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.
Dr. Egolum is trained to administer (oral conscious) sedation, commonly referred to as “Sleep Dentistry.”
Sedation Dentistry Advantages to Patients
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.
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.
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 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
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.
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.
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:
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.
One or more of the following procedures might need to be performed in order to prepare your mouth for a denture:
We will review your particular needs with you during your appointment.
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.
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.
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.
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.’
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.
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.
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.
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.
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.
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.
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 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.
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.
In any case, you should avoid strenuous activities for two (2) days following surgery.
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.
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.
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.
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.
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:
● 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.
● 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.
● 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.
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.
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.
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.
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.