Tooth Extraction and Preprosthetic Surgery

Tooth Extractions
One of the most common procedures performed by oral and maxillofacial surgeons are tooth extractions. Teeth may be indicated for removal for several reasons. Teeth that are beyond restoration due to dental decay may be the most common indication. These teeth may be painful, mobile, infected or abcessed, and possibly a potential compromise to overall health of the patient. Often teeth are removed as part of a comprehensive orthodontic treatment plan. Teeth that are crowded or malpositioned may be extracted to provide adequate space with in the dental arch to assist in the completion or initiation of orthodontics. Primary (baby) teeth may also be considered for removal. Primary teeth are subject to dental decay and may obstruct the eruption of secondary (adult) teeth. Impacted teeth are often symptomatic or potentially problematic and are considered for removal. The most common are the third molars or wisdom teeth; however, other teeth may be impacted like canines, premolars, and supernumerary (extra) teeth. Our doctors will be sure to discuss with you the indications, options, risks, and anesthetic options associated with your individual treatment plan. Your referring dentist's or orthodontist's treatment recommendations will be reviewed and confirmed. A consultation visit may be scheduled in advance with your best interests in mind. Some prescription medications will affect the tooth extraction process. Patients on anticoagulation therapy (Coumadin or Plavix) may require alterations of their medication doses or schedules to prevent undesirable post operative bleeding. Patients with osteoporosis or other medical conditions requiring bisphosphonate therapy (Fosamax, Boniva, Actonel, Reclast) may require pre extraction blood tests and alteration of their medication regimen in order to minimize post operative complications. These medications alter bone remodeling and can disrupt the healing process. Your doctor will discuss the management of these medications with you at your consultation.

For Preoperative Cardiac and Orthopedic Patients

Patients preparing for heart valve replacement surgery or joint replacement surgery should have a comprehensive dental exam prior to their proposed surgery. Occasionally these patients require dental extractions to limit the risk of infection to the prosthetic component. On occasion, medical circumstances and time constraints dictated that these dental extractions be performed in a hospital setting. Our doctors are on staff at both the Reading Hospital and Saint Joseph Hospital, and will coordinate your oral surgical needs with your cardiologist or orthopedic surgeon.

Preprosthetic Surgery
Preprosthetic surgery usually involves preparing the oral cavity for the placement of removable prosthetics (removable full or partial dentures). Often time a patient's treatment plan involves the delivery of a removable denture as a temporary or final restoration. Depending on circumstances the patient's oral supporting structures, bone and gum tissues, may require surgical procedures beforehand to provide acceptable fit, function, and comfort of the denture. The tooth supporting bone is referred to as alveolar bone, and the gum tissue as gingiva. An alveoplasty or alveolectomy involves the reshaping or removal of alveolar bone. This is done to remove undesirable contours, ridges, or sharp edges to provide a smooth more comfortable foundation for a denture. Alveolar bone procedures are often performed simultaneously with multiple tooth extractions, but are sometimes delayed to allow some natural remodeling of bone. Gingivoplasty procedures are similar. They are performed to remove or reshape the gum tissue to provide a more acceptable surface for a removable denture. Occasionally excess or redundant soft tissue requires removal. Lingual tori are deposits of excessive bone on the lingual (tongue) side of the lower jaw. They can vary in size, are usually bilateral (both sides) and are somewhat bulbous in shape. Lingual tori will interfere with the lingual flange of a lower full denture and the lingual framework of a lower partial denture. Lingual tori are often indicated for removal prior to the fabrication of lower removable dentures. Similarly, a palatal torus is an overgrowth of excessive bone on the upper hard palate. Palatal tori interfere with the placement of upper full dentures and usually require removal or reduction prior to making the denture.