Texas Oral Surgery Group

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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How to Prepare Your Home BEFORE Oral Surgery

While you may not feel lucky when you hear you need oral surgery, there are benefits to being able to schedule your procedure. Primarily, you’re able to prepare for your recovery, and, as with most things in life, preparation is key for a successful recovery.

We know that oral surgery isn’t fun but making a few adjustments beforehand can mean the difference between resting comfortably and the alternative. Implement the tips below and you’ll be on your way to a successful recovery:

  • Stock your pantry. Though eating may be the last thing on your mind as you head into surgery, your post-operative diet plays an important role in recovery. Restrictions can vary depending on the procedure, but typically softer foods are desirable for the first couple of days only.  Make sure that you intake proper nutrition to promote healing.  Protein shakes and fish are particularly helpful as a softer source of protein in the first couple of days.  Initially, it is a good idea 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.  To further help your body in the healing process, be sure to stay hydrated but do not use a straw (for the first few days at least) as the sucking motion can cause bleeding by dislodging blood clots.
  • Get ready for a little R&R (rest and recovery, or Recumbency and Relaxation, or Rating your surgeon with 5 stars and Reposting how awesome your oral surgeon is). Make the most of this mandatory downtime by planning ahead. Cue up movies or TV shows you’ve been meaning to binge, grab some good books, and get ready for a few days of sedentary entertainment – doctors’ orders! (this is also an excuse to get out of doing dishes, laundry, etc) 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. Preparing your rest and recovery area before surgery will help you avoid last-minute scrambling, making for an easy transition to home.
  • Line up caregivers. In addition to transportation to and from surgery, you will also need to delegate care for those who rely on you. Sometimes patients downplay the effects of oral surgery, but your body will require rest so it’s best to arrange for a friend or family member to manage child and/ or elder care and walk Rover.
  • Stay ahead of pain and infection. The amount of pain after oral surgery varies depending on the extent of the procedure. Rest assured that Drs. Stewart and Michael will prescribe any necessary medication to prevent infection and/or manage pain. Upon initial consultation as well as postoperatively at discharge you will receive an explanation of the detailed postoperative care instructions. To ensure a smooth recovery, it’s essential that you follow these instructions and return for your post-op appointment. If you experience any recovery related problems or have questions don’t hesitate to contact our office.  We are always available if you have an emergency or any concerns.

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. Further, our entire surgical team at Texas Oral Surgery Group 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), so 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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Platelet Rich Fibrin and Its Role in Oral Surgery

PRF North TXWhen faced with the prospect of oral surgery, patients are understandably concerned about a number of factors, including recovery time and the risk of infection. Fortunately, advances in dentistry over the years have led to improved results and overall patient experience. One such advancement is the use of Platelet Rich Fibrin (PRF).

PRF is a living biomaterial derived from a patient’s blood that helps to promote the healing and regeneration of bone and soft tissue, both of which are critical to the success of any oral surgery procedure.

How is PRF created?

PRF is produced by taking a blood draw immediately prior to the surgical procedure and placing it into a centrifuge which separates it into three layers:

1) Clear liquid or plasma layer

2) Red layer rich in red blood cells

3) Yellow thick layer which is the PRF portion

The thick PRF layer is rich in fibrin, platelets, growth factors, and circulating stem cells. In addition, the fibrin network is composed of leukocytes and cytokines that play a significant role in inflammation and infection regulation.

When is PRF used?

PRF can be beneficial in a wide variety of oral surgery procedures ranging from wisdom tooth extractions to socket preservation and sinus lift procedures.

  • Tooth extraction – Patients’ jawbones have very little blood supply compared to other tissues in the human body, which means this area has less ability to heal and less defense against infection. Placing RFP in the extraction site protects it from infection and delivers proteins that accelerate the healing process.
  • Sinus Lift – This procedure is used when a patient needs an implant in the upper jaw but has a thin sinus wall unable to support implants on its own. A sinus lift grows bone in the floor of the maxillary sinus to enable the secure placement of dental implants. In this instance, PRF can be used to produce faster, stronger bone and soft tissue healing.
  • Socket Preservation – The primary purpose of socket preservation is to preserve the health of the alveolar bone (i.e. the socket that holds the tooth in place). This bone is often damaged by disease and/or infection, which necessitates a tooth extraction that can create a jaw deformity if preventative measures aren’t taken. In a socket preservation procedure, PRF membrane, which contains bone growth enhancing elements, can be stitched over the wound or a graft material/scaffold that is placed in the socket of an extracted tooth before it is closed.
  • Dental Implants – Insufficient jawbone is one of the leading causes of dental implant failure. In sites where implants are placed, PRF occupies the space between the extraction site and the dental implant, helping to expedite healing and creating jawbone structure.

Benefits of Using Platelet Rich Fibrin

Surgeons and patients alike are benefiting from the increased use of PRF in surgical procedures. From decreasing pain to providing a cost-effective option, PRF offers a number of advantages.

  • It’s 100% natural and easy to produce. Because PRF is derived from the patients’ own blood it is 100% natural and readily available. The use of PRF does not require anticoagulants, bovine thrombin, or any other jellying factor. This also means patients have virtually no risk of experiencing a rejection reaction (i.e., a foreign body response), which can happen when synthetic alternatives are used.
  • Significant decrease in patient discomfort. The use of PRF has been shown to reduce the risk of complications and restrictions a patient may experience due to donor site morbidity. The result is a decrease in patient discomfort, post-surgical pain, and post-op bleeding.
  • Faster healing. PRF has been shown to result in faster healing due to its slow polymerization (i.e., the rate at which molecules combine). This process generates a fibrin network that leads to more efficient cell migration and faster healing.
  • High cost-benefit ratio. Due to the fact that PRF is readily available and inexpensive to produce, it is an affordable option for patients and providers. Additionally, by reducing the risk of donor site morbidity, the use of PRF can potentially spare the patient from undergoing a second surgery.

As noted, oral surgery has seen a number of advances in recent years and patients should always consult with their dental provider to discuss which procedures make the most sense based on their individual health history.

 

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Can Oral Surgery Improve How Your Dentures Fit?

oral surgery dentures north txWith dentures, comfort and fit go hand-in-hand. Like pieces of a puzzle, the denture, gum and jaw must all fit together properly to ensure the most comfortable fit possible. For some patients, oral surgery is necessary to create the right alignment before being fitted for dentures. This is known a pre-prosthetic surgery.

When is pre-prosthetic oral surgery needed?

A denture sits on the bone ridge, so for maximum fit and function it is critical that the bone be the right shape and size. One of the most common reasons for pre-prosthetic surgery is to smooth out uneven bone ridge left behind after tooth extraction. Other reasons may include removal of excess bone or addition of a bone graft to create suitable support.

Common pre-prosthetic procedures include:

  • Bone smoothing and reshaping
  • Removal of excess bone
  • Bone or tissue grafting procedures
  • Bone ridge reduction
  • Removal of excess gum tissue
  • Extraction of impacted teeth

Generally, the dental practitioner who is fitting you for your dentures will discuss whether surgery is necessary. If you do need pre-prosthetic surgery, Doctors Stewart and Michael will perform the procedure on an outpatient basis using the most cutting-edge technology available today to ensure your comfort and safety.

Why do my dentures no longer fit?

Dentures are not a one and done treatment. Just like natural teeth, they require proper care and regular dental visits. Because the structure that supports dentures deteriorates over time, it is not uncommon for patients to undergo changes that create an improper fit. Gum ridges in our mouths often shrink as we age, which can cause dentures to become loose. Bone can also shrink, resulting in misaligned jaws. So even if a patient’s dentures initially fit properly, changes in gum and bone structure may require corrective oral surgery later on.

What are the symptoms of poor-fitting dentures?

Discomfort is the most obvious sign dentures do not fit correctly; however, other symptoms include:

  • Dentures that move
  • Difficulty speaking
  • Pain in the gums (sometimes with bleeding)
  • Difficulty eating and swallowing
  • A clicking noise when eating
  • Bad breath or strange taste

What are the dangers of poor-fitting dentures?

Beyond general discomfort, wearing poor-fitting or loose dentures for an extended period of time can cause much more than an inconvenience. Complications can include:

Swollen Gums – If dentures do not fit the contours of your mouth correctly, they rub against gum tissue causing them to swell.

Mouth Soreness – When gum tissue is irritated and inflamed, it creates sensitivity and soreness, which is exacerbated if a patient has other jaw disorders such as TMJ.

Trouble Speaking – Patients with loose or poor-fitting dentures may develop a lisp.

Blisters – When dentures do not fit properly, they rub against areas of the mouth creating blisters which not only cause extreme discomfort, but risk further tissue damage and infection.

Angular Cheilitis –  Poor-fitting dentures often lead to an uneven bite which can cause saliva to pool near the corners of the mouth. This creates a moist environment ripe for a painful bacterial infection.

Headaches – Headaches are a common side effect of poor-fitting dentures, as a sore jaw often creates head pain.

The ultimate goal of dentures is improved quality of life. To achieve this, dentures need to fit as comfortably as possible. With a combined 50 years of service, Doctors Stewart and Michael are committed to providing the right pre-prosthetic surgery for your needs. For additional information, please contact any Texas Oral Surgery Group location (Denton, Plano, Decatur, Gainesville ).

 

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Summertime is the Best Time … to Have Your Wisdom Teeth Removed!

Summertime is the best time…to have your wisdom teeth removed!

Wisdom Teeth ExtractionHaving one’s wisdom teeth removed is essentially a rite of passage, practically on par with high school graduation. Technically known as third molars, history suggests that the more common name – wisdom teeth – came about because they are the last four of our 32 teeth to appear, which generally happens between our late teens and early 20s.

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. As a result, they become impacted in bone or gum tissue, causing crowding among current teeth which can lead to severe jaw pain, infection and damage to adjacent teeth. To reduce a patient’s risk, a surgical procedure is required to remove the impacted teeth. For specific information on the types of impactions, see our section dedicated to wisdom teeth.

Not sure if you or a loved one need wisdom teeth removed? There are several degrees of impacted wisdom teeth, based on where the teeth lie within the jaw. To evaluate the position of the wisdom teeth and determine if there are present or potential problems, patients should undergo an oral exam and x-rays of the mouth. Please note, even if you are not currently experiencing discomfort, you may still require extraction as some patients show no symptoms at all.

While the removal of wisdom teeth is common, it is still considered surgery and should be regarded as such. When performed by an oral surgeon versus a general dentist, a deeper level of sedation is provided for the patient’s maximum comfort. Oral surgeons are trained in a hospital-based residency to administer general anesthesia. The practice of office-based anesthesia is tightly regulated by the state, and oral surgeons in Texas undergo mandated office anesthesia evaluations and our staff is specifically trained in the office based anesthesia model.  We can administer outpatient IV sedation, which allows patients to literally sleep through the procedure with no recollection of surgery.  Drs. Stewart and Michael have over 40 years of combined experience, including extensive training in all types of wisdom teeth treatments and are well-equipped to manage any potential complications that arise.

For non-emergency cases where patients have the ability to schedule wisdom teeth extraction in advance, summer is the ideal time to have it done. The thought of summer vacation 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 in the summer months, it’s generally one of the best times to be out of the office (and there’s no school to miss). As a bonus, when you return to work you may have a lighter load than you would during other times of the year.

Pain Management – Many patients are able to control pain after extraction with over-the-counter medications. However, some people require prescription pain medications that can cause nausea and / or interfere with their ability to focus and stay awake. With a lighter 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.

Be sure to ask Dr’s Stewart and Michael about non-narcotic pain management options- we have several excellent options available.

Special Diet – After this procedure a patient should expect a sore mouth and will need to stick to a modified diet for a few days. Soft foods, such as smoothies, ice cream and popsicles, will make recovery easier – especially when they’re enjoyed outside in the fresh air and sunshine!

Lifted Moods – Summer generally ushers in higher spirits and lifted moods. Even if you find yourself in recovery mode for a few days, being able to walk outside and feel the sunshine makes it much easier to handle than being cooped up inside during frigid temps.

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. Before your calendar fills up with family and friends, contact any of our four locations (Denton, Plano, Decatur, Gainesville ) to schedule a consultation.

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Anticoagulants and Oral Surgery

Anticoagulants North TXWith the aging of the population, and their increased need for medications for cardiovascular and neurologic conditions, many older patients are on some form of anticoagulant therapy. You have probably heard these anticoagulant medications called “blood thinners”.  A new class of medications called Direct Acting Oral Anticoagulants (DAOC’s) are being commonly prescribed. They are used to treat certain blood vessel, heart and lung conditions, including: atrial fibrillation (AFib), peripheral artery disease (PAD) and venous thromboembolism (VTE). Anticoagulants help prevent blood clots from forming in an artery, a vein or the heart, and may prevent existing clots from getting larger.

AFib patients are commonly on one or more of these medications because of their irregular heartbeats, which can cause blood clots that can travel to the brain, restricting the blood supply to the area and causing a stroke. About one in five people who have a stroke has AFib!

These medications include:

  • Apixaban (Eliquis®)
  • Dabigatran (Pradaxa®)
  • Rivaroxaban (Xarelto®)
  • Edoxaban (Savaysa™)

The traditional anticoagulant  Warfarin  (Coumadin) requires continual monitoring in the form of a blood test called an INR. It is necessary to keep the INR within a therapeutic range as determined by your physician. This can be difficult to do and can be affected by many factors including other medications, and dietary issues.

The DAOC’s do not require this type of continual monitoring and for this reason along with others, have become very popular. DOACs have been shown to be highly effective, require less monitoring, and may reduce the risk of brain bleed when taken for stroke prevention. They also work more quickly and clear the system faster than warfarin.

Because we in oral surgery see many patients on these medications, this issue has been studied extensively. There are several scientific articles in the literature now that state that it is safe to remove one or 2 teeth, or perform minor oral surgery such as a soft tissue biopsy, while patients are on the DAOC’s. However, you must read these articles closely, because it does not say that 100% of the people do well 100% of the time! In fact, most authors agree that 83% of the people will do well. That means that 17% of the population will have some form of postoperative bleeding after minor oral surgery if the anticoagulant medication is not stopped prior to surgery.

How do we manage this? Consultation with your physician will be required prior to surgery in most cases. Stopping an anticoagulant medication has side effects itself- such as an increased risk for stroke or heart attack. We must weigh the “risk-benefit” of stopping versus continuing these medications during minor oral surgery. Understand that, if you have postoperative bleeding while on these medications, surgical measures such as suturing and packing (which will be done at time of surgery) may be of little benefit because you are unable to form a clot. If you cannot form a clot, you cannot stop bleeding!  Whether or not to stop your anticoagulant medication pre-surgically is not a simple decision.  The decision involves many factors that must be considered carefully.  If your prescribing physician deems the risk of stopping your anticoagulant medication to be minimal, then that is usually the safest course for surgical procedures (remember that 17% of people will have bleeding without holding the medication!).  If your physician deems your risk of stopping the medication to be moderate or high, and the procedure is a minor one, then stopping the medication is usually not the best course of action.  Ultimately, the decision whether or not to hold an anticoagulant medication for an oral surgical procedure will involve a combined decision between the surgeon and your prescribing physician.

This becomes a medical management issue and on occasion patients may have to be hospitalized or seen in the emergency room. Thankfully this is a rare phenomenon, however excessive bleeding is a risk for anyone on anticoagulants. The effects of warfarin usually can be reversed with vitamin K. One important concern of patients and physicians has been that there was no specific antidote for DOACs. This is no longer the case. In 2015 the FDA approved idarucizumab (Praxbind®) for reversal of dabigatran (Pradaxa®). On May 4th 2018, FDA approved andexanet alfa (AndexXa®) for the reversal of apixaban (Eliquis®) and rivaroxaban (Xarelto®). Ongoing studies are confirming its efficacy in reversing the other DOACs on the market betrixaban (BevyxXa®) and edoxaban (Savaysa®) as well as the low molecular weight heparin enoxaparin (Lovenox®) and fondaparinux (Arixtra®). Physicians can use prothrombin complex concentrate in emergency situations involving blood thinners that do not have a specific reversal agent yet approved by FDA. The good news is, these medications do a tremendous service to patients with cardiovascular, peripheral vascular, and neurologic issues. They save lives. Remember that any medication has side effects, and anticoagulants’ side effect (and intended effect!) is to prevent clot formation.

We will work closely with your physician to choose the best course of action for you if you are on one of these medications. Rest assured that our concern is for your health and safety and we want you to have a pleasant and positive experience.

If you have any questions regarding these medications or how we would manage your case, please feel free to consult with Dr. Stewart or Dr. Michael.

 

Sources:

www.stoptheclot.org/about-clots/blood-clot-treatment/direct-oral-anticoagulants/

www.heart.org/-/media/data-import/downloadables/abh-what-are-doacs-ucm_494807.pdf

 

Texas Oral Surgery Group: LARRY R. STEWART, DDS, MS     WAYNE A. MICHAEL, DDS, MD

PLANO: 972-596-9242

DENTON: 940-387-9015

DECATUR: 940-627-2256

GAINESVILLE: 940-612-2040

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