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Wisdom Teeth

Wisdom Teeth

Wisdom teeth are the third and last permanent molars to develop, usually in your late teens or early twenties. Sometimes these teeth erupt into the mouth and are properly aligned, but most often they are misaligned and require removal via oral surgery.

Many people’s jaws are too small for wisdom teeth to erupt into the mouth and the teeth often become impacted (unable to fully erupt). They may grow sideways, partially emerge from the gum, or remain trapped beneath the gum and bone.

Mayo Clinic impacted Wisdom teeth illustration

Impacted wisdom teeth can become infected, leading to swelling, stiffness, and pain. Pressure from erupting wisdom teeth may disrupt the natural alignment of other teeth. Partially erupted wisdom teeth are prone to tooth decay and gum disease. More seriously, tumors or cysts can form around impacted wisdom teeth, destroying the jawbone and healthy adjacent teeth.

Your dentist may recommend the removal of your wisdom teeth before problems develop. This is especially true in your teenage years when the wisdom teeth’s roots are not fully developed and the surrounding bone is less dense. At this stage, surgical risks, potential complications, and post-operative recovery time are reduced

Studies have documented that early treatment results in a superior outcome following surgery.

Your Dental Evaluation

reviewing x-rays before procedure

During your initial visit, your doctor will evaluate your x-rays, perform a complete oral examination, and review your dental and medical history. He will evaluate the need for removal of your wisdom teeth and the potential risks and complications involved with your surgery.

Your doctor will discuss your options for anesthesia (local anesthesia, a combination of local anesthesia and laughing gas, or IV sedation) and discuss what you can expect after surgery. Following your evaluation, we will review your pre-operative instructions and schedule your surgery appointment.

The Procedure

The surgical approach will vary depending on the position of your wisdom teeth and this will be discussed with you during the consultation. An incision is frequently made in the gum to get access to the tooth and then the gum is closed with dissolvable sutures.

Upon discharge, you will receive post-operative instructions, extra gauze pads, a prescription for pain medication, and possibly a prescription for an antibiotic. You will also be given an emergency contact number where you can reach your surgeon should you have any questions or concerns.

At NCOSO, we provide Oral surgery procedures in a safe environment, utilizing modern monitoring equipment and surgical team members who are experienced in anesthesia techniques.

Surgical Removal of Teeth

We routinely perform the surgical removal of severely decayed, fractured, or infected teeth. As with wisdom teeth, these teeth can be removed under local anesthesia, a combination of local anesthesia and laughing gas, IV sedation, or general anesthesia. Often other adjunctive procedures may be completed at the same time to facilitate utilization of a partial or complete denture.

Contact NCOSO to schedule your wisdom teeth removal today. We have locations throughout North Carolina in Cary (Tryon Rd and St Charles Place), Dunn, Garner, Greensboro, Hamlet, Raleigh, Southern Pines, and Winston-Salem!


Dental Implants

Dental Implants

Implants are small titanium threaded cylinders, which are inserted into the jawbone where teeth are missing. These metal anchors act as the tooth root (the portion of the tooth beneath the gum). They are surgically placed into the jawbone. A small incision is made in the gum tissue and a series of small drills are utilized to create a small hole in the jaw where the titanium screw can then be placed. The bone bonds with the titanium, creating a strong foundation for artificial teeth.

A small post (abutment) is then screwed into the implant. The abutment is the part of the device that connects the implant beneath the gum surface to the crown which is above the surface. The crown, or the portion of the tooth that you see when you smile, is either glued or screwed on into position. When implants are done well, there is no way to tell if it is a natural tooth or an implant unless a radiograph (Xray) is taken. Surgery can take between one and two hours per implant.

Anatomy of a Dental Implant

One Stage Implant vs Two-Stage Implant

There are two main techniques for placing implants – a stage one or a stage two surgical technique. As the name suggests, one is performed in a single step while the other requires a second surgery.

With a stage one technique, a connector that attaches the implant from the bone into the mouth is placed. As previously mentioned, this is known as an abutment. Following a three (3) to six (6) month healing period in which the implant fuses to the bone, a crown is placed on the implant restoring the immediate appearance of a healthy, normal tooth.

With a stage two technique, the implant(s) are placed into the jawbone and the gum tissues cover them. The implant(s) are not exposed to the mouth, rather they stay buried and are left to heal. Once healed, a second surgery is performed to attach an abutment for securing the crown in place. This approach is most commonly used when there is poorer bone quality or quantity.

Our oral surgery staff and surgeons are ready to answer all questions regarding dental implants. If you are interested in learning more about dental implants, please contact NCOSO or request an appointment online here.

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Tooth extractions are usually performed due to a tooth having been broken or damaged by decay that cannot be repaired. Extractions may also be conducted before placing prosthetics such as dental implants, bridges, or dentures.

Durham NC Oral Surgeon Orthodontist

The Tooth Extraction Process

If a simple extraction is right for your individual situation, your doctor will use a local anesthetic to numb your tooth, gums, and jaw bone. Next, he or she will loosen your tooth to widen the socket for removal. When the loosening occurs, you can expect to feel a great amount of pressure, however, this won’t be painful due to the numbing medication administered.

If your tooth cannot be removed through a simple extraction, a surgical extraction will need to be performed. This procedure involves cutting into the gum tissue in order to increase access to the tooth that needs to be extracted. Typically, surgical extractions are only necessary if a tooth is severely broken or completely failed to emerge into the mouth. Both of these procedures will always involve local anesthesia before the process begins.

Types of Anesthesia and Pain Medication after Extractions

At NCOSO, we aim to deliver quality surgical expertise in a comfortable caring environment. Our Oral Surgeons, Sedation Dentists, and our staff are specially trained to administer and monitor all sedation and anesthesia options. Local Anesthesia is always used to numb the area in which the tooth in question is to be removed. We also offer sedation options to help relax patients during oral surgery such as Dental Nitrous Oxide sedation or IV sedation. Read more about your anesthesia options here.

Pain medications after oral surgery vary from patient to patient and are ultimately up to you and your doctor’s discretion. Based on your doctor’s recommendations, you may leave with NSAIDs such as Ibuprofen or another pain med prescription. At NCOSO, our offices are now proud to offer our patients an Opioid-free pain medication called EXPAREL. This is a non-habit-forming pain medication that is injected into the site of extraction during the procedure and delivers long-lasting pain relief. Find out more about EXPAREL and ask your doctor if EXPAREL may be right for you!

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What to Expect After a Tooth Extraction (Post-Operative Care)

After tooth extraction, you will bite down on gauze (cotton dressing) for approximately 30 minutes to an hour so that a blood clot can form and stop the bleeding. If your bleeding continues, you should use another piece of gauze and firmly bite for another half hour.

Once the blood clot forms, it’s crucial to avoid disturbing it. Refrain from vigorously rinsing, smoking, drinking alcohol, brushing teeth, eating hard foods, sucking on straws near the extraction site, and working out for about 3 days. By engaging in these types of activities, you may obstruct the healing process. You should also take pain medication as prescribed and use an ice pack to reduce swelling.

Learn more about our Post-operative care suggestions here | Contact Us

Contact NCOSO For Further Information

In the event that you do need a tooth extraction, we can provide you with quality treatment in a comfortable and safe environment. Request an appointment with NCOSO today!