noticeable with the front teeth, primarily the lower front teeth and is most commonly seen after a patient has had braces. There are a number of factors that cause teeth to crowd after braces or in early adulthood. Retained, impacted wisdom teeth may be a contributing factor. Unless you have an active problem when you see the oral surgeon, the reason for removal is primarily to prevent long-term damage to your teeth, gums and jawbone.

Damage to Adjacent Teeth:

● If there is inadequate room to clean around the wisdom tooth, the tooth directly in front, the second molar, can be adversely affected resulting in gum disease, bone loss around the tooth, and/or decay.

WHAT IF I DON’T HAVE MY WISDOM TEETH REMOVED AS A TEENAGER OR YOUNG ADULT?

As wisdom teeth develop, the roots become longer and the jawbone more dense.When it is necessary to remove impacted wisdom teeth in your thirties, forties or beyond, the post-operative course can be prolonged and there is a higher complication rate. Treating these complications is often more difficult and less predictable than with a younger patient. Healing may be slower and the chance of infection can be increased. If your impacted wisdom teeth are not removed in your teenage years or early in your twenties and they are completely impacted in bone, it may be advisable to not have them removed unless a localized problem (such as cyst formation or localized gum disease and bone loss) develops due to high risk of complications at this point. In general, you will heal faster, more predictably and have fewer complications if treated in your teens or early twenties.

WHAT HAPPENS ON THE DAY WISDOM TEETH ARE REMOVED?

Most people prefer to be unaware of the experience when they have their wisdom teeth removed and usually decide to be sedated. You will be provided with appropriate anesthesia options at your consultation. All outpatient surgery is performed under appropriate anesthesia to maximize your comfort. Our office staff has the training, licensing, and experience to provide the various types of anesthesia. These services are provided in an environment of optimum safety, utilizing modern monitoring equipment and a well trained experienced staff. The Surgical Care Team, the office facilities, and the doctors are inspected on behalf of the Board of Dental Examiners on a regular basis.

On the day of your procedure, you will take medications to help minimize post-operative pain and swelling. We ask that a parent (for those under the age of 18) or responsible adult accompanies you to the office and plans to stay with you the rest of the day. The procedure will take about 30 to 45 minutes and you will probably be in the office for 1 hour. Recent advances in medicine and technology allow patients to undergo wisdom tooth removal in a manner, which promotes rapid healing and minimal post-operative discomfort. State of the art sterilization and infection control techniques are used at all times in our office.

On the morning or afternoon of your surgery, it is essential that you have nothing to eat or drink (excluding prescription medications with a sip of water) for at least 8 hours. This does not mean you should try to fit in one “last meal” exactly eight hours before your surgery. Having anything in your stomach can increase the risk for serious anesthetic complications, including nausea and vomiting. Your procedure will be rescheduled if you have not heeded these guidelines. We may provide you with a prescription for pain medication at your consultation appointment, which for your convenience, can be filled in advance. When you are seated in the surgical room, we will make every effort to make you as comfortable as possible. If you are going to be sedated, we usually will place an IV in your right or left arm. This is a quick and nearly painless procedure that ensures optimal delivery of your medication. Local anesthesia is given to you afterwards to ensure comfort, and allow adequate time to travel home and rest. You will be sleepy for a significant portion of the day.

The Day of Treatment

Be sure to have an adult with you at the time of surgery. Make plans to have a parent or responsible adult stay with you for the rest of the day, following wisdom tooth removal.

If your surgery requires stitches, these are usually the type that dissolve in 5 to 10 days and do not require removal. You may also notice a sensation of your gums feeling swollen and pulling away from your teeth. This is all part of the normal recovery, and will subside in several days.

Once the local anesthesia wears off, you may require prescription pain medication. Please try non-narcotic anti-inflammatory medications such as ibuprofen (Advil®) first, to see if that adequately treats your pain. If not, begin your other prescription pain medication. The local anesthesia may last until the following day, and should not be confused with an injury to your nerve. We recommend starting your post-operative diet with clear liquids such as jello and broths, gradually increasing in substance as your body permits.

We do not recommend using dairy products such as yogurt, ice cream or milkshakes on the day of surgery, as nausea and vomiting may develop in conjunction with the anesthetic and pain medication. If you are given antibiotics and you take birth control pills, please be aware that the birth control pills might become ineffective and take appropriate precautions.

WHAT DOES WISDOM TOOTH REMOVAL COST AND IS IT COVERED BY INSURANCE?

The fee for your treatment is determined by a number of factors. These may include the difficulty involved in removing your teeth and which type of anesthesia is best for you. During your consultation appointment, the surgeon will need to review your x-rays, complete an examination and determine the best option for anesthesia, before an accurate estimate can be provided. Every insurance company has a different policy regarding the extent of coverage for a given surgical procedure. Our office staff will assist you in obtaining the maximum insurance coverage for your treatment.

WHAT IF I HAVE QUESTIONS BEFORE SURGERY?

At the time of your consultation, your specific situation will be discussed in greater detail. We encourage you to ask any questions you may have at this time. If new questions arise after your consultation, please call our office to speak to one of our patient care coordinators.

The Day of Treatment

Please do not eat or drink anything prior to your surgery. Having anything in your stomach can increase the risk for serious anesthetic complications.