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Oral Surgery/Anesthesia for wisdom tooth extraction


I'm 43 and still have my wisdom teeth (I know it's bad...but they never gave trouble). Three months ago, I gave birth to my first -prob only- child. During pregnancy, my top wisdom teeth broke the gums and are causing headaches/toothaches. I'm chronic hypertensive (managed with procardia and labetalol) and homozygous for MTHFR (take a baby aspirin a day and 1mg supplement of folate daily). I've heard N2O is a no no for people with MTHFR and two years ago, the roots of my wisdom teeth were all long and some were quite gnarled. As I was going through fertility treatments, my docs suggested I postpone extraction. What are the best options for this wimp whose dentist has to use loads of novocaine to numb her and who can't stand hearing the tooth extraction noises? I'm sure my age and BP issues could make for a complicated process not to mention the state of the teeth/roots. Any advice?

Staci, MTHFR is contraindicated for Nitrous Oxide inhalation. It is not a contraindication for general anesthesia however. There are many medications that you Oral and Maxillofacial surgeon have in their arsenal that will provide you enough anesthesia so you can sleep peacefully and have the teeth removed. The hospital setting might be better for you v. in an office setting. I hope that helps.  

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James M. Ryan. DDS, MS; Board Certified Oral and Maxillofacial Surgeon


Dr. Ryan's expertise is in the field of Oral and Maxillofacial Surgery. Specifically, Dr. Ryan is an expert in Orthognathic Surgery. He holds uniques experience as the former Assistant Program Director of the Oral and Maxillofacial Surgery Residency Training Program at Washington Hospital Center where he trained residents to perform these complicated surgical procedures. Additionally, Dr. Ryan also has a tremendous amount of experience in reconstruction of the maxillofacial skeleton related to trauma and tooth loss. Dr. Ryan is an expert in 3 dimensional treatment planning for Orthognathic Surgery, Dental Implant Surgery and Wisdom Teeth removal. To learn more about Dr. Ryan, his full profile can be seen at


Diplomate of the American Board of Oral and Maxillofacial Surgery with current hospital affiliations at: Washington Hospital Center Holy Cross Germantown Hospital National Institute of Health/NIDCR

American Dental Association. American Association of Oral and Maxillofacial Surgeons. District of Columbia Society of Oral and Maxillofacial Surgeons. District of Columbia Dental Society. American Board of Oral and Maxillofacial Surgeons. Health Volunteers Overseas.

Journal of Oral and Maxillofacial Surgery Journal of The American Dental Association

S.U.N.Y @ Stony Brook- B.S. in Biochemistry, Stony Brook, NY. Northeastern University- M.S. in Perfusion Technology, Boston, MA. D.D.S.- New York University College of Dentistry, New York, NY. Certificate and Chief Resident- Washington Hospital Center, Washington, DC. Clinical Fellow- The Johns Hopkins Hospital, Baltimore, MD.

Awards and Honors
Dr. Ryan has received numerous awards including: 2006 American Association of Oral and Maxillofacial Surgeons Dental Student Award, Washington Hospital Center 2008 Nurses' Choice Physician Collaboration Award, 2009 Resident Research Summit Scholarship Award, and the 2011 Outstanding Surgical Attending in the Department of Oral & Maxillofacial Surgery at Washington Hospital Center. He has also authored/coauthored and published several journal articles and held several teaching positions,including assistant professor, while at NYUCD.

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