Completing extraction of a tooth is not always predictable- the tooth is coming out for a reason, and not because it is healthy! This typically means large decay on the tooth, infection/abscess of the bone or soft tissue around the tooth, or the tooth is impacted under the tissue or bone. Sedation is the only way to ensure the patient is completely comfortable regardless of how difficult the procedure.

Local anesthesia is not necessarily safer for sick patients. Many patients referred to us have complicated medical histories, including cardiac or lung issues. Achieving local anesthesia requires multiple painful injections and is not always completely effective. This can lead to issues due to pain causing elevated blood pressure/heart rate/respiratory rate that can create problems in medically compromised patients. Sedation allows us to control these variables and complete the procedure quickly and comfortably which results in fewer medical complications. 

It is not always possible to get the tooth/bone completely numb with local anesthesia. Due to infection/inflammation of the bone or soft tissue around the tooth, local anesthesia alone cannot always achieve complete numbness during the procedure. Sedation allows us to know that the procedure can be completed comfortably. Attempting surgical procedures with local results in increased patient discomfort, a prolonged surgical time, and possibly not being able to complete the procedure.

We are a surgical specialty- this is not dentistry. We are not doing fillings. Surgery on every other part of the body is completed under anesthesia. We are performing highly invasive procedures on the bones and soft tissue of the facial skeleton. Completing these procedures under local anesthesia would not be an option for an ENT or orthopedic surgeon. 

The dentist has referred the patient to us for a reason and a general dentist is fully capable of performing extractions under local anesthesia. If the dentist is not comfortable performing the extraction it is because of a highly difficult aspect of the procedure: high risk of a tooth breaking during procedure, risk of injury to nearby structures (sinus cavity, nerve, etc), inability to achieve adequate numbing, or patient specific factors such as a complicated medical history. The ability to provide sedation allows us to complete the procedures comfortably and safely for the patient which is why they are being referred to us!

Your oral health can offer clues about the rest of your body’s health. Poor oral hygiene can have negative impacts on the rest of your body. What different links can you look out for?

• Cardiovascular disease: Poor gum health has been associated with increased risk of cardiovascular disease, including heart disease and strokes. Clogged arteries might be linked to the inflammation and infections that oral germs can cause
• Endocarditis: This is an infection of the inner lining of the heart chambers and valves. This most often happens when germs enter the bloodstream and attach to damaged areas of the heart. Although this affection is rare, it can be fatal.
• Pregnancy and birth complications: Periodontitis has been linked to premature birth and low birth weight through infections and inflammation. These issues can potentially affect the health of the unborn baby and lead to complications during pregnancy.
• Pneumonia: bacteria from the mouth can move down into the lungs and cause respiratory infections. This is a high risk concern for the elderly and those with compromised immune systems. 

Other health issues also have direct relationships with your oral health, such as:

• Diabetes: Diabetes makes the body less able to fight infections, which puts your gums at risk. Gum disease seems to happen more often and be more serious in those with diabetes. Additionally, high blood sugar can increase the risk of gum infections. 
• Osteoporosis: Osteoporosis can lead to bone loss in the jaw. With bone density reduction, the shape of your mouth and the position of your teeth can change.
• Alzheimer’s Disease: Poor oral health has been linked to an increased risk of cognitive decline and Alzheimer’s disease. As the disease gets worse, oral health also gets worse.
• Cancer: A number of cancers can be linked to gum disease. Such as oral cancers, lung, breast, and gastrointestinal tract. 

More conditions that may be linked to oral health include eating or immune system disorders and arthritis. Ensure your dentist is aware of your health status and that they are aware of the medications you take. 

Protect your oral health by brushing your teeth, eating a healthy diet and limiting sugary foods and drinks, and see your dentist for check ups every six months.

Any time you go through with a surgical procedure, there are risks of complications. Different health conditions can increase your risk for complications, but your surgeon is well trained in helping reduce these risks.

Although each patient case is different, many risks for oral surgery can be the same. The term Oral surgery includes several invasive procedures to correct issues within your teeth and gums. The most common and well known oral surgeries are tooth extractions, or more specifically, wisdom tooth extractions, and implant placements. 

Since the majority of oral surgeries take place within your jaw and mouth, there are possible complications that overlap between these different procedures. Many of these complications are rare, but it’s important to ask your oral surgeon how large the risk is for your specific procedure so they can keep your health in mind. 

Dry Socket

Dry sockets are a very painful complication that can occur after any surgical tooth extraction. During the healing process, a clot develops within the extraction site left by the tooth. This clot protects the nerve and bone tissue that’s been exposed from within your gums for 7-10 days after the extraction. Dry sockets occur when the clot gets removed from its healing spot, leaving the nerve exposed and slowing down the healing process. Dry sockets are caused through using straws, smoking, or spitting after a procedure. It’s important to listen to the post-operative instructions given to you by your oral surgeon to prevent this complication. Symptoms include increased throbbing pain radiating into your neck, ears and temple on the side of your extraction site. Treatment of a dry socket includes a visit back to your oral surgeon so they are able to flush out the socket and pack it with medicine such as a gel, paste, or dressing to provide immediate pain relief. You are at the most risk for a dry socket within the first 5 days after getting an extraction.

Numbness

The mandibular nerve surrounds and provides sensation to the face. It runs all the way from your forehead to your gums, dental sockets, and around your chin. Oral Surgery can irritate this nerve and can cause diminished or total loss of feeling in specific spots of your face. The roots of your teeth are at risk of growing close to the nerve, so those who are getting surgery on fully grown molars farther back in their mouth are at higher risk of damage. Oral surgeons are experienced in carefully extracting teeth they know are at higher risk. Numbness is very common after surgery, but will usually subside within 24 hours or less. Permanent numbness may occur.

Sinus Cavities

Sinus cavities are hollow, air-filled spaces in the skull. They connect to your nasal passages and contain the air you breathe. Much like the nerve around your lower jaw, large roots on your teeth can grow to penetrate into the lowermost cavities under your nose. Removing these teeth can cause small holes within the cavity, affecting the drainage of your respiratory system. Small holes can usually heal on their own, but if your oral surgeon is concerned, a stitch can be placed to close the hole. Symptoms can include dark red bloody noses, a whistling sound when you breathe, and fluid going through the cavity into your nose when drinking.

Infection 

Infection can happen when unknown bacteria enters any surgery site. Those who have diabetes or a compromised immune system are at a higher risk for post-surgical infections. Signs of infection from oral surgery can include increased or prolonged swelling in your cheeks and gums, a continued bad taste in your mouth, and a fever. Oral surgeons are able to treat infections with antibiotics.

Root Fragments

Tooth roots can be long or fragile, which creates a risk of breakage during surgery. Oral surgeons are able to remove broken pieces, but may decide to leave them in if it could cause harm to nearby teeth, the nerve, or the sinus. These pieces may later be dislodged, and create a bone spur. A bone spur can become trapped in the gums that have healed since the surgery, or gums near the surrounding teeth. If a spur causes pain your oral surgeon can help take it out.

Injury

Injuries that can occur during an oral surgery include broken neighboring teeth, or injury to nearby tissue. Experienced oral surgeons go to great lengths to prevent these types of injuries from happening.

Jaw Fracture

Weakening of the jawbone may increase the risk that the bone will break. This can happen during removal of impacted wisdom teeth, or with patients who have health complications that weaken bones.

TMJ Problems

Your TMJ is the temporomandibular joint that connects your jaw to your skull. During oral surgery, your mouth is propped open wide to allow for access to your teeth. This can cause soreness, inflammation, or pain within the TMJ joint. This is common for wisdom teeth procedures due to how far back in the mouth the teeth are, but if your pain doesn’t subside within 15 or so days after returning to normal activities post-op, then you may want to check in with your oral surgeon. 

For more information about complications associated with different oral surgery procedures, please consult with a surgeon about your specific case. Our expert oral surgeons can help alleviate any fears you may have about a procedure, and you may be able to take steps to reduce your risk for complications. Contact Us today.

There are many small steps that surgeons take to ensure surgery goes well. They not only strive to make their patients comfortable, but they also take measures during the surgery on a cellular level to safeguard against the body’s natural immune system.

One of the most important things an OMS can do is help enhance healing and tissue regeneration by using Platelet-Rich Fibrin (PRF) in dental surgery. 

Platelet-Rich Fibrin (PRF) is a biological material derived from the patient’s own blood. It contains a high concentration of platelets, growth factors, and cytokines, which are crucial for wound healing and tissue repair. These substances significantly improve soft tissue and bone tissue regeneration.

What’s the process? 

Blood is drawn from the patient and put in a centrifuge machine to separate the blood components. This machine spins the vial of blood at a specific speed, time, and rotation angle to create layers. These layers include white blood cells, platelets, and red blood cells. The PRF is a fiber consisting of all the top layers, excluding the red blood cells. 

What different procedures can this be used for?

• Bone grafting: PRF can be mixed with bone graft materials to enhance bone regeneration
• Socket preservation: PRF can be placed into the surgical site after an extraction as a clot to promote faster healing and preserve the bone and soft tissue formation
• Periodontal Regeneration: PRF can be used in periodontal surgeries to enhance regeneration of the gum tissue
• Sinus Lift: In sinus augmentation procedures, PRF can be used to support new bone formation
• Soft Tissue Healing: PRF can be applied to surgical sites to promote soft tissue healing and postoperative discomfort
• TMJ surgery: In certain TMJ surgeries PRF can be injected in to the joint to stimulate healing in the joint space

How does the treatment work?

The use of PRF works in tandem with the body’s natural capability of self-healing. The substances inside the PRF work in various ways to promote healing and prevent excess bleeding by forming a fibrin clot. They protect the area from infection and speed up self healing. 

PRF treatment adds blood rich in platelets and growth factors back into the body. It also introduces plasma and fibrin into an extraction socket that is left open. 

The benefits of PRF include enhanced healing through the growth factors and reduced inflammation from the anti-inflammatory properties. This minimally invasive treatment has no risk factor and the biocompatibility reduces risk of rejection or allergic reaction. It promotes accelerated healing and shields open wounds from the oral environment. 

PRF is most likely going to be used on patients with systemic conditions that are higher risk for delayed wound healing or infection. This includes patients predisposed to higher risk of rejection, pain, inflammation, holes in the sinus cavity, or those with major health issues. 

Contact us to schedule a consultation with Mid-State Oral Surgery and Implant Center. 

A dental bone graft is a surgical procedure to repair or rebuild the jaw bone through the transplantation of bone tissue. This procedure is unique because although your surgeon places new bone at the site where it’s needed, your body is what does all the work. The bone graft acts as the scaffolding, where your body will then implement its natural healing process and fill in the surrounding area with bone to support the graft and any dental procedures that come afterwards. This procedure is necessary when bone loss has occurred in the jaw.

There are four types of bone grafts

1. Autografts: Bone is taken from another part of the patient’s body and transplanted to the area needing augmentation. This method has a reduced risk of rejection due to the bone coming from the patient’s own body.
2. Allografts: Bone is sourced from a human donor, most often from a bone bank. For transplantation, the donor bone is processed and sterilized in preparation. This is the most common form of bone graft, because it eliminates the need for a second surgical site.
3. Xenografts: Bone is obtained from another species, typically bovine (cow) bone. The process involves removing any organic material to reduce the risk of rejection. This method is most commonly used for patients who just need a little support to regrow their own bone. 
4. Synthetic Grafts: These are grafts made from biocompatible materials such as calcium phosphates, bioactive glasses, or other ceramics. They provide an alternative to natural bone grafts.

Why do you need a bone graft?

The primary goal of dental bone grafts is to provide a stable foundation for dental procedures, such as dental implants, bridges, or dentures. However, other benefits from it can include improved oral health, preventing changes in facial structure to ensure teeth don’t shift, and helping maintain natural contours of the jaw and allowing for a more natural appearance of your face, teeth and gums.

There are many reasons one might need a bone graft, with the main ones being bone loss due to:

• Support for Dental Implants, Bridges, or Dentures
• Bone Loss Due to Periodontal disease
• Bone Loss Due to Tooth Extraction
• Trauma or Injury
• Developmental defects

The main procedure for bone grafts include: 

• Socket preservation: Sometimes called ridge preservation, this type of graft is placed in the socket immediately after a tooth extraction. It fills the void left behind by the missing tooth and prevents the sides of the socket from caving in.
• Ridge augmentation: If your teeth have been missing for a while, the supporting jawbone may be thinner than it was before. Ridge augmentation increases the width and volume of the jawbone so it can provide a stable foundation for implants or other restorative options.
• Sinus lift: The maxillary sinuses sit just above your upper back teeth. If the upper back teeth are missing, the sinuses can drop down and invade the space once occupied by the teeth roots. In this scenario, you wouldn’t want to place implants because they would penetrate the sinus membrane. To address this problem, your oral surgeon or periodontist can perform a sinus lift. This procedure raises the sinus back to its proper position. A dental bone graft is then placed underneath the sinus, creating a solid foundation for dental implants later on.
• Periodontal bone graft. Infection from gum disease can erode the bone that supports the teeth. This can cause the teeth to become loose. A periodontal bone graft is placed around an existing tooth to reduce mobility and provide additional support.

In most cases, bone grafts for dental implants must heal completely before the actual implant is placed. Because each person is unique, recovery times vary. In rare instances, your dentist may be able to place a bone graft and a dental implant at the same time. But this is decided on a case-by-case basis.

What is the process of a bone graft surgery?

Oral and Maxillofacial Surgeons (OMS) need to assess your jawbone and overall oral health through the use of x-rays and sometimes intraoral scans to determine the need for a bone graft. During the surgery, any damaging tissue will be removed, and the area is cleaned before placing the chosen graft material. Often collagen or a gel is used to keep it in place, but there may be a need for screws, membranes, or other materials to ensure it holds. Over time, the graft material will integrate with the existing bone and cue the body to start producing more bone growth in that area. This process can take several months, in which you will need to routinely visit your OMS to monitor the progress.

What are the Risks?

Risks for this surgery include infection, graft rejection, and complications at the surgical site. Dental bone graft rejection is very uncommon given the advanced material and techniques used. However, if you experience persistent pain, infection, graft exposure, shifting or wiggling teeth, loss of function, or sinus issues, you’ll want to contact your OMS.

Patients may experience some discomfort, swelling, or minor bleeding post surgery, but pain can be managed during the initial phase. It’s crucial to maintain good oral hygiene, follow after care instructions, and to keep up with your OMS at follow-up appointments.

Bone grafts are one of the most common procedures for an OMS. They use them to ensure that their other dental procedures are successful, with minimal change to the patient’s face and health. Bone grafts are a unique way to help our bodies heal themselves, and have a 99% success rate when being placed in the jaw. 

If you’re planning to get teeth extracted, it’s important to take the correct postsurgical steps to prevent infection. Complications are rare, but patients can avoid infection and other issues by taking care of their teeth and gums during recovery. 

After extraction surgery, a blood clot will form to protect the extraction site and prevent bacteria from entering the area. If this blood clot is disturbed or dislodged in any way, an infection may result. While some bleeding and swelling are normal after surgery, symptoms you need to watch out for include:

• Excessive bleeding
• Increased swelling of the face and jaw after 7 days
• Pain that does not go away with medication
• Oozing discharge or pus
• Fever

To Prevent Infection the best thing you can do is follow the postoperative instructions given to you by your oral surgeon. This includes keeping track of your oral health, and allowing your blood clot to heal on its own. 

To ensure the healing goes as planned, our surgeons at Mid-State give out these additional tips in addition to those on your post-op instructions:

• Use gauze: In your post-op bag, you will have 4 gauze pads included. Gauze can help manage bleeding at the incision site. To place it, bite down gently and try not to disturb the area. Change it as often as needed.
• Bite on tea bags: If your bleeding continues more than you’re comfortable with, dip a green or black tea bag in cold water, drain the excess, and lightly bite down on the tea bag as you would the gauze. The tannins in the tea will help promote blood clotting to protect the bone as the wound heals. 
• Get rest: Rest after a surgery means sleeping. Your body naturally does a majority of it’s healing when you’re asleep. Avoid any strenuous physical activity for 7-10 days after surgery. You will need to ease back into normal routines while you heal.
• Don’t smoke, vape, or suck on straws: Not only can drugs interfere with the healing process, but the action of these habits can disrupt your blood clots. 
• Use heat to help with swelling: After the initial 3 days, using just ice packs on your swelling will not be as effective. Alternate between heat and ice on your face like you would with a sprained ankle. This will help alleviate the swelling faster. 

It’s most important to take your medications as prescribed. The medications your surgeon assigns you will assist in your healing and ensure you stay comfortable after surgery. It’s important to discuss these medications with your doctor before you are sedated, so that you are best prepared to start your healing process when you get home. Traditional healing from extraction surgery can take anywhere from 3-4 days depending on the complexity of your surgery. 

Contact Mid-State here to ask for a consultation.

Anesthesia Services

A lot of people get nervous to visit the dentist or an oral surgeon. That’s okay! Any doctor’s goal is to make you as comfortable as possible for any procedure you have. For Oral and Maxillofacial Surgeons (OMS), this includes doing procedures under sedation or anesthesia. There are a few different types of anesthesia that can be utilized for different purposes. 

Local anesthesia

Local anesthesia involves numbing a small specific area of the body, typically via a needle. This is used for minor surgical procedures and dental work. OMS use this procedure for biopsies, simple extractions, as well as stitches. The needle injection is applied directly to the target area. There is no loss of consciousness for this procedure, and the patient’s sensory factors to this area are blocked. 

Local anesthesia medications include drugs used to temporarily block nerve impulses to result in a loss of sensation. The most common medications used are Lidocaine, Mepivacaine, Bupivacaine, Articaine, and Procaine. Differences in these medications include onset of action (time taken to affect the area) and duration of affect.

Regional Anesthesia 

Regional Anesthesia involves numbing a specific area of the body, typically an area a lot larger than one numbed with local anesthesia. Typical use of regional anesthesia is for childbirth or to numb extremities in orthopedic surgeries. This anesthesia is an injection into the epidural space, around individual nerves (peripheral nerve blocks), or into the cerebrospinal fluid. Patients can remain awake for some general anesthesia procedures. OMS do not use regional anesthesia, but are trained on how to administer it.

Regional anesthesia medication typically includes a local anesthetic like those listed above, combined with an adjuvant or additive to enhance their effectiveness or prolong the duration of action. These adjuvants or additives can include epinephrine, clonidine, dexamethasone, and opioids. Specific medications are determined depending on factors such as the onset of action of the drugs, type and duration of the procedure, and the patient’s medical history and allergies.

General Anesthesia 

General anesthesia involves loss of both consciousness and sensation throughout the entire body. It can be administered through inhalation (breathing in gasses) or intravenously (through a vein). It is commonly used for major surgeries. OMS use general anesthesia for facial reconstructions, jaw reconstructive (orthognathic) surgery, TMJ procedures, as well as for young children who undergo oral surgery.

The medication involved in general anesthesia includes a combination of drugs to achieve muscle relaxation, unconsciousness, pain relief and amnesia. Intravenous medications can include Propofol, etomidate, and barbiturates; Inhalation medications can include sevoflurane, desflurane, and isoflurane; Other additives for general anesthesia to achieve neuromuscular blocks and pain relief include succinylcholine, non-depolarizing NMBAs, opioids, and benzodiazepines. 

Monitored Sedation 

Sedation is administering medications to induce a state of relaxation and decreased awareness without causing complete loss of consciousness. Often, it’s used in combination with local or regional anesthesia for minor procedures or tests. Sedation can range from minimal (light) to deep sedation depending on the procedure. Deep sedation allows for the patient to be nearly unconscious but still able to respond to stimulation. This is the most common type of anesthesia used in oral surgery.

Depending on the medical procedure and level of sedation will differentiate which drugs are used by your doctor. For minimal sedation, common medications include benzodiazepines and nitrous oxide (“laughing gas”); moderate sedation uses benzodiazepines and opioids; deep sedation uses Propofol, ketamine, and dexmedetomidine. 

Oral Surgery Sedation

Oral Surgeons are qualified to administer anesthesia services due to their 4 year Oral Surgery residency. This education is tailored to the needs of oral and maxillofacial surgery and allows for them to gain both academic education and hands-on experience. At Mid-State Oral Surgery, all of our doctors are certified through the American Board of Oral and Maxillofacial Surgery (ABOMS) and hold licenses for anesthesia procedures through Tennessee Board of Dentistry.  

Every day, our surgeons at Mid-State Oral Surgery use both monitored sedation and local anesthesia. In order to keep our patients as safe as they can be during surgery, not only are our doctors trained in anesthesia, but we use Registered Nurses (RN) to administer it. Having an RN in surgery allows the doctor to focus on the treatment while an RN is closely monitoring the vital signs and respiratory function of the patient. This is imperative to ensure patient safety and optimized treatment. Additionally, we use Certified Registered Nurse Anesthetists (CRNSs) to administer any general anesthesia services for larger surgeries when needed.

Every patient has differences in medical history, age, weight, and procedure complexity. All of these factors and more need to be considered by the healthcare provider administering treatment. We want to ensure that not only the procedure goes well, but also that the patient stays safe during surgery. 

Torus Mandibularis (mandibular or dental tori) are bone growths that develop on the roof or floor of your mouth, under your tongue . Tori growths are not dangerous, and do not cause pain. They vary in size and shape among individuals, and can be uncomfortable and inconvenient. Some people are born with them, and others develop it later in life. 

Typically benign and non-cancerous, Tori are usually asymptomatic and often discovered during dental examinations or imaging studies. Treatment of Tori isn’t necessary unless it interferes with your ability to eat or speak. 

Dental Tori can either be one growth or several, and vary in both number and size. It’s common to have growths on both sides of your mouth. Having Mandibular Tori is relatively uncommon, prevalent in about 27 out of every 1,000 adults in the US. 

Causes and Symptoms

The largest cause of Mandibular Tori comes from genetic and environmental factors. There is a genetic predisposition to developing tori, indicating that it is hereditary. Additionally, factors such as dietary habits, nutritional deficiencies, age and gender play a role. Although none of these factors have been firmly established as causes, they all play a role. 

Although a majority of Tori cases are discovered during a dental exam, you can still notice changes in your mouth when doing at home dental checks. 

Typical symptoms include:

• Noticing the growths themselves
• Difficulty chewing or swallowing
• Difficulty getting dental appliances to fit correctly (retainers, mouth guards, ot dentures)
• Food particles getting stuck in or around the growths
• Speech difficulty
• Inflammation of gums
• Loose teeth

Treatment 

The presence of tori alone does not necessarily indicate a need for treatment, but surgery by an Oral and Maxillofacial Surgeon (OMS) is recommended when tori growths start interfering with speech or life quality. Tori removal itself is simpler than other surgical procedures. Although complications are rare, infection and excessive bleeding can occur following the procedure.

Surgical treatment includes:

• Using IV sedation or a local anesthetic to keep the patient comfortable
• Making an incision using a scalpel through your gums overlying the tori to get access to it
• Remove the extra bone tissue and sand the area down with the help of dental instruments such as drills. 
• Rinse the area with a saline solution and disinfectant
• Use stitches to close the incision 

Recovery

It can take between 6-8 weeks to fully heal after tori removal. Many patients will experience some discomfort and swelling following their surgery, which can be treated with pain medication and ice packs. Other experiences include dry/chapped lips, and slight bleeding following the surgery. Post operative instructions include avoiding strenuous exercise, hard and crunchy foods, and using medications and a mouth rinse daily. As the weeks progress, your ability to eat and do more physical activity will increase. 

There is no way to prevent mandibular tori, so let your dentist know if you have suspicious of Mandibular tori and with early detection they can keep an eye on the growth to make sure they don’t cause any issues. Unfortunately even after surgical treatment, tori can grow back in some cases. Living with tori is possible as long as it doesn’t interfere with your function or quality of life.

To schedule a consultation with our doctors please Contact Us