Dentistry Understandable and Accessible.
The best blog about dentistry and dental implants
So came the New, 2011 year. I congratulate all my friends on this holiday and wish that 2011 was an even better year than 2010. I sincerely want to thank everyone who has shown interest in my humble Learn and actively participated in the discussions, asked questions, wrote comments. I hope next year it will become even more interesting and useful. Thank you all! Today we will touch on a very topical topic – what to do before and after tooth extraction. It would seem that this is the most common operation in the world, here everything has long been studied and investigated, but. oddly enough, it is she who causes the most negative and it is associated with the greatest number of complications in modern surgical dentistry.
In this post, we will discuss with you how to set yourself up for tooth extraction and prepare for it, what recommendations should be followed after the operation and what is their meaning. And at the end of this post you will find memo in MS-Word format, which you can print and use to inform patients or yourself.
And this is just part of the collection of the strangest teeth that I have ever deleted.
So, the doctor recommended you to remove one or another tooth. I do not undertake to discuss the indications for deletion, because there are a lot of them and, in order to examine them, a separate entry is required.
It is only important to understand that if the doctor recommends removing a tooth, then there is every reason for this. Doubt what to eat? Ask another doctor. Do not believe another doctor? Ask the opinion of the third. Do not forget that whatever the recommendations of the dentist are, it is you who decide on the operation and it is you who are responsible for this decision.
It is important to know! Any surgical procedures during the acute inflammatory process are less well tolerated than during relative rest. In other words, the removal of a tooth for acute pain is much more unpleasant, and the postoperative period is much less comfortable than, for example, the planned removal of a heavily destroyed tooth. Therefore, if you know for sure that a tooth is to be removed, it is better not to wait until it gets sick (he will surely get sick!), but rather go to the dentist and get rid of him.
Before tooth extraction
So, you made an appointment with a dentist-surgeon. Together with him you are planning a tooth extraction operation.
Time of receipt. Morning is best suited for surgical procedures.
There are several reasons: – first, you are not tired yet. The body is full of strength and energy, so it will easily survive such stress as an operation. – secondly, after removal after a while pains appear, which sometimes make it very difficult to live. It is better if they pass by the evening, and you will sleep peacefully. – thirdly, your doctor is not tired yet, he will be able to give you maximum time, and the surgery room (if we are talking about municipal clinics) is as clean as possible. – fourthly, in the event of any problems or complications, you can contact your doctor, and not run at night and not look for a 24-hour dubious dental institution.
Usually, before any operation, I ask patients to eat well. First, a well-fed person feels calmer, and his body copes better with stress. Secondly, in well-fed people blood clots better, which is very important in any surgery. But alcohol before the operation is undesirable – it changes the properties of blood, because of this there is a risk of swelling and prolonged bleeding. I’m not even talking about the fact that a drunken person is simply inattentive, can behave inadequately and sometimes forgets all the recommendations that the doctor gives him. This can cause complications.
If sedation, anesthesia or general anesthesia is planned, then it is better to refrain from eating. A doctor or an anesthesiologist usually warns about this.
However, if you are very worried, you can use a weak sedative – valerian tincture, Corvalol, motherwort tincture etc. according to indications. It is reasonable to take them 40-60 minutes before surgery. The main thing – do not get drunk with these tinctures before losing consciousness.
If a large surgical intervention is planned, for example, a complex wisdom tooth extraction, then preliminary results of anti-inflammatory and analgesics, as well as antibiotics, provide good results. It is better to consult with your doctor about whether it is necessary to do this, which drugs to choose and when to start using them.
And finally, the most important thing.Good mood and a positive attitude – the key to successful treatment. I observed many times that even the most complex surgical procedures in positive and cheerful people are much easier than usual, and they are rehabilitated after them incredibly quickly. For example, with one 70-year-old patient, we went to play tennis just three days after implantation (6 implants and sinus lift), because the operation was almost unnoticeable for him, and in the postoperative period nothing bothered him – so he pulled He has me on the tennis court. Therefore – more positive and good mood! It is very important!
At the reception. The first stage of almost any surgery is anesthesia. In dentistry, local anesthesia is most often used — innervation in the area of operation is blocked with anesthetics, providing high-quality anesthesia for several hours. There are a lot of local anesthesia technologies, they are used based on the planned workload, localization of the operation, age and the patient’s health condition.
What you need to know about anesthesia?All modern anesthetics are safe and non-toxic. provided proper selection. For anesthesia in dentistry, only special disposable needles are used (their diameter is smaller than that of ordinary needles) and at least special capsules – capsules with anesthetics, which exclude any contact of the solution with the environment or the syringe body. All this makes the anesthesia process as comfortable and safe as possible.
Anesthetics, if properly selected, do not affect pregnancy or the quality of breast milk. Therefore, pregnant and lactating mothers can and should deal with their teeth.
Selection of anesthetics for children is carried out by age and body weight. The dose of anesthetic is calculated in milliliters per kilogram of weight, at a very early age anesthetics are used without vasoconstrictors (epinephrine or adrenaline). The main problem of anesthesia in children is not an allergy, but an overdose.
Modern anesthetics are hypoallergenic. Just super hypoallergenic. Cases of allergy to them are a very sooo rarity, for 10 years of medical practice I have never encountered an allergic reaction to modern drugs. Therefore, in most cases, anesthetic allergy tests are a waste of time and money. Especially if the patient had not previously received any anesthetics.
Previously, so-called skin tests or sublingual tests were carried out. The point is that a drop of anesthetic is placed on a fresh scratch on the skin or under the tongue – and the possibility of allergy was judged by the reaction of local tissues. But in fact, it has long been known that the risk of an allergic reaction, the possibility of its occurrence and the degree of manifestation do not depend on the volume of anesthetic. In other words, a single substance molecule is enough to cause a strong allergic reaction. This is known to anyone who has not slept on lectures on allergology.
There are no people who are not affected by local anesthesia. There are doctors who do not know how to do it. The quality of anesthesia is not affected either by alcohol or by taking narcotic drugs; addiction does not develop to anesthetics.
Anesthetics do not accumulate in the body. As soon as the effect of anesthesia has ended – the anesthetic in the body no longer exists, it breaks up relatively quickly. Therefore, as soon as the anesthesia is over, you can always add it.
During tooth extraction: The methods of tooth extraction are very many. – it all depends on the initial situation and which tooth is going to be removed. Also, for the removal of each tooth there is a set of tools, so the pieces of iron in the hands of the doctor may differ significantly in shape.
The main task of the doctor during the operation – Not only to remove the tooth, but also to make this procedure as comfortable and safe as possible. Therefore, do not be afraid to tell the doctor about your feelings – this will help him in his work.
In the process, you can feel physical pressure, crunching, clicking, etc.. Usually, tooth extraction does not require significant physical effort, so if the need arises to apply force, the doctor will warn you. Take it with understanding.
Do not tolerate! As soon as you feel pain or significant discomfort – let your doctor know about it. I am sure that he is not a sadist, and if necessary will add anesthesia, and will also be more accurate.
Tooth extraction time can be from several seconds to an hour. or more. On average, the removal of a complex wisdom tooth takes me, for example, 15-30 minutes. Again, a lot depends on the initial situation and the qualifications of the doctor.
After the tooth is extracted from the hole, the doctor treats it and, if necessary, stitches. The question of the need to suture the holes of the removed teeth remains a subject of discussion, but from my own experience I can say that if at least one hint of the need for stitches arises, then it is better to do so. It will be calmer for you and the doctor.
If in doubt, is there anything left in the hole, then you can ask the doctor to show the extracted tooth. Also do not be afraid to ask the doctor about it. If you clearly show that all the roots of a tooth have been removed, then there is no need for a control picture – because if the tooth is completely in your hand, it means that it definitely does not exist in the jaw.
If it is not clear to you and your doctor whether the tooth is completely removed (this happens if the tooth fell apart into many small parts during the extraction process), then a control picture is necessary.
After tooth extraction, in most cases, the well is closed on top with a gauze pad.. The main point of its use is not absorption of blood, but compression, compression of the edges of the hole to stop bleeding. Therefore, it is not necessary to change the gauze, if it was soaked with blood. It is better to press it with your teeth and hold it longer – the bleeding from the hole will stop.
Recommendations after tooth extraction
It is important to know that the body perceives the removal of a tooth as an injury and gives it an appropriate response – post-traumatic inflammation. Its character largely depends on the volume of the intervention, and on the state of your body, so it is not always possible to predict the postoperative period, especially against the background of the low level of data on the health status of dental patients. However, the purpose of the recommendations and appointments that the doctor gives you is the edema of this very inflammation. Therefore, how the postoperative period will pass, how comfortable and calm it will be, depends largely on you.
1. Gauze swab from the oral cavity should be removed after 20-30 minutes. In some cases (for example, in patients with hypertension or simply with poor blood clotting) it is better to hold it longer – 40-60 minutes. Once again I remind you that the purpose of the tampon is not blood absorption (not to be confused with tampax!), But compression, compression of the hole to stop capillary bleeding. According to the same principle, pressure bandages on open wounds work.
2. 2-3 hours not to eat and drink. Until a more or less dense clot has formed in the hole, food debris can get into it and cause complications. In addition, hot food or drinks can disrupt the process of formation of a blood clot, and this will lead to such a nasty complication as alveolitis.
3. For 3 days, exclude from the diet coarse, hot, spicy food. Rough food, especially products such as crackers, chips, nuts, can get into the hole and cause inflammation. Hot or spicy food increases the volume of blood flow in the area of surgery, which can lead to increased postoperative inflammation and pain, swelling, etc. Optimal nutrition after surgery is food that does not irritate or injure the oral mucosa.
4. For 3 days, stop using the bath, hot bath, sauna, solarium, exclude physical exertion and any heating of the body. From these procedures, pressure can rise, a blood clot can fall out of the tooth hole – pain, swelling will occur, bleeding and other troubles will begin. For cleaners – you can take a shower and wash your hair. But not for long without fanaticism.
5. Do not poking around in the hole, do not try to clean it or rinse it. Try not to touch the tooth hole with your tongue. Even if you notice something abnormal in the hole of the extracted tooth, it is best to consult a doctor. Attempting to clean it yourself usually leads to infection, inflammation and the development of alveolitis – a very, very unpleasant disease that is long and difficult to treat.
6. You can not rinse the area of the hole, use lotions, baths, ointments, compresses, etc. Of course, except when recommended by your doctor. Because of the rinses and baths, the blood clot often dissolves and leaches out. The empty hole is quickly clogged with plaque and food debris, becomes infected and inflamed. The rinse point is still a matter of discussion, probably many doctors will disagree with me. But from my own experience I can say that the harm from rinsing and baths is much more than good. Therefore, it is better not to.
7. Careful oral hygiene. Teeth clean regularly, 2 times a day in those places that are not adjacent to the hole of the extracted tooth. For cleaning use the minimum amount of toothpaste (you can never use toothpaste) to make it easier to rinse. After removal of the tooth can not use irrigator.
8. In no case can not warm the area of operation. Due to the heating, the blood flow increases in the area of the extracted tooth, and this can lead to serious complications. The use of cold is mostly justified. A cold compress not only narrows blood vessels and reduces the risk of edema, but also reduces blood flow in the area of operation, does not allow postoperative inflammation to develop. In this case, it is better to prefer a non-frozen piece of ice, and ice water of the border temperature (about 4 degrees Celsius). Do not forget to apply a cold compress through a cloth or paper napkin, and do not hold it (especially strongly frozen ice) for more than 15-20 minutes. For the use of cold packs, it is better to consult your doctor.
9. Patients suffering from diseases of the cardiovascular system, it is necessary to monitor blood pressure and take appropriate medications. In 90% of cases, the cause of alveolar bleeding, the appearance of edema or hematoma is an increase in blood pressure. Therefore, stable blood pressure is a necessary condition for a comfortable postoperative period.
10. Surely the doctor will prescribe you some medications. It is necessary to take them, according to the scheme proposed by the doctor.
11. In the event that something bothers you, you experience some strange sensations or you just have a question – First of all, you should contact your doctor. All good doctors leave their phone number to patients for prompt communication. And the best doctors also necessarily appoint patients for postoperative examination.
After removal, you may experience some phenomena that in one way or another accompany any surgical procedure: – pain in the area of the tooth extraction. As a rule, the most painful period is 1-2 hours after removal, when the effect of the anesthetic weakens. In some cases, weak pain may disturb several days – that is why the doctor prescribes anti-inflammatory painkillers.
– pronounced swelling of the gums or soft tissues of the face in the area of the extracted tooth. The cause of edema is still the same post-traumatic inflammation. This is especially true of wisdom teeth, because of the anatomical location of the edema there happens quite often (about 40% of cases). The swelling reaches its maximum at 2-3 days after the operation; you should not be afraid of it. But it is better to keep the swelling under control and, if you suddenly feel worsened, you should immediately consult a doctor.
– difficulty opening the mouth, pain when swallowing. Especially often happens after the removal of wisdom teeth, which is again due to their anatomical location. Difficult opening of the mouth occurs if post-traumatic edema extends to the masticatory muscles. As a rule, for 3-4 days after removal, the situation improves. If this does not happen or vice versa, the mouth opens worse and worse – seek medical attention immediately.
– appearance of a bruise or hematoma on the skin in the area of the extracted tooth. It often happens in patients with hypertension, as well as after the removal of wisdom teeth. The scheme is as follows: edema first develops, then it begins to pass, and a bruise appears in its place, usually yellow.
– increase the evening body temperature to 38 degrees Celsius. Moreover, in the evening the temperature is as high as possible, and in the morning it is either normal or slightly above normal. This is a normal process, everything suggests that the body fights and copes with the resulting inflammation. In this case, an increased body temperature should not be viewed as a pathology, but as a protective reaction of the body. The temperature should be monitored twice a day at the same time, say, at 8-00 in the morning and at 20-00 in the evening. The measurement results are an indication of your condition, so tell your doctor about them.
– short-term deterioration of health. Anyway, any operation for the body is a serious stress. And he, the body, responds to it with an appropriate response. Theoretically, we can nullify it, but in practice this is not always possible – hence the unpleasant sensations in the form of headache, weakness, digestive disorders, etc. It is difficult to say what is normal and what is not, therefore for any occurrence or feeling better to consult with your doctor.
In general, all these unpleasant phenomena pass in 6-10 days (in particularly difficult cases, a maximum of two weeks), provided that you follow the recommendations and fulfill the prescriptions made by your doctor. The most important rule – no action and no self. This is the only way to ensure that nothing terrible will happen to you after tooth extraction – in my practice, in 99% of complications after tooth extraction, they are associated either with self-treatment or with the failure of the doctor’s recommendations.
Finally, I give a link to the memo, which I use in my practice. It lists all recommendations in the most convenient form for patients, medications for prescriptions and additional information for patients. You can download it here print on one sheet from two sides, add your name and the clinic logo – and boldly hand out to your patients. I hope it will be useful to you! As usual, I am waiting for your questions and comments.