Extractions of Teeth Questions and Answers

Question:

My two lower wisdom teeth are coming in and I have been feeling discomfort and pain for about five months, the pain has been on and off. The first time was in August and then again in December and now just recently. The first time the pain was very minimal. I felt some discomfort in my gums and they were swollen, this lasted about a week or so and then I was fine again. The second time the pain got stronger and now for the third time the pain has gotten unbearable. My right cheek is completely swollen, my gums and jaw are sore from the pain, my gums irritated, and I have also experienced some throbbing. I have been taking asprin and have been using an oral anesthetic for the pain. I have also experienced difficulty concentrating and falling asleep because of the pain. My concern is that I recently had my braces removed and I'm worried that my wisdom teeth might affect my newly straightened teeth! Before I got my braces I had 4 extractions: 2 lower and 2 upper. I originally planned on letting my wisdom teeth come in because I didn't want to go through any more extractions and also because I figured that I had enough space for them to come in anyway, but after experiencing such pain I am not sure what to do any more. Should I just wait out the pain again like I did in the past or just get the extractions done? What would be less painful and how long would the recovery be? How long does it take for your wisdom teeth to fully come in? What is the cost to get this procedure done? Would it be best to go to a regular dentist or an oral surgeon?

Answer:

Myra, You had braces, and wanted to let your third molars to erupt? ot a good idea. If you had to have extractions for the braces, I'd guess you have a small mouth. If there is no room for the molars to erupt then you could be threatening the long term stability of your orthodontics.( I hope you're weariing your retainer!) Sounds like you have pericoronitis. I'd call your orthodontist, and have him refer youto an Oral surgeon. Don't let your general dentist do the extractons.

Theodore Morgan, DDS
Gorham, ME

Question:

I am 29 years old. I have a slight underbite and a bad crossbite. I do NOT want oral surgery. My ortho wants to "expand" my palate. I would be happy if my top front teeth overlapped my bottom slightly (right now they are basically set on edge and when I relax my jaw they drift to a place where they are totally "crossed and set on edge" which is very uncomfortable and is driving me nuts. I don't need a movie star smile - I would be happy if my teeth rested comfortably in my mouth. It seems like if my upper jaw was 1 millimeter forward this would be the case. I understand that jaw bones are no longer growing in an adult. If my ortho thinks he can "expand" my upper jaw (to correct my crossbite) isn't he moving or "stretching" my hardened bones? Is this possible? If it is possible, then it seems to me that "stretching" my upperjaw would be possible as well. I understand that you can't really make an evaluation without "seeing" my particular case. However, could you please answer this question to the best of your knowledge: Can bone be minutely "stretched" or "moved" in an adult jaw? I am fairly confident that one millimeter (maybe even slightly less) would be enough to improve my bite and my comfort level drastically. Also: I am very embarassed about getting braces . . . can braces be applied to the back of my front teeth during the treatment? Please let me know what you think. Thanks. - seeking a second opinion in Chicago.

Answer:

Bones cannot be moved in adults without surgery. In some cases, teeth can be extracted to compensate for skeletal discrepancies. Ask your Orthodontist if you are a candidate for lingual braces.

William Keene, DDS
Trenton, NJ

Question:

I had a toothe extracted 6 weeks ago, I got a dry socket and was told there is nothing that can be done. It has been very painful, and now I have an abcess in the whole and have to see an oral surgion. What will have to be done? They said the infection is spreading through my jaw.

Answer:

As an Orthodontist, I specialize in the treatment of malocclusions (bad bites and crooked teeth). I suggest you contact a general dentist or a specialist for your area of concern.

William Keene, DDS
Trenton, NJ

Question:

I have 2 questions: 1. My daughter who is nearly 7 years old, has inherited Class III, skeletal malocclusion. Two out of three orthos we've consulted recommend starting treatment right now. Treatment would consist of expanding the upper arch and the use of a chin cup with anterior traction to upper teeth. We've read studies that indicate that in the short-term results from this treatment are very effective but that long-term, growth of the lower jaw can resume, in adolescence. What is the success rate for permanent treatment of class III at an early age? Can early treatment lead to greater problems later on to correct additional growth at a later age? Do you recommend treatment at this age? 2. My other daughter who is nearly 9 has excessive overcrowding. Two orthos we've consulted recommend we wait until more adult teeth come out. One ortho recommends the extraction of 7 baby teeth and the use of a space maintainer to allow more room for the adult teeth. Do the baby teeth not already act as a space maintainer, therefore making this apparatus unnecessary? Is there a chance that her jaw will develop normally allowing room for all her adult teeth? What do you recommend? Any info. you can provide would be greatly appreciated, as we are a little confused given the differences of opinion. Thank You

Answer:

1) Class III malocclusions are very difficult to correct. If the discrepancy between the upper and lower jaw is too great, jaw surgery in combination with orthodontics is required to achieve a correction. Consequently, children in the 7 to 9 year range who demonstrate class III growth are frequently treated to re-direct this unfavorable growth. I treat each patient individually addressing their specific circumstances. Sometimes I do begin treatment at 7 years of age. 2) While I can't diagnose a patient without seeing him/her, generally the space for the permanent teeth in front of the first permanent molars has been determined as soon as these molars erupt. There are appliances available to expand the dental arches to some extent. Although all orthodontists have similar goals for the patient, the method of achieving those goals can vary from orthodontist to orthodontist. Sometimes there can be a significant variance in the treatment plan.

William Keene, DDS
Trenton, NJ

Question:

My 7 year old son developed an infection in a baby molar that had been previously filled. The dentist removed the filling and did a root canal on his tooth. He told us he wanted to save the tooth because it wouldn't come out until he was about 12 years old and he wanted to maintain the space the tooth occupied. The tooth became infected again about 2 months later and he reworked the root canal. He packed it with medication and put a tempory filling in the tooth. He scheduled him to come back in 6 weeks for him to check it. Now he tells us the tooth is probably gonna have to be pulled anyway. The tooth is not hurting my son and the gums around the tooth look fine. Do I need to get a second opinion about the condition of his tooth? I am beginning to worry that the dentist is money hungry and I don't want my child to go through anymore unnecessary pain. A Concerned Parent

Answer:

Dear Tammy, The dentist was trying to save the tooth. However, if he now feels it should be extracted, he should do so but also he should fabricate a space maintainer for that area. A space maintainer is a small metal piece that will keep the teeth on each side of the extraction area the proper distance apart until his neww tooth grows in.

Arvin Oberai, DDS
Winter Park, FL

Question:

My upper 3rd molar on my left side has been slowly cracking and decaying over a period of time (there is very little tooth left) and I have yet to have it removed. I am interested to find out whether any of the new laser devices and techniques can be used for an extraction? Thanks for your prompt answer!!

Answer:

No, There are no lasers available that can remove teeth. If you are concerned about the procedure maybe you should consider having the procedure under sedation. Good Luck

John Carollo, DDS
Florham Park, NJ

Question:

About 1 1/2 years ago, I had a couple teeth extracted. A tooth on top of one of those teeth has started to come down to compensate. First, will this do any damage to my teeth? Secondly, would you recommend maryland bridges for the teeth that were extracted? Thank you for your time.

Answer:

To answer your question properly and fully, I would need to know your age and what teeth were extracted. Please write back with this information.

Arvin Oberai, DDS
Winter Park, FL

Question:

Dear Dr.,I had 2 teethextractions 9 wks ago.Having persistant painradiating down to chinWhat can I do? Dr. said it is in my head!Been onKeflex 500mg qid 2x already. When Iget off after 3 days symptoms return. notetransient edema, warmth, and pain return. Allergic to pcn,sulfa. Pain is pronouced from r.earradiating down bone tochin. I am a nurse. Dr. states I am looking or attention.Not true. To the visible eye, site looks good. But the molar extracted is still deep. I had r. bottom wisdom tooth removed and the molarin front of it.Went to regular dentist and he tok 4 x-rays. Said hesaw complications-infection. But the maxio. guysaid he saw nothing.I have known him sence high school. I am 43. Have little faith in him. Chooses to ignore my symptoms. I have chronic TMJ bilaterally and do not want to have more chronic problems. I am concerned about bone infection.He never put me on an antibotic until 1 week after the surgery. The pain has also started radiating underneath chin. I amnot crazy, but he is blaming symptoms on anxiety. He has chooseto ignore me,stating,not knowing what to dobut play the waiting game.I need advice since no one listens to what I am saying. Never had these symptoms before the extractions.Adviseplease.Seek a 2nd opinion? Any idea whatit could be? Would nerve damage act like that?

Answer:

Dear Jean, There is never anything wrong with a second opinion. Regaurdless of the outcome the offer you the piece of mind of having a second expert evaluate you. I would recommend that when you go for a second opinion that you take any radiographs that you may have from before and after the surgery. By doing so it may allow the surgeon a greater understanding of your situation and specifically address your concerns regaurding nerve injury. Good luck

John Carollo, DDS
Florham Park, NJ

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