Oral surgery

Oral surgery covers the procedures in the mouth that go beyond an ordinary filling or extraction: teeth that need to be removed surgically, wisdom teeth, rebuilding bone before implants, and removing cysts from the jaw. Most of it is done under local anaesthesia, with sedation available for longer procedures or anxious patients.

Who it’s for

• Surgical extractions for teeth that are broken at the gum line, have curved roots or can’t be removed in one piece.
• Wisdom teeth that are impacted, keep getting infected, decay or press on the tooth in front. A wisdom tooth that causes no harm and can be cleaned can stay.
• Bone grafts where bone has shrunk after tooth loss and an implant is planned.
• Sinus lift in the upper back jaw, where the sinus sits too close to the bone ridge for an implant.
• Cysts, fluid-filled sacs in the jaw that often show up on a routine X-ray and can slowly destroy bone if left.

How it’s done

Every case starts with an examination and panoramic X-ray at the clinic, both free. For lower wisdom teeth close to the nerve, and for grafts and sinus lifts, a 3D scan (CBCT) may be needed for planning.

For a surgical extraction the gum is opened, a little bone is removed if needed, and the tooth may be divided so it comes out in pieces with less force. The wound is closed with stitches. A bone graft uses graft material placed where the bone is missing, often covered with a membrane, and is left to heal for several months before an implant is placed, or sometimes placed at the same time as the implant. In a sinus lift, the membrane lining the sinus is gently raised and graft material placed beneath it. A cyst is removed completely and the cavity is cleaned; the tissue may be sent to a laboratory for examination.

Before you travel

Send a panoramic X-ray and a list of your medicines. Blood thinners, bone medicines such as bisphosphonates, diabetes and heart conditions all affect planning; don’t stop any medicine without talking to us and your doctor. If you have sedation, someone needs to take you back to your hotel and stay with you for the rest of the day. Leave enough days before your flight; after a sinus lift that means more than after a simple extraction.

Afterwards

Bite on the gauze for 30 to 60 minutes. For the first 24 hours don’t rinse, spit hard, drink through a straw, smoke or drink alcohol, as these can dislodge the blood clot. Use a cold pack on the cheek, eat soft, lukewarm food and sleep with your head raised. Swelling peaks on day two or three. For two weeks after a sinus lift, don’t blow your nose, and sneeze with your mouth open. Stitches dissolve or are removed after about a week.

Risks and alternatives

Possible complications include bleeding, infection, dry socket and swelling that limits mouth opening for a few days. Removing lower wisdom teeth carries a small risk of numbness in the lip, chin or tongue, usually temporary and rarely permanent, which is why the position of the nerve is checked first. A sinus lift can tear the sinus lining or lead to sinus infection. Bone grafts don’t always take fully.

Alternatives depend on the problem: monitoring a wisdom tooth with X-rays rather than removing it, root canal treatment to keep a tooth instead of extracting it, or a shorter or angled implant, or All-on-4, to avoid a graft.