I am Dr. Andrew Comerci and Integrity Dental on the north side of Pueblo, CO. Today I would like to answer some questions regarding Oral Surgery.
When is a procedure considered Oral Surgery?
Oral Surgery can generally be described as anytime we are doing some kind of invasive procedure where we are either removing a tooth or agitating gums or tissue in the mouth.
What are the common types of oral surgery and why might they be necessary?
The most common oral surgery procedure is the removal of a tooth which is also called an extraction. This could be necessary for several different reasons; a bad infection can cause a tooth to be removed and that can result from a cavity or broken tooth. Sometimes we can extract for orthodontic purposes to make space when a tooth is poorly positioned. But the most common oral surgery is an extraction of a tooth.
Other kinds of oral surgery would be gum-grafting, when your gums are receding down past the tooth and exposing roots, we can take a piece of tissue from the roof of your mouth and transplant it over to cover the roots, that is also called gingival grafting. Another procedure that is very common is implant therapy. When you are missing teeth and you would like to have those teeth replaced, the best way to do that in most cases is with an implant. An implant is basically a post that will go into the bone, the bone heals around the post, and once it’s solid in the bone we can build teeth on it and get you your teeth back in areas you didn’t formerly have them!
Other oral surgery procedures that are less common are biopsies of soft tissue to make sure that it is not cancerous, and in some cases gum surgeries to help you with gum disease. So realistically, there is a wide range of things that classify as oral surgery, but anything that is a little more invasive outside of the typical filling or root canal or crown could be considered oral surgery.
What is Maxillofacial Surgery?
Maxillofacial Surgery is a fancy way of saying a surgery that involves the upper or lower jaws. So, any kind of oral surgery could be considered Maxillofacial Surgery. Maxillo = upper jaw, facial = anything in the face.
What happens during Oral Surgery?
The first thing the dentist should do is explain the procedure. So, when you sit down in our chair, we would say “this is what we have planned today, this is why, and this is what you can expect.” So, before we begin the procedure, you should have a very good conceptual idea of what the plan is and what to do after that fact for healing. Then, the dentist will apply local anesthetic to make sure that you are very comfortable during the procedure. After good anesthetic, oral surgery should not be painful, it may be a little uncomfortable having someone in your mouth working, there may be some noises or some pressure that can be a little unpleasant, but it should not be painful with good anesthetic. So, once you are anesthetized, the dentist will go to work at whatever the job is, the job will be completed, and there are sometimes sutures after the procedure or gauze in the mouth that the patient will bite on to help stop the bleeding. And then there will be a good description of post operative pain control that will involve oral medication or otherwise.
So, it starts with a good explanation of care, some good anesthetic/numbing, then the dentistry itself and then the explanation on how to take care of yourself after the fact.
Can my regular dentist perform oral surgery?
Another term we would use is a “General dentist,” or a family dentist. And the answer is, definitely. Different dentists have different skillsets. Different types of dentists do different types of dentistry. But the typical general dentist will do at least some oral surgery, meaning some dental extractions, maybe some biopsies, or some other gum procedures perhaps. But it depends on the dentist. Here at Integrity Dental, we are a comprehensive dental office, which means we do almost everything. We refer very little out because we have the training and expertise to do the wide scope of the majority of what you would need, right here in our office. We, as comprehensive dentists, do oral surgery. But in some other dental offices they may refer you to an oral surgeon, or a periodontist, to have the surgery done, and then return to them for other care.
It ultimately depends on the dental office what procedures are offered.
How should I prepare for Oral Surgery?
The first thing you should do is make sure that you understand what the process is. A good dental team, as we do at Integrity Dental, will spend sufficient time explaining what the condition is, making sure that it is put in terms the patient understands, what the treatment options are, and what the plan is once you have decided how to proceed. Then, before coming to an oral surgery, you want to be comfortable. You will want to make sure that you are in comfortable clothing. You also may want to consider taking some medication before the surgery for pain management. Of course, this will depend on if you are on any medications already and what kind of surgery you are having. But often, a preoperative dose of Ibuprofen and/or Tylenol can be very helpful with post operative discomfort. Next, come on time! Sometimes even a little early can be helpful. And be sure to ask any and all questions you may have to be ready for post operative care.
What anesthesia options will be available to me during oral surgery?
Well, there are different ways to think about anesthesia. Let’s step back and think about anxiety control. If you have oral surgery coming up and that is causing a significant amount of anxiety or nervousness, have a conversation with your dentist about ways that the treatment can be done to help minimize your nervousness and anxiety. Here at Integrity Dental, we have various options, and we like to discuss those options before the procedure and how we can get you into dentistry in a way that is a positive experience. The first thing we would offer would be nitrous oxide (NO2). Some people call it laughing gas, and this is a very common medication used with children. It’s a nose piece that goes on and you breathe in a gas called nitrous oxide and it makes you very relaxed. It doesn’t actually sedate you; it just takes the edge off and helps you feel a little more mellow and helps you tolerate the procedure. It works very well for patients who just need a little nudge into the chair and feel more relaxed. Another common way to help you relax in the chair and not so anxious is oral medication. The medication can be called Valium, Halcion, or Triazolam. It is basically an anxiety control drug that we can give before the procedure. NOTE: a patient cannot drive once they have taken this oral medication. They must be driven to and from their appointment. You will feel a little sleepy, a little relaxed, the procedure will happen, and then it will be time to drive home! This is a common treatment and very inexpensive.
For more invasive procedures, say wisdom teeth surgery, particularly when we are doing multiple wisdom teeth in one sitting, or we are doing a significant amount of dentistry, or if we have a patient who has a significant history of dental anxiety, we can also offer what is called conscious sedation (IV sedation/ “twilight sedation”). What that process looks like is we would start an IV in your arm which is essentially a little tube that goes in your vein, so that we can give medication and fluid right into your system and we would then give medications that make you very relaxed and sedated. Little by little you will start to feel very relaxed until you are just floating around not minding what’s going on. Patients will not typically remember the procedure when they do IV sedation. The dentist will numb things up once you are sedated and make sure you are comfortable, do the dentistry, and then have someone else drive you home. So, to answer the question “what are different types of anesthesia,” well anesthesia in some people’s minds means simply relaxation and helping with anxiety and there are several ways to do that (medication, nitrous oxide, or sedation), but as far as the anesthetic, which is the numbing agent, what we use is called local anesthesia. That will involve an injection in whatever area we are working, we do very well at injecting and work very hard to make you comfortable. You should not feel anything when we are working with the exception of pressure, noise, or water as we are cleaning. It should be very minimal pain if any at all.
Can I drive myself home after oral surgery?
Most patients arrive by themselves and leave by themselves after oral surgery when we use local anesthetic only which is what we typically use. With only local anesthetic, your mind and your faculties are still intact, and you can drive yourself home. If you are taking advantage of one of our sedation dentistry options, whether that is oral or IV, you will need to have an escort that will come with you and drive you home. So as long as you are not getting any sort of sedation, you can arrive and leave all by yourself.
How can I minimize pain and discomfort after oral surgery?
A good way to do that is to have pain medication on board before the treatment. The most common medication would be Ibuprofen, and/or Tylenol. Ibuprofen and Tylenol can be combined. Of course, you will want to check with your doctor and dentist to make sure that those medications are safe for you to take. But for the typical patient, a dose of about 600mg of Ibuprofen about 30 minutes before the procedure or on the way into the dentist will help to get some of that medication on board so that by the time the surgery is over, you’ve already got pain medication on board and that will produce post operative pain control. Some other things that will help are to be prepared with good hydration. So, make sure you are not thirsty or overly hydrated before coming into the dental appointment, and then having some good post operative care available for you afterwards like having some easy foods to eat and chew, things like soup and mashed potatoes. This can help with post-operative pain because it will reduce the touching in the mouth after surgery. You can also be ready with ice packs to use; we also recommend that patients sleep with a little bit of extra elevation to keep their head above their heart in order to minimize swelling. Anything that you can do to reduce swelling will reduce pain.
How long does it take to recover from oral surgery?
Well, that is very specific about to procedure you will be having. Our general answer to this question is 2-3 days. Studies have shown that pain and swelling will usually peak around the 48–72 hour window. So, if you were to do surgery today you would know that your pain will likely be worse on the second or third day. So, most patients, if you can get through those first 3 days with good pain management, good rest, good icing, most of the time you can get back to life as normal on that fourth day. But of course, the more invasive the surgery, the more involved it is, the longer it will take you to recover. So, that’s a good question to go over with your dentist when going over the procedure you are going to be having.
Does insurance typically cover the costs of oral surgery?
It depends on the insurance plan. That being said, most good insurance plans typically cover basic oral surgery, meaning basic extractions or other surgeries the patient will likely need. It doesn’t always cover implant therapy, it doesn’t always cover bone grafting and some of the extra things that we do that can be very helpful. So, it’s something that you will want to know well. Read your insurance plans when you know that you need a dental procedure, ask your dental team to help explain those benefits to you and we can help give you an idea of what your out of pocket. Long story short, a good percentage of oral surgical procedures are covered by insurances, but every plan is different, and you will want to find out beforehand!
If insurance does not fully cover the cost, is financial assistance available?
This is a great question to ask whatever dental team you are working with! Here at Integrity Dental, we do offer various payment plans. The first thing we would do is try to make sure the dental treatment matches the patient’s budget. We don’t want a patient to invest in things that are outside their ability to cover reasonably. We never want you to be overstretched. So, once we are in the ballpark of something that will work well for you, we have different ways to pay for it. If you are not getting great insurance coverage and you don’t have the money at the time and still want to do it, we can look into what is called CareCredit. CareCredit is a lending agency that helps patients with medical, dental, and veterinary expenses and they can offer a short-term loan. These loans can be 3 to 6 or even up to 24 months. So, the cost of the dentistry can be broken into monthly payments. Sometimes there is even a grace period or waiting period before the first payment is due. Sometimes the loans can have interest if going beyond 6 months, so we try to avoid that if possible. We will often break payments up into three months. If a patient comes in and does not want to do any CareCredit and cannot afford the treatment at the time, we can break it up into 3 even, monthly payments. We often won’t go for longer than three months, but every office does things differently so you may find other options. But that is how we do it here at Integrity Dental.
How can I get scheduled to discuss oral surgery?
The easiest and best way is to contact us over the phone; our phone number is 719-545-2468. Give us a call and talk with one of our treatment plan coordinators, or get an exam and speak with one of the dentists so that we can go over the different options for treatment and have one of our treatment plan coordinators go over finances including what your insurance is likely to cover and what your estimated out of pocket expense will be.
I hope this discussion on oral surgery has been helpful! If we didn’t cover the question you had, please give us a call and set something up with us! We are a comprehensive General Practice on the north side of Pueblo. You can reach us again at 719-545-2468 or look us up online at letushelpyousmile.com
Thanks very much!