A tooth dies.  This might happen for various reasons: the tooth may be diseased, possibly from decay, or because a nerve died. When decay (which is full of bacteria) gets near to the ‘nerve’ (pulp), and is not treated in time, the nerve will die off. The inflammation in the healthy pulp chokes of the blood supply.

Tooth trauma might come through sports injuries, a fall that causes the teeth to strike a hard object or having a struck by a hard object. If the impact severs the blood supply at the tip of the root, the pulp dies.

Other reasons for tooth removal  include an overcrowded mouth. Sometimes dentists pull teeth to prepare the mouth for orthodontia, which would make it possible to properly align the teeth. In the case of the third set of molars, called wisdom teeth, an impacted tooth cannot break through the gum because there is not room in the mouth for it, your dentist may recommend pulling it.

Clearly, having a tooth pulled in adulthood is sometimes necessary.

What to Expect when You Get a Tooth Pulled

If you needed to get a tooth removed you would look for a dentist or an oral surgeon.  Before having an individual tooth removed you will most likely receive an injection of a local anesthetic to numb the area where the tooth will be removed. When the dentist is pulling multiple teeth, or if a tooth is impacted, you may get a strong general anesthetic. This will prevent pain throughout your body while you sleep through the procedure.

With an impacted tooth the dentist cuts away gum and bone tissue covering the tooth and then, using forceps, grasps the tooth with forceps while gently rocking it back and forth to loosen it from the jaw bone and ligaments that hold it in place. In some cases, a hard-to-pull tooth must be removed in pieces.

With a tooth removed, a blood clot usually develops in the socket. Following the removal,, the dentist will pack a gauze pad into the socket and have you bite down on it to help stop the bleeding. Often the dentist will place a few self-dissolving stitches to close the gum edges over the hole left by the tooth.

However, if the blood clot in the socket breaks loose it exposes the bone in the socket resulting in a painful condition called dry socket.. If this happens, your dentist can place a sedative dressing over the socket for a few days to protect it as a new clot forms.

What to Tell Your Dentist Before You Have an Extraction

Pulling teeth, when a dental professional does it, is generally safe. However, the procedure can  possibly allow harmful bacteria into your bloodstream if you don’t take appropriate precautions. In addition, the gum tissue could become infected. In short, if you have a condition that puts you at high risk for developing a severe infection, the dentist may recommend that you take antibiotics before and after the removal. Prior to having teeth pulled, you should let your dentist know your complete medical history, as well as any medications and supplements you might take. If any of these conditions apply, be sure to discuss them with the dentist.

• Damaged or man-made heart valves
• Congenital heart defect
• Impaired immune system
• Liver disease (cirrhosis)
• An artificial joint, such as a hip replacement
• History of bacterial endocarditis

After You’ve Had a Tooth Removed

Following the removal, your dentist will send you home to recover, which will probably take a few days. You can minimize discomfort, reduce the risk of infection, and speed recovery by doing the following:.

• Take painkillers as prescribed.
• Bite gently but firmly on the gauze pad that your dentist will place at the extraction site to reduce bleeding and allow a clot to form in the tooth socket. You will want to change gauze pads before they become soaked with blood, but leave a series of pads in place for three to four hours after the removal.
• Applying an ice bag to the affected area immediately after the procedure will keep swelling to a minimum. Keep ice in place for 10 minutes at a time.
• Rest and relax for at least 24 hours after the extraction and limit your activity for a couple of days.
• Avoid rinsing or spitting forcefully for 24 hours after the removal to avoid dislodging the clot that forms in the socket.
• After 24 hours you should rinse your mouth with a solution of eight ounces of eight ounces of water with a half teaspoon salt.
• Do not drink from a straw for the first 24 hours.
• Do not smoke, which can inhibit healing.
• Eat soft foods, such as soup, pudding, yogurt, or applesauce the day after the procedure. Add solid foods gradually to your diet as the site heals.
• When lying down, prop your head up with pillows. This slows the flow of blood to the location of the pulled tooth, whereas lying flat may prolong bleeding.
• Continue to brush and floss your teeth, and brush your tongue, but be sure to avoid touching the removal site in order to avoid infection.

When to Call the Dentist after a Tooth Removal

You are likely to feel some pain after the anesthesia wears off. For 24 hours after having a tooth pulled, you should also expect some swelling and a little residual bleeding. On the other hand, if active bleeding continues or you feel severe pain more than four hours after the tooth is pulled, you need to call the dentist. Notify the dentist if you experience any of the following:

• Evidence of infection, which would include fever and chills
• Nausea or vomiting
• Redness or swelling in the affected area, or excessive discharge from the affected area
• Coughing, shortness of breath, or chest pain

You can expect the healing period to last a week or two. Meanwhile, new bone and new gum tissues will grow into the gap where the tooth was.

The initial healing period usually takes about one to two weeks. New bone and gum tissue will grow into the gap where the tooth used to be. However, a gap from a missing tooth can allow the remaining teeth to shift position. This can affect your bite and make it more difficult to chew. Your dentist will probably recommend that you replace the missing tooth or teeth with an implant, a fixed bridge or denture.

Gateway Oral Surgeons at Your Service

Your dental health is important. You want to have a surgeon performing this procedure that you can trust. Let Gateway offer you the highest level of skill and competence to bring you peace of mind for all your dental needs.

It aches, throbs and may even keep you from opening your mouth. Severe TMJ disorder can be debilitating. If your TMJ pain is rooted in deeper jaw dysfunction, your dentist may refer you to an oral surgeon in St. Louis, MO for surgical intervention.

What Is TMJ Disorder?

TMJ stands for temporomandibular joint. It’s the joint on either side of your jaw that allows your mouth to open and close. Each is a concert of maxillofacial structures, including your skull, jaw bone, ligaments and a group of muscles. They’re so strong that they can exert a bite force over 200 pounds.

TMJ disorder is a broad term for a group of problems that cause pain and discomfort in the joint. In mild cases, a sufferer might experience headaches, a sore jaw and feel their jaw click when they open their mouth. In severe cases, the pain is so intense that eating is difficult and the jaw can cease opening or closing completely.

What Causes It?

Like many joint-related conditions, TMJ disorder has a number of potential causes. A dentist or oral surgeon will need to take a detail history, take x-rays and perform a through exam during a consultation appointment to pinpoint the cause.

A few of the more common causes include:

• Long-term teeth clenching or grinding (bruxism)
• Erosion or misalignment of the disk in the joint
• Cartilage damage from injury or arthritis
• Gout
• Serious misalignment of the jaw

Conservative Treatment Options

In most cases, TMJ disorder can be treated without oral surgery. Once the underlying cause has been identified, your dentist will recommend a treatment plan that’s right for you.

Some common treatments are:

• Hot/cold therapy
• TMJ massage
• Jaw stretches and exercises
• Practicing posture and body awareness
• Night guard fitting
• Physical therapy
• Biofeedback
• Orthodontic work

A night guard is a dental device fitted specifically to your teeth. Worn at night, it creates a soft barrier between your upper and lower teeth. It keeps them apart, helping the muscles relax, preventing pain and alleviating chronic spasms. You may be tempted by over-the-counter night guards, but it’s important to get a night guard from a qualified dental professional. A poor fit can make TMJ pain worse instead of better.

Severe TMJ Disorder

Surgery is a last resort for TMJ pain. It’s reserved for the worst cases and when there is a good chance that surgery can treat the underlying cause of the pain. Talk with your dentist before you see an oral surgeon in St. Louis, MO to find out if surgery could be right for you.

If your dentist recommends surgery, you’ll be referred to oral surgeons for a second assessment and treatment. Depending on the underlying cause of your pain, different surgical options may be presented to you.

Some surgical options include:

• Restorative dental work
• Jaw reconstruction
• Bite adjustment

Restorative Dental Work

Restorative dental work is typically the mildest form of surgical intervention for TMJ pain. When multiple teeth are missing, it often sets off a cascade of bite issues, bone loss and shifting teeth that easily lead to bruxism and TMJ pain. Restoring the teeth and underlying bone can help reduce stress on the jaw and alleviate TMJ dysfunction.

Dental implants are the best way to restore missing teeth and support the jaw underneath. Dental implants are titanium posts that are screwed into the jaw, often with bone grafting material, to anchor a dental prosthetic. They can be done tooth by tooth, used to anchor a dental bridge or used to anchor dentures.

If your remaining teeth have shifted significantly, restorative dental work may need to be paired with orthodontics to set your bite back in alignment. In cases of severe tooth damage, we may recommending pulling teeth and replacing them with implants rather than risk an unsuccessful treatment plan. We’ll work in concert with your dentist and orthodontist to help you make the decision that’s right for you.

Jaw Reconstruction

When a portion of the jaw is lost or weakened from missing teeth, disease or trauma, jaw reconstruction can restore bone to its natural shape, strength and health. At Gateway, we utilize the latest bone grafting techniques reconstruct the jaw.

Bite Adjustment

Surgical bite adjustment, or orthognathic surgery, addresses situations in which the upper and lower jaw don’t meet or fit together correctly. Surgery usually preceded by orthodontic work. The jaw can be moved forward or backward depending on the bite issue at hand. Bite issues this extreme can be heredity, environmental or causes by trauma.

Contacting an Oral Surgeon in St. Louis, MO

Severe TMJ pain should not be ignored. As a qualified oral surgeon in St. Louis, MO, Gateway Oral Surgery will assess your situation and offer an individualized treatment plan. If you would like more information on maxillofacial surgery, call our office today.

No two bodies grow exactly the same way. The ways in which we’re unique even extends to our teeth, and wisdom teeth are no exception. They can come in sideways, get trapped in the jaw or come in straight like any other tooth would. When you need a wisdom tooth extraction, how your tooth is positioned will determine what type of procedure you need.

Types of Wisdom Tooth Extraction

How your wisdom teeth are removed will depend on how they’re growing in. They can be straight up and down, sideways or even backwards. The biggest concern is impaction, meaning the tooth doesn’t fully erupt and is trapped.

• No Impaction: The crown of the tooth is above the jawbone and gum line.
• Soft Tissue Impaction: The tooth is covered by gum tissue. If it’s extensive, a “flap” is cut in the gum to expose the tooth and allow for extraction.
• Partial Bony Impaction: The tooth is partially exposed, but part of the crown is trapped below the gumline and in the jaw bone. An incision is made to expose the tooth, and a small amount of bone is shaved away until the tooth is exposed. The tooth is often cut in half along the crown and for easier removal.
• Complete Bony Impaction: The tooth is completely encased in the jaw bone. This is more common with sideways (horizontal) and backwards (distoangular) teeth. A “flap” is cut in the gum to expose the tooth, and the jaw bone is carefully shaved away until the tooth is exposed. The tooth will likely be cut into two or more pieces so they can be rocked out of place easily.

Why Are Wisdom Teeth So Problematic?

Anthropologists theorize that wisdom teeth are relics of our past. When our diet consisted of tougher foods like raw roots, nuts and leaves, having a third set of molars helped us crush the food and ease the wear on our teeth.

Over thousands of years, our diet got softer and our mouths got smaller. There’s less space in our mouths for a third, unnecessary row of teeth. When they try to come in, they can be forced into strange angles and get trapped beneath gum and bone. The American Association of Oral and Maxillofacial Surgeons estimates that about 85% of people will need their wisdom teeth removed.

When Do They Come Out?

Wisdom teeth typically come in between the ages of 17 and 25. If you start experiencing issues or your dentist sees where they’re going to cause a problem in the future, it’s best to get them removed right away. Younger mouths are still settling into their adult shape and recover from surgery faster and have less chace of complications.

It’s possible for wisdom teeth to come in normally and not cause concerns for many years. Our mouths are active and shift as we age. You could develop a cavity, have your teeth shift into a more cramped position or develop an abscess due to bacterial build up. Wisdom tooth extraction is appropriate whenever the teeth are causing problems, even if you’re in your 50s before something hurts.

Do They Need To Come Out?

Not everyone will need to get their wisdom teeth removed. It’s possible for the teeth to come in just like any other and never be a cause for concern. The most common reasons your dentist will recommend extraction are:

• Tooth Damage: The pressure and awkward placement of impacted wisdom teeth can damage the teeth in front of them. Tooth decay, gum disease and even bone loss can occur.
• Nerve Pain: Mouths are tight spaces. If a wisdom tooth comes in at the wrong angle, it can easily become inflamed. The pain can be considerable.
• Infection: Your normal teeth have a rim of gum tissue around the bottom edge. Wisdom teeth often erupt with excess gum tissue covering too much of the tooth. Food and bacteria can get trapped under the tissue, leading to tooth decay and painful infection.
• Disease: In rare cases, impacted wisdom teeth can cause cysts or tumors in the surrounding tissues.

Wisdom tooth extraction is a common procedure that our oral surgeons are happy to help you through. To schedule your evaluation, call Gateway Oral Surgeons of St. Louis today.

Dental implants have revolutionized how we can restore incomplete smiles. As the base for single tooth replacements, bridges and full dentures, they support your bone and give you a more stable solution for dental prostheses. For people with bone loss, your oral surgeon may recommend getting bone grafting before your implants. This now-routine procedure can help you achieve a more complete, secure smile.

Why Do Dental Implants Require Grafts?

Titanium implants sit inside the gum and jaw bone. They rely on the surrounding bone for support. In a healthy jaw, the bone will heal around a fresh implant and effectively cement it in place. A jaw with bone loss is weaker. It may not cement the implant in place, and it provides a less stable base for the implant. The amount of grafting necessary will depend on the amount of bone loss and the number of implants needed.

Not all implant procedures require grafting. Bone grafts are typically necessary when there’s bone loss in the areas where the implants need to go or the jaw isn’t otherwise enough for the implants. In some cases, a surgeon may decide to use grafting as an “insurance policy” to make sure an implant will be successful even in a healthier jaw.

Why Does Bone Loss Occur?

Our bones are living tissues. They can be damaged by disease and often rely on other structures to support them. The most common cause of bone loss is missing teeth. The bone in our jaw is strengthened by the pressure of our teeth and the action of chewing. When a tooth is lost, the surrounding bone reabsorbs into the body. The longer the tooth has been missing, the more extensive the bone loss will be.

Gum disease is another common cause of bone loss. As the infection sinks below the gum line, it loosens the teeth and weakens the bone. Because of risk factors like diabetes, dry mouth, hypertension and weakened immune systems, the elderly are disproportionately at risk for gum disease. Any disease that causes bone loss directly, like osteoporosis, can weaken the bone as well.

How Bone Grafting Works

Bone grafting works by combining a graft material with a growth medium. The graft material works like a scaffold, encouraging your body to fill in the spaces around the graft with fresh bone.

The graft material can be artificial “bone”, sterile donor bone or bone taken from your own body. It’s crushed into a powder and mixed with a growth medium. The growth medium is a mixture of collagen and protein that stimulate bone growth.

Gateway Oral Surgeons offers two augmented implantation methods: Platelet-rich plasma uses platelets taken from your own blood. Platelets are rich in growth factions, and they’ve been shown to improve the speed, healing time and overall success rate of bone grafts.

Bone morphogenetic protein (BMP). BMP occurs naturally in your own body, though in small amounts, and stimulates bone healing and growth. We use an identical, lab-created version. It’s soaked into a sponge made of collagen and set in place with donor bone tissue.

Associated Procedures

In some cases, like for implant-supported dentures, you may have bone grafting done on the same day as your dental implants. In cases of extensive bone loss, you may need separate grafting with an accompanying procedure to restore your jaw thickness prior to implant placement.

• Sinus Augmentation: One of the best places to put an implant is often the molar region of the jaw. Unfortunately, it can also be a difficult area. The bone is thin with the sinus cavity in close proximity. During a sinus augmentation, the sinus floor is surgically lifted and then thickened with bone graft material.
• Ridge Modification: Bone loss anywhere along the inside ridge of the jaw can complicate implant placement. Incisions are made along the gums to expose the affected area, and the problem spot is filled in with bone grafting material.
• Distraction Osteogenesis: Bone loss often causes the jaw to shrink. During distraction osteogenesis, a key area of the bone is cut and carefully pulled apart. The space is packed with grafting material to thicken the site.
• Socket Preservation: Socket preservation, also known as aveolar ridge preservation, is performed at the same time a tooth is pulled to help preserve the bone. The wound is packed with grafting material and either sutured closed, or covered with a collagen material..

For more information or to schedule a consultation, contact Gateway Oral Surgeons of St. Louis.

Fear of pain and dental anxiety are two of the most common reasons people put off essential dental work. At Gateway Oral Surgeons, our doctors want you to be comfortable during your procedures. Modern anesthesia gives us safe and effective ways to help manage pain and anxiety during surgery. Our guide will familiarize you with how each one works and what options you have available.

Local Anesthesia

At the start of your procedure, we’ll use local anesthesia to numb the area. Local anesthetics work only around the area where they’re applied, but they can be powerful. Local anesthetics administered in your gum line, for instance, can end up numbing your lips and cheek for several hours.

Local anesthetics are divided into two categories:

• Topical: These are used to numb the surface of tissues. We typically use them to numb areas before we inject a stronger anesthetic to make the injection more comfortable.
• Injected: These numb a broader but still controlled area. When we need to numb deep structures, we may use a few progressive injections to minimize your discomfort. That way, the needle rarely touches an area that hasn’t already been numbed.

Local anesthetics offer the lowest risk, but you’ll want to be careful while it wears off. You can easily bite your lip, tongue or cheek. It might not hurt now, but it will later. Stick with soft foods until you regain sensation.

Nitrous Oxide

Nitrous oxide, also known as “laughing gas,” is a form of inhaled, light sedation. While you remain conscious, it helps you feel more relaxed, content and even happy.

One of the biggest benefits of nitrous oxide is that you can control how much of its effects you feel. If you want to feel more of an effect, you can simply breathe slowly and deeply. It’s also eliminated from the body quickly.

Nitrous oxide is cost-effective and offers minimal risk. For minor procedures and patients that experience mild to moderate anxiety, it’s an invaluable tool.

Oral Sedation

Oral sedation is a moderate form of conscious sedation administered as pills. You’ll likely retain memories of your procedure, but it’s strong enough that you’ll need a ride to and from your appointment.

Your surgeon can prescribe a medication for you to take approximately an hour before your appointment time. This way, you’ll arrive at your appointment relaxed and comfortable. Oral sedation is often the most affordable option and can be an economical choice for patients without dental insurance.

One drawback to oral sedation is that its effects and duration can vary. If you’ve taken an oral sedative in the past that worked well for you, mention it to your oral surgeon to see if it’s an option. Oral sedation is safe for most patients, but it’s important you give your doctor a full, honest and accurate list of all medications you take to prevent possible interactions.

Intravenous Sedation or General Anesthesia

Intravenous sedation, also called IV sedation or “twilight sleep,” is the deepest form of conscious sedation. It puts you in a state of profound relaxation and security. IV sedation often uses the same medications as oral sedation, but they’re significantly faster and predictable when administered intravenously. IV sedation is our most effective tool for patients with anxiety.

Complications from IV sedation are extremely rare. The medication is administered gradually and monitored at all times. The most pressing concern for most patients needing a ride home. IV sedation can leave you disoriented and sleepy for several hours. Children under the age of 18 will need to be accompanied by a parent or guardian that stays in the office until the procedure is complete. All patients undergoing IV sedation/general anesthesia must have a responsible adult bring them to the office, say in the office during the procedure and take them home.

As with oral sedation, it’s important you give your surgeon a complete list of all medications you take prior to your appointment date. On the day of your appointment, remember not to eat or drink anything after midnight. This is a very important and can be life-threatening if this is not followed.

Our Oral Surgeons

Always seek sedation from dentists and surgeons with the proper training and certification. At Gateway, both Dr. Scott Nolen and Dr. Hiran Fernando have advanced training in anesthesia.

From pain relief to stress relief, anesthesia makes dental procedures easier and more comfortable. If you’re ready to schedule your appointment, call Gateway Oral Surgeons of St. Louis.

A good night’s sleep is invaluable. Adequate sleep helps us stay focused and productive, keeps our brain elastic and improves our mood. It even reduces the risk of certain diseases. For patients with obstructive sleep apnea (OSA), their own bodies steal away the sleep they need night after night. OSA has different causes, and oral surgery is a potential treatment option for certain candidates.

What Is Obstructive Sleep Apnea?

Sleep apnea is a serious sleep disorder that causes your breathing to stop and start while you sleep. There are two main types. With central sleep apnea, the brain fails to send proper signals telling your body to breathe. With obstructive sleep apnea, a structure in the upper respiratory system is slumping when your muscles relax and blocking air flow. OSA is the most common form of sleep apnea

Picture the respiratory system like a straw that you’re inhaling and exhaling through. In a healthy respiratory system, air can flow easily in and out of the straw. For people with OSA, it’s as if they have a rubber flap partially or completely blocking the tube. You have to inhale and exhale harder to force air through. When you exhale hard enough, the flap can vibrate and make noise. This is why people with OSA tend to snore.

In adults, OSA can cause:
• Nighttime restlessness
• Snoring that tends to be severe
• Teeth grinding
• Night sweats
• Headaches
• Low blood oxygen during sleep
• Cardiovascular stress
• Daytime drowsiness and fatigue
• Trouble concentrating and decreased productivity
• Depression, forgetfulness and irritability

In children, OSA can also cause:
• Bedwetting
• Learning and behavior disorders, both short and long term
• Difficulties at school
• Trouble socializing

When Oral Surgery Is Appropriate

OSA needs to be diagnosed by a sleep specialist following a sleep study. After diagnosis, most patients are given a device called a PAP (positive air pressure) machine to help them breathe at night. PAP machines use air pressure to keep the airway open and have high treatment success rate. PAP does require wearing a face mask at night, and not all patients adjust to it. For patients that find themselves not using their machine, surgery could be an alternative treatment.

To determine if you’re a good candidate for oral surgery, your doctors need to determine the extent, type and location of your blockage. They’ll take a detailed medical history and assess your maxillofacial region. They may review or take new x-rays and could perform a naso-pharyngeal endoscopy with a flexible camera.

Different types of doctors may handle different types of blockages. For the soft palate, hard palate, jaw and some structures in the back of the throat, an oral surgeon steps in.

Maxillomandibular Advancement (MMA)

MMA addresses the bone structure of the upper jaw, lower jaw and chin. Rather than trimming back tissue to open the airway, MMA widens the airway by shifting bone forward. The jaw is advanced by 10 to 12 milometers and stabilized with titanium plates and screws. It’s typically limited to patients with small, narrow jaws or a recessed lower jaw and chin. MMA is rarely recommended, but it sees a roughly 90 percent success rate when it is.

At Gateway, MMA is performed under general anesthesia at the hospital. A brief hospital stay is necessary. In order to ensure the teeth match up correctly, the jaw must be held shut while the bones heal. Patients start on a liquid diet and progress gradually back to a solid diet. MMA procedures also alter the patient’s appearance. The chin is moved forward and becomes more prominent.

These are only a few of the surgical procedures for OSA. If you have OSA and want to know if maxillofacial surgery is an option for you, schedule a consultation with Gateway Oral Surgery today.