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Oral Surgery/Tooth extraction


QUESTION: Dear dr. Joel S. Teig,

I have an old root canal with crown, tooth # 30.   The root cracked and is infected.  
The surgeon prefers to give me local shots to numb the area and twilight general anesthesia.
I am leaning for local only because I get  nauseous easily with any anesthesia.  
Is their any reason why I should not use local shots for pain solely for the extraction and future procedures
For an implant?
I've never had a problem with local injections for a root canal why would it be a any
Different for an extraction and later   a implant?

Thank you

ANSWER: Kay - Local anesthesia can be utilized for the extraction and the implant, but there is a major difference between removal of decay and placement of fillings.  With and extraction and with implant placement, there is more than just pain.  Sure local anesthesia can make it numb, but there is significant pressure and cracking sounds associated with the implant.  These other stimulants (pressure and sound)are often uncomfortable for many patients.  These patients are the ones where general anesthesia or heavy sedation is necessary to curb the discomfort of the pressure, cracking sounds and other sounds.  With an implant, again there are sounds and pressure which many find uncomfortable.  

Root canal treatment can produce some pressures, but no where near the extent with an extraction or implant placement.  So my suggestion, if you have any apprehensions at all, have the doctor sedate you or use light general anesthesia.  The key factor is to make sure the doctor is a board certified oral and maxillofacial surgeon.

If you have any questions or clarifications, do not hesitate to get back to me.

---------- FOLLOW-UP ----------

QUESTION: Dear dr. Teig,
Because of the infection the dentist explained after the extraction,  I must wait 3 months for healing before he can even begin
the process of starting the Inplant.  He thinks I have enough bone that no grafting or very  little will be necessary when he starts 3-4 months later.
By waiting 3 months, won't I start loosing gum and bone loss? Or waiting 3-4 months will not be a long enough time to effect
the gum and bone.
Per the dentist, After the extraction I will not have anything over the gum while healing.
Thank you kindly for your help.

ANSWER: Kay -  if you do have an existing infection, the dentist is completely correct that you must wait a minimum of 3 months after the extraction before implant placement is performed.  After the extraction, leaving the socket open is the best way to achieve a sound healthy site for the implant placement.  So I agree that waiting is correct.

Rather than losing gum and bone, this will retain the tissues and allow a healthy healing to retain them.

---------- FOLLOW-UP ----------

QUESTION: Dear Dr. Teig

I had my #30 molar extracted last Tuesday,
The oral surgeon ended up breaking down in pieces the remainder of the tooth, root canal  in pieces, used a drill and cut and sew the gum.
The dentist put me on antibiotics because of the infection.
The next day I went back in since I was still bleeding.  Another oral surgeon cleaned the socket and put
In surgifoam to help stop the bleeding. I recall that he said before putting in the surgifoam the socket was starting to clot?

I have a little swelling in the lower jaw and saliva gland. Low grade off and on throbbing pain in jaw area but I think it's from the gums and not the socket?  (I have Dry mouth caused by the drug Arimidex  I think.)
Drinking lots of water and keeping my mouth clean.  Breath slight order unless drinking water.
The socket when looking with a flashlight is lumpi  with yellow-creamy,pink and some dark specks.

Questions please:
1: I read that you should not use surgifoam if their is an infection or with stitches present.   Since the dentist cleaned the socket first before is using the surgifoam ok?  The stitches are not covering the socket just for the cutting of the gum.
Im terrified of getting a recurring infection.
2:  is the bumpie creamy,ping with dark normal and how much longer will healing take place because of the surgifoam?

Thank you again for your help.

Kay -it is definitely preferable to not use the gel foam if there is an infected present.  The use of the foam might have been necessary to stop bleeding.  In that situation, the use of the foam is imporant, but the doctor must to prevent infection by having the patient a minimum of 10 days antibiotic to contain or kpreferably urtail the infection.  Repeat antibiotic might be necessary until all signs of an infection is definitely gone. So make sure to have the surgeon follow the healing until all assurances from the doctor have been made.

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Joel S. Teig, DMD, Diplomate ABOMS, retired


I am a board certified oral and maxillofacial surgeon available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.


Board Certified Oral and Maxillofacial Surgeon practicing for over 20 years. Assistant Clincal Professor at State University School of Dentistry.

American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

BA- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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