Texas Oral Surgery Group

Patient Tips for Managing Oral Surgery During the Holidays

Oral Surgery Recovery North TXThe holidays are traditionally a time when we surround ourselves with family and friends, make that long trip to visit Grandma, or ring in the New Year shoulder-to-shoulder with fellow revelers – but nothing has been traditional about 2020. While no one wants to spend their holidays undergoing and recovering from oral surgery, if it needs be done, the holiday season is a good time to do it.

We know that oral surgery isn’t exactly festive but making a few adjustments beforehand can mean the difference between resting comfortably and the alternative. Put the tips below on your list, be sure to check it twice, and you’ll be on your way to a successful recovery:

Share the cookies and eggnog with Santa. Eating might be the last thing on your mind as you head into surgery but your post-operative diet plays an important role in recovery. Restrictions vary depending on the procedure, but plan on advancing your diet back to normal as soon as possible after surgery. Your jaw muscles are used to talking and eating every day.  It is best to avoid long periods of time without using those muscles as they will tend to stiffen, cramp, and become very sore.  It’s best to avoid spicy or acidic foods, such as tomato-based sauces and orange juice, which can cause burning or pain if ingested too soon after oral surgery. Hydration also plays an important role in recovery. Though seasonal spirits might be on your mind, we -urge you to use caution when consuming alcohol if you are taking narcotics or acetaminophen (Tylenol).

Rest & Recovery is the new Holly & Jolly. While you won’t be out caroling, you can make the most of this mandatory downtime by planning ahead. Cue up movies or TV shows you’ve been meaning to watch, grab some good books and get ready for a few days of sedentary entertainment – doctors’ orders! While we encourage a quick return to normal, it is extremely important to manage your pain properly in the first 48-72 hours following oral surgery.  Proper pain management often requires taking medicines that make you drowsy.  Thus, it is best to have some easy at-home entertainment ready to go.  To help minimize swelling, it’s important to keep your head elevated, so keep pillows and blankets within arm’s reach of your couch, recliner, or bed. Whether it is the TV room, bedroom, or den, preparing your rest and recovery area before surgery will help you avoid last-minute scrambling, making for an easy transition home.

Don’t wait until the ball drops to get ahead of pain and infection. The amount of pain after oral surgery varies depending on the extent of the procedure and the patient’s individual health history. Drs. Stewart and Michael will prescribe any necessary medication to prevent infection and/or manage pain. Before surgery, and again upon discharge, you will receive detailed postoperative care instructions and schedule a follow-up appointment if needed. To ensure a smooth recovery, it’s essential that you follow these instructions and keep your post-op appointment if applicable. If you experience any recovery related problems or have questions, don’t hesitate to contact our office.

Texas Oral Surgery Group has served the greater Dallas/Fort Worth community for over three decades and Drs. Stewart and Michael have over 50 years of combined experience. Our entire surgical team at Texas Oral Surgery Group is Dental Anesthesia Assistant National Certification Examination (DAANCE) certified, which is the highest level of certification granted by the American Association of Oral and Maxillofacial Surgeons (AAOMS). If oral surgery is on your list this holiday season, you can rest assured that you’ve made the right choice for your oral and maxillofacial needs.

We pride ourselves on delivering the best patient experience possible. From your first call and consultation with Drs. Stewart and Michael through the entire treatment process, our team is dedicated to providing quality patient care.  If you have questions, please don’t hesitate to reach out to any of our locations (Denton, Plano, Decatur, Gainesville ).

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The Most Wonderful Time of the Year

It’s the most wonderful time of the year…for wisdom teeth removal? While we generally don’t associate the holidays with oral surgery, if you could choose a good time to have your wisdom teeth removed, the holiday season would be among the best.

How do you know if you need your wisdom teeth removed?

While not everyone needs to have their wisdom teeth removed, the vast majority of us do because we simply don’t have space by the time these molars arrive. Wisdom teeth are the third set of molars that erupt in the late teen years to early 20s after the rest of our teeth have come in. Although, some people will develop these teeth much earlier! As a result, they become impacted (unable to erupt normally) in bone or gum tissue, causing crowding among your current teeth, which can lead to severe jaw pain, infection, and damage to adjacent teeth. For specific information on the types of impactions, visit our page dedicated to wisdom teeth.

Each patient is unique, and there is never a one-size-fits-all approach when it comes to oral surgery. However, the timing for wisdom teeth removal is usually based on three factors – patient age, root formation, and tooth position.

As far as a patient’s age goes, the younger, the better, as younger patients typically do better with surgical procedures and have fewer overall complications. The older the patient, the longer their recovery period will be from a wisdom tooth extraction, which is why most patients opt to get their wisdom teeth removed as early as possible.

Age is also related to root formation. In young adults, the root system of wisdom teeth is softer and not fully developed. As a result, the extraction process is typically much easier and less complex during this time. As time progresses, wisdom teeth develop hard, dense root systems that are integrated more solidly with the jaw bone, making extractions in later adulthood much more difficult.

Position of the teeth is another determining factor when deciding on wisdom teeth removal. Wisdom teeth are frequently misaligned and may position themselves horizontally, be angled toward or away from the second molars, or be angled inward or outward. This increases risk, as poor alignment of wisdom teeth can crowd or damage adjacent teeth, the jawbone, or nerves.

It’s important to note that even if you are not currently experiencing discomfort, you may still require extraction, as some patients show no symptoms at all. To determine the position of the wisdom teeth and see if there are present or potential problems, patients should undergo an oral exam and x-rays of the mouth. For a complete evaluation, we encourage you to contact one of our four practice locations (Denton, Plano, Decatur, Gainesville ).

Why the holiday season?

For non-emergency cases where patients have the ability to schedule wisdom teeth extraction in advance, the winter holidays are a convenient time to have it done. The thought of winter break probably doesn’t bring images of a dental chair to mind, but you might think differently after reviewing the following reasons:


  • Recovery Time – Healing from oral surgery takes time. Typically, we recommend taking a few days off from work or school to rest after your wisdom teeth are removed. Given that we tend to have lighter schedules over the holidays, it’s generally one of the best times to be out of the office (and there’s no school to miss).
  • Pain Management – Many patients are able to control pain after extraction with over-the-counter medications. However, some require prescription pain medications that can cause nausea and / or interfere with their ability to focus and stay awake. With a more casual holiday schedule, patients are better able to rest comfortably, with or without prescription medications, as there isn’t the usual rush to get back on schedule.
  • Insurance Benefits – At the end of the year, many dental benefits expire on families’ insurance plans. If you or your family has a Flexible Savings Account (FSA), you’ve likely allotted a certain amount of money for dental procedures. These funds usually expire and restart at the beginning of the new year. Scheduling your wisdom teeth extraction during the winter holidays is the perfect way to take advantage of these benefits before they expire.


We understand that no one wants to spend their holidays undergoing and recovering from oral surgery, but if it has to be done the end of the year is a good time to do it. We recommend taking a few days off from work or school to rest after your wisdom teeth are removed and the holidays provide some built-in  down-time. We suggest getting this taken care of, so you can put wisdom teeth and 2020 behind you for good. Contact any of our four locations (Denton, Plano, Decatur, Gainesville ) to schedule a consultation today, but hurry because we’ll be singing Auld Lang Syne before you know it!

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Can Socket Preservation Save My Smile?

Socket Preservation North Central, TXRemember how exciting it was to have a loose tooth as a child? The impending visit from the Tooth Fairy, showing off that new grin to your friends, watching as a new tooth grew! Adults? Not so much. The Tooth Fairy has a reputation for neglecting her older clients, our colleagues most certainly will not be impressed with a gap-toothed smile, and, to make matters worse, we now have a missing tooth and the risk of bone loss to contend with – oh, the joys of adulthood!

When a tooth is extracted, it leaves behind an empty socket in the strip of bone that surrounds the roots of teeth (i.e., the alveolar ridge bone). Since there is no longer a tooth to support, it’s not uncommon for the bone beneath the socket to begin to resorb and remodel once the tooth is removed. This process can be significant, with the average patient losing between 3 and 5 mm of alveolar bone within three months of tooth extraction.

Now, you may be wondering, “Do I really need to be concerned with bone loss if I don’t have a tooth there anyway?” In short, yes. Each tooth is securely attached to the jawbone with an intricate network of bone, nerves, soft tissue, and ligaments. When a tooth is extracted, a number of oral health issues can occur:

  • Aesthetics: Without adequate support from bone structure and teeth, your smile starts to cave in in the area of extraction – much like a Halloween jack-o-lantern that was carved too early. Over time, your skin may begin to look shriveled and your smile will be unbalanced and unnatural.
  • Alignment Issues: Your teeth are always moving, particularly into open spaces. As time passes, a hole on one side of your smile can lead to a severe shift of your teeth, affecting your smile and subsequently requiring orthodontic treatment.
  • Implant Complications:  If you plan on getting a dental implant to replace the extracted tooth in the future,  a damaged and recessed bone greatly increases the likelihood of complications.

Fortunately, bone loss is no longer inevitable thanks to a  technique known as socket preservation.  Socket, or alveolar ridge, preservation involves placing a bone graft into the socket, where the tooth once was. This graft can be made of synthetic materials, bone from other animal sources or human bone. In addition, the use of Platelet Rich Fibrin (PRF), a natural product from your own blood may be added to the bone graft to enhance healing and bone formation. After putting the graft in the socket, the surgeon usually covers it up with a collagen membrane, then sutures the opening to keep it closed. The goal of socket preservation is to improve the appearance of the remaining teeth and gums and make the process of getting a dental implant in the future less complicated.

Though socket preservation was once deemed unnecessary, multiple studies have shown less bone resorption when socket preservation procedures were used, compared to cases where no graft material was placed in fresh alveolar sockets. And a recent retrospective review of the world’s published literature on socket grafting showed that human bone allograft and PRF produced the most predictable positive results.  Due to how quickly bone resorption begins, socket preservation should be performed at the same time as the tooth extraction to ensure the best outcome possible.

With a combined 50+ years of experience, Drs. Stewart and Michael are well versed in socket preservation.  If you’re interested in learning more about socket preservation procedures, please don’t hesitate to reach out to any of our four locations (Denton, Plano, Decatur, Gainesville). Our team would be happy to answer any questions you may have.

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Sharing Concerns with Your Oral Surgeons

Oral Surgery Consultation North, TXTexas Oral Surgery Group has provided unsurpassed oral surgery treatment for over 30 years, and we pride ourselves on delivering the best patient experience possible. To Dr. Stewart and Dr. Michael and our entire team, this goes beyond adhering to stringent safety guidelines and includes patients’ overall comfort.

We understand that while a procedure might be “routine” for Dr. Stewart and Dr. Michael, it likely is not for our patients. That’s why we work hard to make sure patients are informed and comfortable every step of the way. While patients may not look forward to the procedure itself, the experience doesn’t have to be frightening or uncomfortable.

Dr. Stewart and Dr. Michael have found that open, honest communication is the key to easing patient fears and creating a successful treatment experience. However, they can’t do it alone.

Communication is a two-way street, and just as it’s up to us to ensure that our patients have all the information they need, it is vital that patients take an active role in sharing information, as well as concerns. The Texas Oral Surgery Group team will do everything feasible to make your experience as stress-free as possible, and your willingness to share concerns is essential.

Fear of the unknown is often the root cause of anxiety, and arming yourself with information is usually the best strategy to alleviate that anxiety.

Ask questions

At Texas Oral Surgery Group, our job starts well before we put on the exam gloves. The team’s collective goal is to deliver the best patient experience possible, and that means making ourselves available for questions and ensuring patients understand the information provided. Patients who are prepared for both the procedure and associated healing period are more likely to have a smoother experience and faster recovery. So yes, questions are encouraged!

Don’t be afraid to speak up.

Each patient is unique and has their own individual tolerance levels. If something doesn’t feel right, let us know.  We also want you to know that it’s ok to ask about alternatives!

Remember, you are in control.

Dr. Stewart and Dr. Michael will always present you with all of your options. While they will make suggestions based on their knowledge and experience, final treatment decisions are always up to you.

Quality patient care has always been at the heart of Texas Oral Surgery Group and we are here to answer your questions. We encourage you to contact any of our four convenient locations (Denton, Plano, Decatur, Gainesville)  to schedule a consultation or speak with a team member.

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How Oral & Maxillofacial Surgeons Handle Esthetic Implant Cases

Dental Implants North Central, TXAt Texas Oral Surgery Group, we understand the far-reaching impact our work has on patients. That’s why we’re committed to providing the best care possible via the latest technology and innovative procedures, including esthetic implants.

An esthetic area is any area that is visible in a patient’s full smile. Given the significant role a healthy smile plays in one’s self-confidence and quality of life, the demand for esthetic dental work continues to increase. Fortunately, so have procedure options.

Unlike earlier days where teeth loss was only treatable using dentures and bridges, today, missing teeth can be treated using dental implants. Not only do today’s implants restore function, but, just as importantly, they also fulfill patients’ esthetic expectations.

What exactly are dental implants?

Dental implants are essentially artificial tooth roots that create a strong foundation for artificial teeth, which are known as crowns. Crowns are custom-made to fit a patient’s mouth and match their natural teeth.

Am I a good candidate for dental implants?

As long as facial growth and development are complete – usually around 16 years of age for girls and 18 for boys  – dental implants can be an excellent option for those who were born without a tooth or have lost teeth due to injury or decay. Ideally, implant surgery candidates are non-smokers with good oral health, which includes a sufficient amount of bone in the jaw and healthy gums. However, with over 50 years of combined experience, Drs. Stewart and Michael are able to overcome numerous treatment obstacles. We encourage you to contact us for a second opinion even if you don’t meet the ideal patient profile or have previously been told that you are not a good candidate for implants.

Are there different types of implants?

The currently available dental implants have been time tested and have been in wide usage since the early 1980’s. The biologic basis for implant success has been studied with literally thousands of research papers. The majority of dental implants are made of titanium, however dental implants made of zirconia are now being utilized as well, especially in esthetic areas where the tissue may be thin. Shaped like small screws, these are placed in the jawbone itself.  These “new” zirconia implants are a rebirth and redesign of early zirconia implants from the mid 1980’s, made possible by advancements in CADCAM milling. Zirconia implants require specific restorative protocols and materials that may increase the overall cost.

Depending on the health of your jawbone and your specific needs, Drs. Stewart and Michael may suggest some alternative treatment options, including:

  • Immediate load dental implants.Also called “same day” implants, immediate load dental implants allow placement of an implant and a temporary tooth during the same appointment. This may be a good option if you have enough natural bone and an implant secure enough to support immediate placement and pressure on the new temporary tooth.
  • Mini dental implants (MDIs).Also called small or narrow diameter implants, these toothpick-sized implants are narrower than most commonly used dental implants. They are placed using less-invasive techniques and are used primarily to stabilize a lower denture.
  • All-on-4®.All-on-4 is a procedure that replaces an entire arch of teeth by inserting four (or more) dental implants into the top, bottom, or both jaws. Specifically placed so that each are able to support multiple teeth in the arch, these four implants provide support of the prosthesis which allows a thin, non-removable implant supported bridge to be secured into place. Patients are allowed to begin eating a soft diet while the gum tissues heal and the implants bond with the natural bone. After about six months, the permanent implant bridge is placed and the patient is able to chew as if with natural teeth.

What steps are involved?

Just like any other esthetic dental procedure, dental implants require the development of an individualized treatment plan. All implant surgeries at Texas Oral Surgery Group employ a coordinated treatment approach that includes the patient, oral and maxillofacial surgeon, and restorative dentist.

Our goal is to ensure all parties have a clear understanding of what needs to happen to meet the patient’s expectations. To help with this effort, we have an Implant Coordinator who is responsible for ensuring each step of the planning, treatment, and follow-up are discussed with the patient and referring doctor.

Patients begin the process by meeting with members of the implant team to review treatment options. The work up for dental implant surgery requires meticulous planning and execution. Since coordination among all parties is required, it can take several weeks to properly prepare and plan for dental implant surgery. We at Texas Oral Surgery Group  have many years of experience and thousands of cases of satisfied patients, we feel confident that we can assist you in your dental implant needs, even if you have previously been told that you “were not a candidate”. Let us help you to regain your oral health.

Where do I go from here?

Regardless of the method used, dental implant surgery is a subject that requires a thoughtful approach. Please contact any of our locations (Denton, Plano, Decatur, Gainesville ) to schedule a consultation. Drs. Stewart and Michael will assess your oral health and make a recommendation about the type of implants that are most appropriate for you.


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How Does an Oral Surgeon Remove an Impacted Tooth?

Impacted Tooth North TXAn “impacted” tooth is simply one that is submerged beneath the gum tissue and/or bone, and either can’t or hasn’t yet been able to break through or erupt into function.

Depending on the location and severity of the impacted tooth, treatment may not be necessary. However, in many cases surgical intervention is required to prevent other teeth from becoming damaged or displaced along with other reasons.

If removal of an impacted tooth is required, treatment will generally consist of one or more of the following procedures:

  • Extraction of Extra Teeth – Extra teeth–called “supernumerary” teeth—is indicated usually in cases where the tooth is inhibiting normal positioning or eruption of another permanent tooth.  Likewise a supernumerary tooth may be removed if it is impeding orthodontic movement.

    Surgical Exposure for Orthodontics
    – When considering teeth that are slow to erupt (what we call “delayed eruption”), often times the orthodontist will need the impacted tooth to be “surgically exposed”.  This procedure involves removing gum tissue and bone to expose the impacted tooth. Once the tooth is accessible, Drs. Stewart or Michael will bond an orthodontic bracket and chain to the exposed tooth. The chain will then be temporarily attached to an appliance previously placed by the patient’s orthodontist. Depending on the patient, the impacted tooth may be left uncovered by suturing the gum above the tooth or making a window in the gum covering the tooth. More frequently though, the gum is returned to its original location and sutured closed with the chain remaining visible through a small hole in the gum. The first 24-36 hours post-surgery, patients may experience a limited amount of bleeding from the surgical sites. Although some discomfort is to be expected, most patients are able to manage their pain with Tylenol or Ibuprofen. Additional details on what to expect post-surgery can be found here.
  • Extraction of the “Ankylosed” Impacted Tooth – Occasionally, some teeth are found to be essentially fused to the surrounding bone (called “Ankylosed” teeth).  Despite extensive efforts, these teeth are nearly impossible to move and usually must be extracted.  Extraction of Ankylosed teeth is generally a fairly difficult and technically challenging procedure to perform.  Ankylosed tooth removal should only be attempted by those well-trained to do so.

For your convenience and comfort, Drs. Stewart and Michael perform these procedures in one of our four office locations (Denton, Plano, Decatur, Gainesville). For most patients who want to be asleep during the procedure, it is performed under IV sedation. This route is also recommended for patients with mild to moderate anxiety; however, another option is to perform the surgery using Nitrous Oxide sedation and local anesthesia (numbing medicine).

At Texas Oral Surgery Group, we understand that surgery is never a minor consideration, and we want you to be confident knowing that we put our patients’ well-being above all else. That’s why our entire surgical team is Dental Anesthesia Assistant National Certification Examination (DAANCE) certified. This is the highest level of certification granted by the American Association of Oral and Maxillofacial Surgeons (AAOMS). Additionally, while most procedures today are office-based, Drs. Stewart and Michael maintain privileges at Medical City Plano, a Level I Trauma Center located in Plano, Texas.

Drs. Stewart and Michael and the entire team at Texas Oral Surgery Group are committed to delivering quality patient care and are happy to answer any questions. Please don’t hesitate to reach out to any of our four locations (Denton, Plano, Decatur, Gainesville).


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6 Signs You Might Need to Have Your Wisdom Teeth Removed

Wisdom Teeth Removal North TXBy the time wisdom teeth form, the other permanent teeth have already established their position in the mouth—often leaving little to no room for any more teeth.  As a result, wisdom teeth can become “impacted” in bone or gum tissue- ie., unable to fully erupt into normal position.  This often results in bacteria traps that can cause infections of the gingiva or bone.  We know that there is clear evidence that impacted wisdom teeth cause bone loss around and damage to the adjacent molars (the 12-year molars).  There used to be the thought that impacted wisdom teeth would “push” the teeth in front of them and result in crowding.  Based on many well-designed studies, we now know that there is no evidence to support that claim.

A major thing to consider when planning to remove wisdom teeth is the anatomy of the developing wisdom teeth.  There is clear evidence that removing the wisdom teeth earlier in their development (i.e., before the roots are allowed to appreciably form) usually results in a far lower number of complications and much more predictable healing.  As oral surgeons, we evaluate the stage of formation of the teeth as well as the anatomical position of the teeth in the upper and lower jaws when deciding the best time for removal.  There is no magical “age” that is best for removing wisdom teeth.  Each patient needs to be evaluated as an individual.  Regular dental check-ups with periodic x-rays can help monitor the development of wisdom teeth. Please note that even if you are not currently experiencing discomfort, you may still require treatment as some types of pathology show no symptoms at all. There is a fairly common saying: “The absence of evidence is not the evidence of absence”.  This is particularly true when considering the potential issues associated with impacted wisdom teeth.

Here are 6 common signs that you may require wisdom teeth removal:

  • Sensitivity & Pain in the Back of Your Mouth
    Whether it’s eating, brushing your teeth or doing nothing at all, if you begin to experience pain, sensitivity or a slight throbbing sensation, you should schedule an appointment to have them evaluated. Pain associated with the teeth should never be ignored.  A dental issue that causes pain can often be remedied with a straightforward procedure if addressed quickly.  But when left untreated that same issue can quickly progress to something that requires a much more involved treatment.  A common example would be a simple cavity that can be treated with a small filling/restoration.  That simple cavity can quickly progress if left untreated and become large enough to require a crown.  Further progression could lead to needing Root Canal Therapy.  Even further progression may render the tooth non-restorable and result in the need for extraction.  With wisdom teeth initial pain may progress to severe pain and ultimately to a serious infection.
  • Inflammation Around the Gums
    When wisdom teeth begin to emerge, they can create a flap of gum tissue behind your 12-year molars that traps particles of food and bacteria. When the tissue around the tooth becomes irritated and inflamed, it can appear as slightly swollen, reddish areas along the gum line that are sore to the touch and can make it challenging to properly brush. Known as pericoronitis, this condition can occur around wisdom teeth that are still underneath your gums, and is one of the most common reasons patients seek care for wisdom teeth. As oral surgeons, we hope to prevent you from getting to this point with early evaluation with proper exam and radiographs.
  • Bad Breath / Bad taste in the Mouth
    The delicate gums surrounding impacted or misaligned wisdom teeth are difficult to clean, which results in trapped food and bacterial plaque that can lead to infection. The resulting wound-infecting bacteria releases sulfur compounds that can create extremely bad breath or a constant unpleasant taste in your mouth.

  • Cysts Develop in Your Mouth
    If symptoms of wisdom teeth are ignored, cysts can begin to develop. Cysts are sacs that surround the crown of the tooth and were responsible for tooth formation. These sacs become filled with fluid. If left untreated, cysts can destroy bone, roots and surrounding structures and potentially develop into various tumors requiring additional surgery.
  • Stiffness & Pain in Jaw
    When wisdom teeth grow, and they are allowed to erupt into an improper position into the mouth, they can start to interfere with the way your teeth normally bite together. As a result, you may experience muscle stiffness and pain in the jaw area. Difficulty opening and moving your mouth and jaw can also be indicators. If left untreated, an improperly aligned bite can and often does lead to significant TMJ issues.
  • Sinus Problems
    Sinus issues can be sometimes linked to dental issues, including wisdom teeth. When teeth grow in the upper jaw, developing roots can deform the bony sinus floor. This can lead to sinus pain, pressure, headaches and congestion.

Wisdom teeth extractions are one of the most common dental procedures. For your benefit and health, we encourage you to have your wisdom teeth evaluated by an oral surgeon before you experience any of the above signs or symptoms.

We understand that no one wants to spend precious summer hours undergoing and recovering from oral surgery, but if it has to be done there’s no better time than summer! We recommend taking a few days off from work or school to rest after your wisdom teeth are removed and, since most of us currently have more down-time than usual, why not get this taken care of?

Contact any of our four locations (Denton, Plano, Decatur, Gainesville ) to schedule a consultation.  We promise that there will be smiling and caring faces under those masks!

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Oral Surgery Infection Prevention and Control

oral surgery infection control North TXOral surgery infection prevention and control is comprised of two main components – precautions taken in preparation of and during surgery and those prescribed post-surgery.  You may be assured that Texas Oral Surgery Group takes infection prevention and infection control very seriously.

Patient safety is our team’s highest priority and that means adhering to stringent infection control procedures and complying with all regulations put forth by the state of Texas and the Centers for Disease Control and Prevention (CDC).

These include:

  • Thorough hand scrubbing with antimicrobial soap for the recommended time.
  • All dental staff involved in patient care scrub their hands before each patient with a fast-acting, antimicrobial agent that has a broad spectrum of activity and a persistent effect.
  • Use of appropriate personal protective equipment such as gloves, masks, and eyewear by all team members involved.
  • New PPE (personal protective equipment) is used for each patient.
  • Sterile surgeon’s gloves are used to minimize transmission of microorganisms from the hands of surgical personnel to patients and prevent contamination of the hands of surgical personnel from a patient’s blood and body fluids.
  • Before a patient enters the exam room all surfaces, including the dental chair, instrument tray, dental light, drawer handles, and countertops, are cleaned and decontaminated according to all current CDC guidelines.
  • Patients are asked to rinse with an antimicrobial solution prior to surgery.
  • Disposable items, such as needles or gauze, are placed in special biohazard bags or containers, noted for biohazard disposal and disposed of according to biohazard protocol as established by our hazardous waste disposal company.
  • Non-disposable dental instruments are washed, ultrasonically cleaned, sterile bagged and then steam sterilized between patients.
  • Our sterilizers are checked weekly with a biologic spore check system provided by a 3rd party that assures the autoclaves are working as designed.
  • Use of sterile irrigating solutions and devices designed for delivering sterile irrigating fluids, such as a sterile bulb syringe, sterile single-use disposable products, or sterilizable tubing. We utilize only sterile irrigation solutions (never tapwater) and the delivery system is a sterile single use device or sterilizable tubing.

Patients’ compliance with post-surgery directives is just as essential to preventing infection as the precautions taken by Texas Oral Surgery Group. Successful recovery is closely linked to adherence of post-operative instructions, and while patients leave our care with personalized instructions, we’ve included a few common guidelines below:

Use Gauze to Manage Bleeding – Depending on the type of procedure, it’s not uncommon for patients to experience some bleeding after leaving our office. The best way to manage this is by keeping your head elevated, placing damp gauze over the incision site and lightly biting down for 30-60 minutes. If bleeding remains an issue, please reach out to us.

Take Antibiotics if Prescribed – It’s critical that patients take any prescribed medication as instructed by Drs. Stewart or Michael  before and/or after their procedure. Oral surgery increases the risk of local or systemic infection because microorganisms from inside or outside a patient’s mouth can enter their circulatory system through the oral cavity. However, proper use of antibiotics prevents bacteria from causing an infection.

Most people are able to safely undergo oral surgical procedures without the need for antibiotics. There are however, occasions when antibiotics may be prescribed either prior to, or after surgery.  In these cases compliance with the prescribed instructions is necessary.

It is important to note that patients who stop using antibiotics prematurely (i.e., those who do not finish the prescribed quantity) increase their risk of a post-operative infection.

Do Not Smoke or Use Tobacco Products – Smoking can interfere with the body’s immune system and  natural healing process which can lead to postoperative complications such as delayed healing, infection, or  and lead to dry socket. Dry Socket is a condition which occurs when the blood clot at the site of a tooth extraction fails to develop or dislodges before the wound fully heals. Additionally, use of any chewing tobacco products before your surgical wound is completely healed may cause painful complications as the substance is likely to stick to the wound site. and delay wound healing

Don’t Forget to Rest – In an effort to minimize disruption in their lives, some patients neglect to allot enough recovery time. Unfortunately, this will only prolong recovery. Depending on the procedure, you may be able to resume your normal routine after 48-hours, but it’s important to listen to your body.

Remember, some bleeding, swelling and pain are to be expected after dental surgery. The extent depends on the individual patient and the type of procedure, but if these symptoms persist please contact one of our locations (Denton, Plano, Decatur, Gainesville) if you would like to hear more about oral surgery infection prevention. Drs. Stewart and Michael and the entire team at Texas Oral Surgery Group is committed to delivering quality patient care and are happy to answer any your questions.

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Signs You May Have Untreated Bruxism

BruxismDo you often wake up with sore jaw muscles or a headache? How about general aching in the face, head or neck? Before you write it off as the effects of life’s everyday stressors, take a moment to consider that it might be something more.

Bruxism is a condition that causes you to grind, gnash or clench your teeth. People with bruxism may unconsciously clench their teeth throughout the day (i.e., awake bruxism) or clench or grind them while they sleep (i.e., sleep bruxism). Over time, untreated bruxism can lead to tooth pain and loose or chipped teeth. In some instances, parts of the teeth are literally ground away, and the surrounding bone and gum tissue are destroyed. It can also lead to painful jaw issues, such as temporomandibular joint disorder/dysfunction (TMD).

Unfortunately, most people with bruxism are unaware they suffer from the condition until obvious damage, such as chipped teeth, has occurred.

Signs and symptoms of bruxism may include:

  • Teeth grinding or clenching, which may be loud enough to wake up your sleep partner
  • Teeth that are flattened, fractured, chipped or loose
  • Worn tooth enamel, exposing deeper layers of your tooth
  • Increased tooth pain or sensitivity
  • Tired or tight jaw muscles, or a locked jaw that won’t open or close completely
  • Jaw, neck or face pain or soreness
  • Pain that feels like an earache, though it’s actually not a problem with your ear
  • Dull headache starting in the temples
  • Damage from chewing on the inside of your cheek
  • Sleep disruption

While the exact cause of bruxism is not completely understood, it’s thought to be due to a combination of physical, psychological and genetic factors.

Factors that potentially increase your risk of bruxism include:

  • Stress – Increased anxiety or stress can lead to teeth grinding, as can anger and frustration.
  • Personality – Having a personality type that is aggressive, competitive or hyperactive can increase your risk of bruxism.
  • Medications – Bruxism may be an uncommon side effect of some psychiatric medications, such as certain antidepressants.
  • Caffeine & Tobacco – Use of tobacco products, caffeinated beverages or alcohol have been linked to an increased risk of bruxism.
  • Genetics – Sleep bruxism tends to run in families. If you have bruxism, other members of your family also may have a history of it.
  • Other Conditions – Bruxism can also be associated with medical conditions such as Parkinson’s disease, dementia, gastroesophageal reflux disorder (GERD), epilepsy, night terrors, sleep-related disorders such as sleep apnea, and attention-deficit/hyperactivity disorder (ADHD).

Bruxism itself has no cure, but damage to the teeth can be reduced or eliminated with a combination of treatments. After a thorough examination, our team can help you determine the source of your bruxism and create a treatment plan based on the amount of tooth damage and its likely cause.

Common treatment methods include:

  • Wearing an oral appliance while sleeping — Made specifically to fit your teeth, the appliance slips over the upper teeth to protect them from grinding against the lower teeth.
  • Finding ways to relax — Because everyday stress seems to be a major cause of bruxism, anything that reduces stress can help.
  • Reducing the “high spots” of one or more teeth – This procedure evens out your bite, to help teeth fit together. Abnormal bites may also be corrected with new fillings, crowns or orthodontics.

Not all cases of bruxism require treatment; however, if you or a loved one is experiencing painful symptoms, take the first step and contact one of our four locations (Denton, Plano, Decatur, Gainesville). Drs. Stewart and Michael and the entire team at Texas Oral Surgery Group is committed to delivering quality patient care and are happy to answer your questions.



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Oral Biopsy Patient FAQ’s

Oral Biopsy North TXTexas Oral Surgery, patient care is our priority. We understand the anxiety that can accompany oral biopsies and know that information significantly reduces patient stress. If you or a loved one requires an oral biopsy, At the questions and answers below may help to alleviate your concerns.

What should I expect?

Depending on your symptoms and what  Drs. Stewart and Michael want to explore, they will choose one of the following procedures.

  • Exfoliative cytology:During this in-office procedure, the doctor gently scrapes cells from the suspicious area and smears the collected tissue onto a glass slide. The sample is then stained with a dye so the cells can be seen under the microscope. This non-invasive procedure is a quick and painless way to check for oral cancer. However, because this method doesn’t detect all types of oral cancer, patients may need to undergo an incisional
  • Incisional biopsy:This is the most common type of biopsy used to check changes in the mouth and throat. In this procedure a small sample of the abnormal tissue is cut out for testing. If Drs. Stewart and Michael can easily access the sample site, this procedure is done in our office using local anesthesia. However, if the suspicious tissue is located deep inside the mouth or throat the biopsy may be performed under general anesthesia in the operating room.
  • Fine-needle aspiration (FNA) biopsy: If you have a lump in your neck, your doctor may order an FNA biopsy. During this in-office procedure, the doctor numbs the affected area and uses a very thin needle to draw out fluid or cells from the lump. While FNA is very helpful in diagnosing the cause of a new neck lump or mass, it is often performed after oral or oropharyngeal cancer has been diagnosed to find out if the cancer has spread to a patient’s lymph nodes. This procedure is also used for patients who have undergone cancer treatment to determine if a new neck mass in the treated area is scar tissue or cancer that has returned.

Is it painful?

Understandably, this is one of the most common questions we’re asked. The short answer is that you shouldn’t feel pain during the oral biopsy. You may, however, feel a sharp pinch or pin prick from the needle used to inject the numbing agent or the needle used to take the biopsy. You may also feel some pressure from the instruments used to collect the sample. Depending on where in the mouth or throat the sample was removed, some patients do experience brief minor pain after the anesthesia wears off.

How should I prepare?

In-office oral biopsies generally don’t require any specific preparation. Before your procedure, Drs. Stewart and Michael will review your health history and our team will advise you of any medications to withhold. If you’ll be undergoing general anesthesia, we will provide additional information, such as  how long to fast before the procedure.

What is the recovery process?

While the biopsy site may be sore for several days, Tylenol is usually sufficient to manage the pain. Sometimes the doctor may advise avoiding NSAID’s, such as aspirin, Advil or Aleve, as these may increase the risk of post-operative bleeding.  Any lingering effects should disappear within 10-14 days. Avoid hot, spicy, and/ or abrasive foods post-procedure, which can hinder the healing process, and instead opt for soft, cool foods which will soothe.

At Texas Oral Surgery Group, we value the important role we play in patient care. From your first call and consultation with Drs. Stewart and Michael through the entire treatment process, our team is dedicated to providing the highest quality patient care possible.  If you have specific questions please feel free to contact any of our locations (Denton,Plano, Decatur, Gainesville ) to speak with a team member.

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