ANZAOMS list of oral and maxillofacial surgeons Call the centres to learn why they are next available.

. SOMS Bondi Junction and Balmain offices th reopens Monday 7 January 8:30am Macquarie OMS Macquarie Street th reopens Monday 7 January st March 1 11:00am, bring relevant OPG and referral notes written by Dr. Wasserman Chatswood Dentistry reopens Thursday 3 January Dr Leesa Rix 6 Macintosh St Chatswood reopens Monday 7 January th February 4 2:20pm, bring relevant OPG and referral notes written by Dr. Wasserman Dr Lydia Lim not available until March. Dr Wasserman for analyzing state of teeth (not surgery), and any decay. Other ways to relive symptoms of pericoronitis whilst surgeon is all booked out?? Or go to hospital for removal.
th rd

Rinsing with water after Listerine defeats the purpose. 1/1/13 Lymph gland swelling has gone down and no longer painful to the touch. Placing a bit of gum on the upper wisdom teeth is pointless as it doesnt solve the question: why does the upper left wisdom tooth need to be removed? Differences between upper and lower mandible Upper and lower teeth and wisdom teeth Lower W/T are more difficult to remove and the dentist would normally send his patient to hospital to have them removed because there is a slight chance that the Inferior Dental Nerve could be damaged resulting in paresthesia. Many times pericoronitis can be resolved by removing the upper wisdom tooth on that side. Most upper teeth are easier to remove and heal more quickly than lower teeth.

There is much more gum on the lower mandible than the upper mandible. Therefore, pericoronitis occurs on the lower mandible, instead of the upper mandible. Upper wisdom teeth hitting the lower gum In some cases, the condition [pericoronitis] can be made worse when the upper molar comes through fully before the lower one. If the lower gum flap is inflamed and swollen with pericoronitis, the upper tooth may bite down on the lower gum flap, causing additional irritation and swelling. Frequently, an opposing upper tooth may cause ulcers on the swollen operculum by biting on the gum flap. It [pericoronitis] most often occurs with the wisdom teeth, most commonly the lower wisdom teeth. This [pericoronitis] happens more often with the lower wisdom teeth than with the upper ones. To understand this, you have to understand the differences in the upper and lower mandible. Lower wisdom teeth are more likely to be impacted than upper ones. In other words, the lower mandible is usually more crowded. Therefore, conditions arising from impactions are more likely. It is usually lower wisdom teeth that give problems and often the upper ones will be removed to prevent problems (they are often very easy to remove too). Problems with upper wisdom teeth

 If the upper wisdom teeth come through normally but the lower ones are impacted, the top ones can overgrow and bite into the lower gums, which can be sore. Upper wisdom tooth is biting down on the lateral surface of the gum (which moves in as the teeth (hinge joint) closes. This is proved by a visual of a dark brown spot on the side of the mouth where the tooth is biting into the mouth. X-ray confirms there is not enough space, and the upper wisdom tooth is hitting the gum, when in a normal human being, it should not be.

Looking at the X-ray of healthy teeth positioning, the mouth gap is a very slight concave curvature. All the teeth follow this curvature. The teeth in the upper jaw alternate the teeth of the lower jaw (like a zip).

Note mastication principle Chewing on one side of the teeth only, misaligns the jaw and causes mouth muscles of the contralateral side to be bitten on by the contralateral back teeth. Lower jaw is not as large as the upper jaw, upper jaw is wider than the lower jaw. The upper jaw is fixed (does not move), but the lower jaw is free to move up, down, and left and right (movements of the lower jaw) to meet the upper jaw. Front teeth of the lower and upper jaw fit together when the hinge closes, but not the side teeth. The lower jaw must move left to make the left side teeth fit together, and must move right to make the right side teeth fit together. I have the dentigerous/follicular cyst. Dentigerous cysts (also known as follicular cyst) occur on the crowns of impacted teeth, not erupted or partially erupted teeth. It is an odontogenic cyst. Odontogenic refers to teeth formation. On an X-ray: The radiographic differentiation between a dentigerous cyst and a normal dental follicle is based merely on size. Radiographically, a dentigerous cyst should always be differentiated from a normal dental follicle. Dentigerous cysts are the most common cysts with this radiographic appearance. Radiographically the cyst appears unilocular with well defined margins and often sclerotic boarders. Infected cysts show ill-defined margins. The most common location of dentigerous cysts are the mandibular 3rd molars and the maxillary canines, and they rarely involve deciduous teeth. Since the dentigerous cyst develops from follicular epithelium it has more potential for growth, differentiation and degeneration than a radicular cyst. Occasionally the wall of a dentigerous cyst may give rise to a more ominous mucoepidermoid carcinoma. Due to the tendency for dentigerous cysts to expand rapidly, they may cause pathological fractures of jaw bones.

A follicular cyst on top of left maxillary molar 2 causing its impaction. (Remember the right of an X-ray is the patients left.) The most common odontogenic (cyst forming during or from teeth formation ) cyst is a radicular cyst, also known as a periapical cyst (of inflammatory origin). Usually, a periapical cyst is asymptomatic, but a secondary infection can cause pain. On radiographs, it appears a radiolucency (dark area) around the apex of a tooth's root. Pain & infection are other clinical features of some radicular cysts. These cysts are painless unless infected. However, complain of pain is also observed in patient without any evidence of infection. Periapical cysts are usually caused due to root infection involving the tooth affected greatly by carious decay. The resulting pulpal necrosis causes release of toxins at the apex of the tooth leading to periapical inflammation. This inflammation leads to the formation of reactive inflammatory (scar) tissue called periapical granuloma. Further necrosis and damage stimulates the Malassez epithelial rests, which are found in the periodontal ligament, resulting in the formation of a cyst that may be infected or sterile (The epithelium undergoes necrosis and the granuloma becomes a cyst). These cysts [periapical cyst] may persist even after extraction of the offending tooth, such cysts are called residual cysts. Small [follicular] cysts are without symptoms but large ones expand the affected jaw and may cause pain and less often paresthesia. They often are in contact with the crown of an included tooth which can be dislocated by the growth of the cyst itself. Follicular cysts develop from follicular tissue, but the out-breaking factors are nowadays unknown. Occasionally, other more ominous lesions arise within the walls of the dentigerous cyst, such as mucoepidermoid carcinoma, ameloblastoma or squamous cell carcinoma. The cyst can then become quite large and can place the patient at risk for pathologic jaw fracture. Particular X-ray for assessing the roots of wisdom teeth - OPG The most used radiograph to assess wisdom teeth is called OPG. This x-ray is most often required to show the end of the roots of wisdom teeth and its location in relation to important nerves and the sinus. Its advisable to have this x-ray prior to any wisdom teeth removal consultation. An OPG or panoramic X-Ray is very important if not essential during the consultation of wisdom teeth removal. This X-ray not only shows all the patient s teeth but also shows the Inferior alveolar nerve and its proximity to the lower wisdom teeth. The OPG

X-Ray also shows the sinus around the upper teeth and helps assessing risks of an oral antral communication. With this X-Ray the surgeon is able to evaluate all 4 wisdom teeth and all nobel structures around it with 1 single film. This same X-Ray can also be used for an overall examination of all other teeth by another dentist in case further treatment is required. The OPG X-Ray in an invaluable tool during the assesment of Wisdom Teeth and all remaining dentition. The OPG X-Ray also provides a financial benefit for the patient if more than 1 tooth is required to be removed. Wisdom teeth removal surgery when acute infection is present Generally speaking, wisdom teeth removal should be delayed in the presence of infection. Most of the time is preferable to control the infection with antibiotics and oral hygiene first. The tooth extraction of the opposing wisdom tooth is also sometimes advised but that needs to be decided during the consultation with the dental surgeon or the oral surgeon.
Site: http://www.wisdomdentalemergency.com.au/wisdom-teeth

Its about organizing the OPG and bringing Wassermans referral notes. Ask dentist centre to send OPG to oral surgeon (never use your print-out copy). Call the OAMS surgery that did not pick up earlier.

Protect all my nerves! Qu: Is the adjacent wisdom tooth causing the decay in my case, or is it something else? It is the adjacent wisdom tooth is causing the decay. Qu: Should I remove 2 teeth at a time so that chewing is not so difficult? The pain and chewing problem is the same with 2 teeth removed as it is with 4. Remove 2 or all 4 Using the mouth will still be difficult with 2 removed, and you will have to go through it twice. Twice the painkillers, twice the anaesthetic, twice the difficulty. Cyst From the X-ray, it looks like the cyst is directly above the tooth. It is in the way of the wisdom tooth and so must be removed anyway. I just had a wisdom tooth removed as well as a dentigerous cyst about the size of a marble. I was unaware of the cyst in there until the oral surgeon did a better x-ray post surgery. He removed the cyst and sent it to pathology, hence the diagnosis. Frequently, follicular cysts will develop if the wisdom tooth is still covered by bone or gum tissue. The tooth is then no longer salvageable and must be removed together with the cyst. [In other words, the cyst must be removed as well it wont break down naturally] Treatment usually involves removal of the entire cyst and the associated unerupted tooth. Recurrence is uncommon, but may occur if parts of the cyst lining are left in situ. The cyst was caused by the tooth. If you only remove the tooth and not the cyst, the cyst will stay there. Once it grows, it has to be removed. It does not break down on its own. Whether it be drained out or cut out, an excision must be made to get to the cyst and the hole must be wide enough for the cyst to be removed. I think its obvious that all of the cyst must be removed to prevent any reoccurrence of a cyst (just like the mole just grows bigger and bigger if trapped). Upper wisdom teeth Crowded wisdom teeth in the upper jaw have a tendency to lean sideways and grate against the cheek. This may cause ulcers on the cheek and chewing problems. Decay of the second molar Decay: A wisdom tooth that is hard to clean due to its position or because it is partially covered by gum tissue may collect cavity-causing bacteria. This could also lead to decay in the tooth next to it. The decay might either be on the wisdom tooth itself, or else on its neighboring tooth (the adjacent 2nd molar).

Chu 2003 evaluated over 3800 impacted wisdom teeth. The reported findings were that 2 to 3% of the lower wisdom teeth and roughly 7.3% of their adjacent second molars had tooth decay. Another study (Linden 1995) evaluated a group of patients ages 13 to 75 years who collectively had over 2800 wisdom teeth removed. In regards to these extracted teeth, 7% had cavities, as did 42% of their adjacent 2nd molars. Note, fully impacted wisdom teeth have no potential to decay. Wisdom teeth cause decay of the adjacent molar because they wind up putting pressure on the root of a tooth in front to the point of root breakdown (resorption). At this stage, the tooth can be repaired with the help of fluoride, proteins and minerals (calcium and phosphate) in the saliva. The saliva also helps reduce the acid levels from bacteria that attack the tooth. Once the decay breaks through the enamel to cause a cavity, the damage is permanent. A dentist must clean out the decay and fill the cavity. But if you have early decay, what should be done? Do you need a filling right away? Not necessarily. These days, dental decay is "a slowly progressing disease," says David A. Albert, D.D.S., M.P.H. Dr. Albert is an associate professor of clinical dentistry at the Columbia University College of Dental Medicine. "From start to finish in the general population, it can take five years to go from early decay to full-blown involvement of the pulp," Dr. Albert says. The pulp is the center of the tooth, where the nerves and blood vessels are. Early in the 20th century, decay could reach the pulp in a matter of months, Dr. Albert says. In some cases, a filling is a no-brainer. If you're in pain or have an obvious cavity, you need a filling. But, says Dr. Albert, "If there's no cavity and no pain, the tooth can fix itself." At this stage, decay can be reversed with home and dental office fluoride treatments, better oral hygiene and changes in your diet, Dr. Albert says. Tooth decay disease is caused by specific types of bacteria that produce acid in the presence of fermentable carbohydrates such as sucrose, fructose, and glucose.[3][4][5] The mineral content of teeth is sensitive to increases in acidity from the production of lactic acid. To be specific, a tooth (which is primarily mineral in content) is in a constant state of back-and-forth demineralization and remineralization between the tooth and surrounding saliva. For people with little saliva, especially due to radiation therapies that may destroy the salivary glands, there also exists remineralization gel. These patients are particularly susceptible to dental caries. When the pH at the surface of the tooth drops below 5.5, demineralization proceeds faster than remineralization (meaning that there is a net loss of mineral structure on the tooth's surface). Most foods are in this acidic range and without remineralization, this results in the ensuing decay. Depending on the extent of tooth destruction, various treatments can be used to restore teeth to proper form, function, and aesthetics, but there is no known method to regenerate large amounts of tooth structure. Instead, dental health organizations advocate preventive and prophylactic measures, such as regular oral hygiene and dietary modifications, to avoid dental caries. A person experiencing caries may not be aware of the disease.[7] The earliest sign of a new carious lesion is the appearance of a chalky white spot on the surface of the tooth, indicating an area of demineralization of enamel. This is referred to as an incipient carious lesion or "microcavity".[8] As the lesion continues to demineralize, it can turn brown but will eventually turn into a cavitation ("cavity"). Before the cavity forms the process is reversible, but once a cavity forms the lost tooth structure cannot be regenerated. A lesion that appears brown and shiny suggests dental caries was once present but the demineralization process has stopped, leaving a stain. A brown spot that is dull in appearance is probably a sign of active caries. There are four main criteria required for caries formation: a tooth surface (enamel or dentin); caries-causing bacteria; fermentable carbohydrates (such as sucrose); and time. All caries occur from acid demineralization that exceeds saliva and fluoride remineralization, and almost all acid demineralization occurs where food (containing carbohydrate like sugar) is left on teeth. Though most trapped food is left between the teeth, over 80% of cavities occur inside pits and fissures on chewing surfaces where brushing, fluoride, and saliva cannot reach to remineralize the tooth as they do on easy-to-reach surfaces that develop few cavities.

The frequency of which teeth are exposed to cariogenic (acidic) environments affects the likelihood of caries development.[24] After meals or snacks, the bacteria in the mouth metabolize sugar, resulting in an acidic by-product that decreases pH. As time progresses, the pH returns to normal due to the buffering capacity of saliva and the dissolved mineral content of tooth surfaces. During every exposure to the acidic environment, portions of the inorganic mineral content at the surface of teeth dissolves and can remain dissolved for two hours. Since teeth are vulnerable during these acidic periods, the development of dental caries relies heavily on the frequency of acid exposure. The carious process can begin within days of a tooth's erupting into the mouth if the diet is sufficiently rich in suitable carbohydrates. Evidence suggests that the introduction of fluoride treatments have slowed the process.

(A) A small spot of decay visible on the surface of a tooth. (B) The radiograph reveals an extensive region of demineralization within the dentin (arrows).

Post-op wisdom tooth surgery

Immediately following surgery

For the next 24 hours do not drink from a straw, do not spit, and do not rinse mouth.
Bite on the gauze pad placed over the surgical site for an hour. After this time, the gauze pad should be removed and discarded and replaced by another gauze pad. Refer to the section on BLEEDING for specific details. Avoid vigorous mouth rinsing or touching the wound area following surgery. This may initiate bleeding by causing the blood clot that has formed to become dislodged. To minimize any swelling, place ice packs to the sides of your face where surgery was performed. Refer to the section on SWELLING for explanation. Take the prescribed pain medications as soon as you can so it is digested before the local anesthetic has worn off. Having something of substance in the stomach to coat the stomach will help minimize nausea from the pain medications. Refer to the section on PAIN for specific details. Restrict your activities the day of surgery and resume normal activity when you feel comfortable. If you are active, your heart will be beating harder and you can expect excessive bleeding and throbbing from the wound. Diet: Drink plenty of fluids. Try to drink 5-6 eight ounce glasses the first day. Drink from a glass or cup and dont use a straw. The sucking motion will suck out the healing blood clot and start the bleeding again. Avoid hot liquids or food while you are numb so you dont burn yourself. Soft food and liquids can be eaten on the day of surgery. The act of chewing doesnt damage anything, but you should avoid chewing sharp or hard objects at the surgical site for several days. Return to a normal diet as soon as possible unless otherwise directed. You will find eating multiple small meals is easier than three regular meals for the first few days. You will feel better, have more strength, less discomfort and heal faster if you continue to eat. If you suddenly sit up or stand from a lying position you may become dizzy. Therefore, immediately following surgery, if you are lying down, make sure you sit for one minute before standing. Oral Hygiene: Good oral hygiene is essential to proper healing of any oral surgery site. You can brush your teeth the night of surgery but rinse very gently. Vigorous rinsing should be avoided until the day following surgery. The day after surgery you should begin rinsing at least 5-6 times a day especially after eating. Salt water (cup of warm water mixed with a teaspoon of salt) is ideal but plain water is also OK. Mouthwash has an alcohol base to it so it may be pretty zingy when it comes in contact with fresh oral wounds. After a few days, dilute the mouthwash in half with tap water and rinse out your mouth. This will make it taste and smell better. You can gradually build up to full strength mouthwash as you feel more comfortable. [You cant vigorously gargle anyway due to the

presence of stitches.] Activity: You should keep physical activities to a minimum for 6-12 hours following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Keep in mind that you are probably not taking normal nourishment. This may weaken you and further limit your ability to exercise. Other Complications: If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, this is usually temporary in nature. You should be aware that if your lip or tongue is numb you could bite it and not feel it so be careful. Call Dr. Smith if you have any questions about this. Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots; they are the bony walls which supported the tooth (the walls of the tooth socket). These projections usually smooth out spontaneously. You may not notice this for days to weeks after surgery. If the rough edges bother your tongue or cheeks, call the office so Dr. Smith can evaluate the area and smooth them down for you. If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as Vaseline. Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days. Stiffness (Trismus) of the jaw muscles may cause difficulty in opening your mouth for 7-10 days following surgery. This is a normal post-operative event which will resolve in time. The muscles that operate the jaw are not used to holding open for prolonged times (like gardening for the first time in the spring). The physical therapy of eating, talking, yawning and chewing help the stiffness to resolve. EFFECTS Diet: Drink plenty of fluids. Try to drink 5-6 eight ounce glasses the first day. Drink from a glass or cup and dont use a straw. The sucking motion will suck out the healing blood clot and start the bleeding again. Avoid hot liquids or food while you are numb so you dont burn yourself. Soft food and liquids can be eaten on the day of surgery. The act of chewing doesnt damage anything, but you should avoid chewing sharp or hard objects at the surgical site for several days. Return to a normal diet as soon as possible unless otherwise directed. You will find eating multiple small meals is easier than three regular meals for the first few days. You will feel better, have more strength, less discomfort and heal faster if you continue to eat. If you suddenly sit up or stand from a lying position you may become dizzy. Therefore, immediately following surgery, if you are lying down, make sure you sit for one minute before standing. Oral Hygiene: Good oral hygiene is essential to proper healing of any oral surgery site. You can brush your teeth the night of surgery but rinse very gently. Vigorous rinsing should be avoided until the day following surgery. The day after surgery you should begin rinsing at least 5-6 times a day especially after eating. Salt water (cup of warm water mixed with a teaspoon of salt) is ideal but plain water is also OK. Mouthwash has an alcohol base to it so it may be pretty zingy when it comes in contact with fresh oral wounds. After a few days, dilute the mouthwash in half with tap water and rinse out your mouth. This will make it taste and smell better. You can gradually build up to full strength mouthwash as you feel more comfortable. [You cant vigorously gargle anyway due to the presence of stitches] Activity: You should keep physical activities to a minimum for 6-12 hours following surgery. If you are considering exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Keep in mind that you are probably not taking normal nourishment. This may weaken you and further limit your ability to exercise. Other Complications: If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, this is usually temporary in nature. You should be aware that if your lip or tongue is numb you could bite it and not feel it so be careful. Call Dr. Smith if you have any questions about this.

 Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots; they are the bony walls which supported the tooth (the walls of the tooth socket). These projections usually smooth out spontaneously. You may not notice this for days to weeks after surgery. If the rough edges bother your tongue or cheeks, call the office so Dr. Smith can evaluate the area and smooth them down for you. If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as Vaseline. Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days. Stiffness (Trimus) of the jaw muscles may cause difficulty in opening your mouth for 7-10 days following surgery. This is a normal post-operative event which will resolve in time. The muscles that operate the jaw are not used to holding open for prolonged times (like gardening for the first time in the spring). The physical therapy of eating, talking, yawning and chewing help the stiffness to resolve. Swelling: The swelling that is normally expected is usually proportional to the surgery involved. There is usually a fair amount of cheek retraction involved with the removal of impacted wisdom teeth. Therefore, you should expect swelling of the cheek after your surgery The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. The swelling may be minimized by the immediate use of ice packs. Sealed plastic bags filled with ice, ice packs, or a bag of frozen peas or corn wrapped in a washcloth should be applied to the side of the face where surgery was performed. The ice packs should be applied 20 minutes on/20 minutes off for the afternoon and evening immediately following your extraction. After 24 hours, ice has no beneficial effect. Thirty-six (36) hours following surgery the application of moist heat to the side of the face may help some in reducing the size of any swelling that has formed. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. Soft, puffy swelling that you can indent with your finger after oral surgery is very normal. Bright red, rock hard, hot swelling that does not indent with finger pressure which is getting bigger by the hour would suggest infection. This usually would develop around day 3-4 after surgery when you would expect swelling to be going down, not up. Temperature: It is normal to run a low grade temperature (99-100F) for 7-10 days following oral surgery. This reflects your immune response to the normal bacteria that are present in your mouth. A high temperature (>101F) might exist for a 6-8 hours after surgery but no more than that. 2 Tylenol or 2-4 Ibuprofen every 4-6 hours will help to moderate a temperature. A temperature >101F several days after surgery, especially if accompanied by rock hard swelling and increased pain, is usually indicative of infection. Bruising: When the bone requires smoothing to allow for the fit of the denture, there is a good chance there will be some bruising on the surface skin over the area. The most common location is over the upper eye teeth (on the cheek and below the eye). Bruising may not be obvious for a day or two. By the time it reaches the surface it may have already turned from purple to green to yellow in color. Pain: Pain or discomfort following surgery is expected to last 4-5 days. For many patients, it seems the third and fourth day may require more pain medicine than the first and second day. Following the fourth day pain should subside more and more every day. Many medications for pain can cause nausea or vomiting. It is wise to have something of substance in the stomach (yogurt, ice cream, pudding or apple sauce) before taking prescription pain medicines and/or over the counter pain medicines (especially aspirin or ibuprofen). Even coating the stomach with Pepto Bismol or Milk of Magnesia can help prevent or moderate nausea. For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours or Ibuprofen (Motrin or Advil) two-four 200 mg tablets may be taken every 3-4 hours. For severe pain take the tablets prescribed for pain as directed every 4 hours in addition to the Tylenol or Ibuprofen. The prescribed pain medicine will make you groggy and will slow down your reflexes. If prescription pain medications are required beyond 4 days, further treatment may be indicated. Please call the office and discuss your situation with us.

Google Upper wisdom tooth biting gum Reasons for upper wisdom teeth removal Brush before meals. The acidity in meals (your mouth pH drops) softens the enamel. Then when you brush, the enamel is eroded by the action of the toothbrush. The time it takes for the pH of your mouth to return to normal is 30 minutes, so seeing that bedtime brushing must be done, its still fine. Saliva Your mouth and teeth are constantly bathed in saliva. We never give much thought to our spit, but this fluid is remarkable for what it does to help protect our oral health. Saliva keeps teeth and other parts of your mouth moist and washes away bits of food. Saliva contains minerals that strengthen teeth. It includes buffering agents. They reduce the levels of acid that can decay teeth. Saliva also protects against some viruses and bacteria.

Wisdom teeth have to be removed. Reasons: the positioning of the three wisdom teeth, been causing pain in my mouth, caused recurring pericoronitis of the superior gum and tooth decay of the second molar (predisposition for disease and pain with my wisdom teeth), recurring toothaches, recurring inflamed uvula and throat (symptomatic just like enlarged lymph nodes) these problems will continue for the rest of my life unless the wisdom teeth (the source of the whole problem) are removed. Do we absolutely have to extract wisdom teeth? Not necessarily. Is there enough room on the jaw for healthy development? Alternatively, are we dealing with tooth crowding that calls for orthodontic treatment of the jaw that would be significantly easier to administer with the wisdom teeth removed? Does it make sense to support already-damaged molars with wisdom teeth? These questions must be answered. When wisdom teeth are removed, a variable amount of bone will need to be removed as a standard technique of the surgery.

Tip for taking capsules (if you are ever in a position of taking them) - Place the capsule deep into the mouth. - Perform a strong swallow, not a half-swallow. Antibiotic diarrhea (AAD antibiotic-associated diarrhea) - probiotics help - original solid stool times were morning (before and during breakfast) and before exercise - now, stool is keeping with the original, just divided into more than one sitting 30/12 Bowel movements: 9am, 9:30am, 12:30pm (initial was loose bits of stool, but the end was more solid stool), 3pm (mainly solid)

Some say diarrhea will go away a few days into taking the antibiotic as your body gets used to it (temporary). Others say the diarrhea will go away once treatment is complete (permanent as long as treatment is being taken). Not sitting slumped, but upright, seems to alleviate the feeling of needing to move bowels.

If you've got chronic diarrhea, then one of the things you've likely tried to slow down your bowel motility is psyllium seed powder or ground flax seed. Likewise, if you suffer from constipation, you've likely tried the same remedies. How is it that the same substances work for completely opposite maladies? Stool bulking agents, like psyllium and flax, improve cases of chronic diarrhea because they absorb a lot of liquid. When you remove the excess water from the intestines, it reduces the pressure and bowel movements become less urgent and less explosive. These same bulking agents improve constipation since constipation often involves very hard, dried out stools that are difficult to pass. When you regularly ingest bulking agents, they keep water in the stool, so the stool remains softer and easier to pass. In both cases, it's easier on the peristaltic mechanism to move stool along that is normal-sized and soft, yet formed. Likewise, this type of stool is easier on the rectum and anus and helps prevent fissures and hemorrhoids.

It may be a good idea to make changes to your diet whilst you are having diarrheal or constipated side effects. There are many ways you can approach the problem. Thinking in the opposite way, eating foods that stop diarrhea is the same as eating foods that cause constipation . Foods that especially bind/cause constipation: 1 Banana, 2 Dairy products 3 All meats (esp. red meat) Ripeness of the banana Interestingly, bananas can either be a cause of constipation or a source of constipation relief, depending on their ripeness. Unripened, green bananas are constipating, says Tammy Lakatos. But ripe bananas are very high in soluble fiber, which in some cases can help to push waste through the bowels, so bananas can also be helpful in eliminating constipation issues. Bristol stool chart/scale

The Bristol stool scale or Bristol stool chart is a medical aid designed to classify the form of human faeces into seven categories. Sometimes referred to in the UK as the "Meyers scale", it was developed by Dr. Ken Heaton at the University of Bristol. The seven types of stool are: Type 1: Separate hard lumps, like nuts (hard to pass) Type 2: Sausage-shaped, but lumpy Type 3: Like a sausage but with cracks on its surface Type 4: Like a sausage or snake, smooth and soft Type 5: Soft blobs with clear cut edges (passed easily) Type 6: Fluffy pieces with ragged edges, a mushy stool

Type 7: Watery, no solid pieces. Entirely liquid Types 12 indicate constipation, with 3 and 4 being the ideal stools (especially the latter), as they are easy to defecate while not containing any excess liquid, and 5, 6 and 7 tending towards diarrhea. Oxford Dictionary, in the literal sense: If a food (or medicine) is binding, it makes the patient constipated. In the physical and medical sense, food binding is the clumping together of separate foods.

The BRAT diet for stopping diarrhea The BRAT diet is no longer routinely recommended by nutritionists at the Seattle Cancer Care Alliance (SCCA) to patients who have had stem cell transplants and have diarrhea due to Graft-versus-host disease as long-term use can lead to nutritional deficiencies. BRAT is nutritionally incomplete and may be deficient in energy, fat, protein, fiber, some vitamins and calcium. Cultured foods, rice water, coconut water and soluble fiber foods/supplements are more effective at treating ongoing diarrhea in conjunction with tolerated foods and beverages. A well-balanced diet is not always best during diarrhea. The intestinal mucosal cells are damaged in common viral enteritis, and are not able to properly absorb nutrients until they regenerate, which requires about 48 hours. Fiber Soluble fiber is fiber that is soluble in water (i.e. binds). Insoluble fiber is fiber that is insoluble in water (like oil is to water). Soluble fiber, with the exception of psyllium fiber, does not have a laxative effect. Insoluble fiber has a laxative effect. Laxatives are foods or drugs taken to loosen stool, most often to treat constipation. Laxatives work to increase the movement of feces along the colon. Bulkproducing agents (both soluble and insoluble fiber) cause the stool to be bulkier and to retain more water, as well as forming an emollient gel, making it easier for peristaltic action to move it along.

Do not rub too hard; you want to preserve the skin so it doesnt hurt too much.

Lymph gland = lymph node Submandibular lymph node swelling = submandibular lymphadenopathy and indicates to the patient a mouth or dental infection Adenopathy is enlargement of a lymph node. Why isnt there enough space for wisdom teeth? We should probably blame evolution (and migration) for the problems we might have with wisdom teeth. Ancient humans had larger jaws and larger teeth than modern humans - maybe because we don't need to chew as much nowadays. Wisdom Teeth Wisdom teeth are considered vestigious. Website - type into google: Pericoronitis (infection near wisdom tooth).

Do not reveal dentist until driving there. Otherwise parents will have time to mess with the dentist. Wisdom teeth are at the back of your teeth. They usually grow through the gums late-teens, between the ages of 17 and 25, at about 18 years of age. ONLY THE MOST PRACTICAL THINGS - Questions - Side effects - Dentist should do it oral surgeon. - How the procedure goes, to make sure the dentist sticks to it. However, if there isn't enough space for them to grow at the back of your mouth they become 'impacted' wisdom teeth, causing pain, swelling and/or infection. Having your wisdom teeth removed is often the only way to permanently relieve your symptoms. 100% removing my wisdom teeth (both?), since symptoms are presenting constantly. Removing how many wisdom teeth (all at once?) Dentist or Oral surgeon Use a dentist to confirm what the problem is, and use the oral surgeon to remove the wisdom tooth if that is the problem. GO TO THE ORAL SURGEON!! In most cases dentists don't put in stitches just for safety reasons (like if the place where your tooth was pulled out of, the hole was way too big etc.) and I have heard wisdom teeth are the worst, but it depends on how much your tooth is fused to the bone (ask for an x-ray when you see him and ask about how tightly your tooth is holding on). Most general dentists are very capable of extracting partially erupted molars. However, many do not enjoy performing the procedure as well as the potential of dealing with the postextraction complications (dry sockets, bleeding, swelling, possible nerve damage). Oral surgeons are more experienced as they extract teeth on a daily basis, have seen more complications so they're more prepared to deal with complications should something happen. If your dentist or healthcare professional recommends that your wisdom teeth be removed, you will most likely be referred to an oral and maxillofacial surgeon for the procedure.
Site: http://www.aaoms.org/wisdom_teeth.php

Pre-op understanding your symptoms and the STATE of your teeth Infection: The gum tissue around the crown of the wisdom tooth becomes irritated, inflamed and infected. This infection may spread to the cheek, throat or neck resulting in pain, swelling and stiffness of the jaws. Ulcers, if you have any, are white in colour (and look like a blister on the gum/mouth/tongue). Impacted wisdom tooth tooth has not reached the surface Impacted teeth can be bony or soft tissue impactions Erupted wisdom tooth tooth has reached the surface of the gum but stops growing Mesioangular impaction is the most common form (44%), and means the tooth is angled forward, towards the front of the mouth. Distoangular impaction (6%) means the tooth is angled backward, towards the rear of the mouth. Vertical impaction (38%) occurs when the formed tooth does not erupt fully through the gum line. Horizontal impaction (3%) is the least common form, which occurs when the tooth is angled fully 90 degrees sideways, growing into the roots of the second molar.

Typically mesioangular impactions are the most difficult to extract in the maxilla (upper jaw) and easiest to extract in the mandible (lower jaw), while distoangular impactions are the easiest to extract in the maxilla and most difficult to extract in the mandible. Frequently, a fully erupted upper wisdom tooth requires bone removal if the tooth does not yield easily to forceps or elevators. Failure to remove distal or buccal bone while removing one of these teeth can cause the entire maxillary tuberosity to be fractured off, thereby tearing out the floor of the maxillary sinus. Impacted wisdom teeth may also be categorized on whether they are still completely encased in the jawbone. If it is completely encased in the jawbone, it is a bony impaction. If the wisdom tooth has erupted out of the jawbone but not through the gumline, it is called a soft tissue impaction. Impaction or eruption will determine what procedure you get. If the tooth is impacted, the gum must be cut through until the tooth is revealed. The tooth must be sectioned off (there may be drilling) by cutting the top (crown) of the tooth, then the rest of the tooth (the roots) is extracted manually. What are the different states of wisdom teeth? Wisdom teeth rarely fully erupt out of the gum and emerge as complete teeth. For this reason wisdom teeth may be extracted at several different stages of growth. Impacted wisdom teeth dont have enough room in the mouth to erupt and grow as normal teeth. These wisdom teeth often develop at an angle or sidewise, and thus they can put pressure on neighboring teeth and harm bite alignment. They can also remain trapped in the jawbone. Partially erupted wisdom teeth may be partly covered by gum tissue, or only slightly emerge from the gum line. These teeth are prone to infection because it is difficult to clean teeth that are not fully above the gum. Sometimes it is faster to extract partially erupted wisdom teeth compared to impacted teeth, though this depends on the level of impaction, as well as other factors such as size of the tooth and mouth. Partial eruption of the wisdom teeth allows an opening for bacteria to enter around the tooth and cause an infection, which results in pain, swelling, jaw stiffness, and general illness. Impacted teeth have no opening so there isnt an infection of the same sort.

Self-diagnosis: Both left wisdom teeth are erupted. Lower left wisdom tooth is only very partially erupted, upper left wisdom tooth is nearly fully erupted.

Partially erupted/partially impacted tooth. Swelling is above the area where the tooth is still impacted. Partial impaction is the same as partial eruption (like glass half-full, half-empty).

PERICORONITIS I have some pericoronitis on the medial side of the left gum. Pericoronitis is a common dental problem in young adults with partial tooth impactions. It is an acute infection causing swelling or inflammation of gums and surrounding soft tissues of a partially erupted tooth. It usually occurs within 15 to 24 years of age as it is when the third molars start erupting. It occurs when the tissue around the wisdom tooth has become inflamed because bacteria have invaded the area. Poor oral hygiene and mechanical trauma on nearby tissue can cause the inflammation of the soft tissue. This soft tissue covering partially impacted tooth is known as operculum.

Operculectomy However, it can be impossible to effectively brush the necessary area and prevent this from occurring due to a partially erupted tooth. Chronic pericoronitis may be the etiology for the development of paradental cyst, an inflammatory odentogenic cyst. The gums around the wisdom tooth can inflame (pericoronitis). Pericoronitis is an acute infection in which there occurs the inflammation of gingival and surrounding soft tissues around an incompletely erupted tooth and the most infected one is the area around 3rd molar or wisdom tooth. Treatment for minor symptoms of pericoronitis (spontaneous pain, localized swelling, purulence/drainage, foul taste) is irrigation. Major symptoms of pericoronitis (difficulty swallowing, enlarged lymph nodes, fever, limited mouth opening, facial cellulitis/infection) are usually treated with antibiotics. In most instances the symptoms will recur and the only definitive treatment is extraction. If left untreated, however, recurring infections are likely, and the infection can eventually spread to other areas of the mouth. The removal of the wisdom tooth (extraction) should occur at a time when the acute phase or "infection" is not present, as extracting this tooth during the time of the acute/painful infection can cause the infection to spread to dangerous area around the throat. Therefore, a dentist will usually clean the area and/or prescribe antibiotics and wait for it to calm down until scheduling the extraction of it. Pericoronitis can be managed with local debridement and warm salt water rinses (by the way, oral irrigation is not rinsing, it is a dental water jet). However, if the tooth does not completely enter the mouth, and food and bacteria keep building up under the gum, pericoronitis will more than likely return. If the affected tooth is removed or erupts fully into the mouth, the condition cannot return.

Pericoronitis (inflamed swollen tissue covers the tooth more than it should be covering it)

Pericoronitis infection around wisdom tooth Causes of wisdom tooth pericoronitis Incomplete eruption of a wisdom tooth produces a large space between the gum flap and the tooth, making it an ideal location for food debris to collect and allow bacteria to grow. It can easily become infected, causing the tissue to be extremely inflamed and painful. There is constant inflammation in the area and the dental pericoronitis could be chronic if no acute symptoms are present. Frequently, an opposing upper tooth may cause ulcers on the swollen operculum by biting on the gum flap. Wisdom tooth infection can occur when the tooth is partially erupted and there is poor oral hygiene. Bacteria can cause decay of the tooth and lead to inflammation of the gum tissue surrounding the tooth. Impacted wisdom tooth, whereby the wisdom tooth could not erupt properly into the mouth due to obstructions, for example blockage from the adjacent teeth, which can lead to impaction of food and plaque accumulation under the gum flap. Pericoronitis is caused by a mixed infection and the various bacteria found in dental plaque, particularly anaerobes, can be the cause of the disease. Signs and symptoms of wisdom tooth pericoronitis This disease is a common problem associated with young adults as the wisdom teeth start erupting. The wisdom teeth usually start appearing in the mouth from the age of 17 to 21 though they vary from each person. Some may not have wisdom teeth at all. The signs and symptoms usually present in wisdom tooth pericoronitis are: Soreness and tenderness around the wisdom tooth area in the back of the mouth. Redness and swelling of the gums in the affected area. Pain is severe and spontaneous, and is often aggravated by closing the mouth. In some severe cases, pain may be worsened by swallowing and there may be difficulty in opening or closing the mouth to allow examination of the area. Pain can spread to throat and ear. Swelling of the cheek.

Bad taste in the mouth or bad breath. Occasionally pericoronitis may be accompanied by fever, swelling in the neck and body discomfort. Enlarged lymph nodes In severe cases, pus may flow out from the infected area. Wisdom tooth pericoronitis is often a recurrent problem if the main cause is not removed. Wisdom tooth pericoronitis treatment and management There are several considerations in managing wisdom tooth pericoronitis which include the severity of the case, whether it is a recurrent problem and the possible complications involved. Initial treatment is aimed at resolving the symptoms. Food debris in the infected area will be removed from under the gum flap by gentle flushing with warm water or dilute hydrogen peroxide. Any dead tissues will be removed under anesthetic agent applied to the tissue. Your dentist will then instruct you to rest at home, keep the mouth clean using warm saltwater mouthwash and drink fluids to avoid dehydration. Your dentist may prescribe you antibiotics, particularly when there is fever and enlarged lymph nodes. Penicillin or penicillin and metronidazole will be given and should be taken according to instructions. Another appointment may be made for further irrigation of the affected area and once the symptoms have resolved, further assessment is done. The position of the affected tooth, its relationship to the second molar and any complicating factors will be determined by using Xrays. If X-rays show that the third molar is badly misplaced, impacted or decayed, it should be extracted after inflammation has subsided. If the tooth is to be retained, the operculum is removed, especially when an upper tooth is biting on the flap and to allow proper cleaning of the area. Pericoronitis is a painful dental disorder observed mainly in teenagers and young adults between 1524 years of age. The pain is caused due to the infection caused either by one or both staphylococcus and streptococcus types of bacteria found around the gum tissues of the molar teeth, especially around the wisdom tooth. The growth of the wisdom tooth creates a cavity around the gum, providing an easy entry for the bacteria. The presence of leftover food particles in the cavity creates favourable condition for the bacteria to thrive in and cause acute pain and inflammation of the gum tissue. The person suffering from pericoronitis, experiences extreme difficulties in chewing food, due to acute pain and creates a bad taste in the mouth. Pericoronitis requires immediate treatment for the intolerable pain, and in extreme cases, the infection may spread through the jaw line aggravating the discomfort. It is easy to treat pericoronitis at home unless the infection turns serious enough, calling for immediate medical attention. In case of acute infection, the dentist may opt for oral surgery uprooting the wisdom teeth. It prevents the spread of infection to other teeth. Otherwise, administering pain killers and antibiotics are the common modes of pericoronitis treatment. Many go for heat treatment; this may provide some sort of relief for the time being, but it spreads the infection and worsens the condition. Application of ice pack or swallowing ice cubes several times throughout the day is the best way to get relief from the pain according to Delhi-based expert dentist, Dr. Aman Arora. How to treat pericoronitis Pericoronitis treatment can be carried on successfully at home during the initial stages of the infection. Observe the symptoms such as swelling of the gums around the molars and acute pain followed by difficulty in opening the mouth, cautiously. These are clear indications of pericoronitis. If swelling is observed in the jaws including the cheeks, you should immediately consult a dentist for suitable pericoronitis treatment. In case, the swelling and pain is restricted only around the wisdom tooth, you can safely treat it at home. Whenever you sense the growth of the wisdom tooth, wash your mouth thoroughly with lukewarm salted water every day after meals to prevent any bacterial infection. Growth of wisdom tooth is usually followed by pain and infection.

Make sure that no food particles are left around the teeth and gums. It is safe to brush your teeth twice a day after the meals. Rinsing the mouth with antiseptic mouthwash solutions after brushing is also effective in treating pericoronitis. You can take aspirin or other painkillers to reduce the pain. Doxycycline and penicillin are safe in interaction together. Penicillin is the primary antibiotic used against the staphylococci and streptococci bacteria. The bacteria responsible for pericoronitis (just like P.acnes is for acne) is either the staphylococcal or streptococcal bacteria, or both. The antibiotics take care of the infection aspect of the problem but you should be taking Tylenol for the inflammation. In order to treat pericoronitis, your dentist will most likely begin by removing the infected/dead tissue, and cleaning the area of pus and debris. You may also have to take antibiotics until the infection clears. Seems that the tooth has stopped growing, will not erupt any further . Typically, once you have a wisdom tooth removed, pericoronitis will not return. In some situations, it may be necessary to remove both wisdom teeth. The resulting flap of gum causes discomfort, especially if the opposing tooth touches it when eating. For example, if the upper wisdom tooth is biting into the lower gum, the upper tooth will have to be removed in order to prevent further problems. Excision of the flap or removal of the tooth. Even after an operculectomy the problem can return. Removing the wisdom tooth is the only permanent way to stop pericoronitis.

Untreated infection spreading to the cheek and neck (swollen face due to pericoronitis) Make sure the infection doesnt spread any further by taking oral antibiotic. The pain from chewing is due to top teeth hitting the affected swelling area. The pain from swallowing is due to swelling and pain spreading to the muscles that do the swallowing (jaws and cheek). THE PROCEDURE OF REMOVAL The procedure for removing your wisdom teeth will depend on how deeply impacted your teeth are. Many wisdom teeth can be extracted simply like any other molar. Once the anaesthetic has taken effect, your dentist or oral surgeon will widen the socket (the area your tooth sits in) using a tool called an elevator or a pair of special forceps. The tooth will be moved from side to side until it is loose enough to be removed completely. However, if your tooth is more difficult to remove, your dentist or oral surgeon will cut through your gums and may remove some of your jawbone to reach your tooth. They'll remove your

wisdom teeth and then close your wounds with stitches if necessary. Most wisdom teeth only take a few minutes to remove, but the more difficult cases can take around 20 minutes. Step 1: positioner and X-ray Step 2: topical, then local anaesthetic Step 3: Loosen the periodontal ligament attached to the tooth by elevating the tooth with with a dental elevator. Step 4: Use dental forceps to rotate the tooth in a clockwise, rocking motion until is loose and removable. Blood will spill out. Step 5: Suction the socket out to clean the blood off for a better visual. Step 6: Spray the socket and the patients mouth with water. Step 7: Suction the water out of the socket and patients mouth. Step 8: Patient now needs to bite down on some gauze for a few minutes to allow the socket to properly form a clot. If the patient is clotting properly, we can go ahead and place fresh gauze over the socket.
Site: http://www.surgerysquad.com/surgeries/virtual-wisdom-tooth-extraction/

Anaesthesia (done) The operation is usually done under local anaesthesia. This completely blocks pain from your gums and you will stay awake during the procedure. You may be offered a sedative to help you relax during the operation. If you go to a hospital and your wisdom teeth are particularly challenging to remove, you may be put under general anaesthesia. The local anaesthesia is injected into the gum (again, lidocaine). Side effects of general anaesthesia Eating and drinking usually you will be asked not to drink or eat for several hours before the operation. Shaving - you may need hair shaved from the operation site. General anaesthetics can be given in a number of ways. One method is by injecting drugs into your veins, and another method is by anaesthetic gas given by inhalation through a mask. Sometimes, injections and the anaesthetic mask can be used at the same time.

Stitches (definitely stitching up the socket and definitely removable stitches) Stitches reduce the chance for dry socket. Dry sockets are more common in lower extractions than upper ones. The occurrence of dry sockets is much more likely in patients who don't follow dentist orders after surgery and do things such as drinking from a straw and rinsing or brushing vigorously. All the research I've done - through several dentists, the internet, and personal accounts suggests that the best way to prevent dry sockets is to get stitches. I don't know why any dentist would leave the hole open, but many do. For dissolvable vs removable stitches, use the surgeons idea that dissolvable is always inferior to removable. POST-OP RULES Do not lie flat. This may prolong bleeding. Elevate your head. Whether you're sleeping on your couch or on your bed, place pillows beneath your head to elevate your mouth. Elevation will decrease swelling. You should only have a soft food diet on the day of surgery and the day following surgery. Drink lots of fluids to rehydrate. Avoid hard, crunchy foods such as chips that may disturb the extraction site for at least three days. After the third day, you may eat anything you wish, unless given other specific instructions by the dentist. Relax after surgery. Physical activity may increase bleeding. Do not perform any motion which creates suction in the mouth. Spitting creates suction. Avoid rubbing the area with your tongue or touching it with your fingers. While you shouldnt rinse for the first 24 hours, after this initial period you should gently rinse 4 times a day using warm salt water (1 teaspoon of salt in a glass of warm water). Do not spit out forcefully! [III sites say salt water]. Rinse after every meal and snack, making sure that the water removes any bits of food around the area where the tooth is missing.

 Avoid all brushing, rinsing or spitting the day of the surgery. The day after your surgery, you may brush your teeth, but avoid brushing near the surgical site(s) for 3 days. Rinse with cup warm water and a pinch of salt beginning 3 days after surgery. Rinsing the mouth during this period is counter-productive, as the bleeding stops when the blood forms clots at the extraction sites, and rinsing out the mouth will most likely dislodge the clots. The end result will be a delay in healing time and a prolonged period of bleeding. Remember, you WANT the blood to clot to reduce bleeding. Blood clots HELP the healing process. Gauze pads should be placed at the extraction sites, and then should be bitten down on with firm and even pressure. This will help to stop the bleeding, but should not be overdone as it is possible to irritate the extraction sites and prolong the bleeding or remove the clot. Try using an ice pack on the outside of your cheek for the first 24 hours. Ask for extra gauze (better to be safe than sorry). Remember to remove gauze before eating or drinking. Swelling around the mouth, eyes and cheeks is normal following any surgery, and usually takes 2-3 days to fully develop. Applying ice to your face and keeping your head elevated for the first 24 hours will help reduce swelling. Ice serves no useful purpose after 24 hours and may contribute to stiffness in the jaw. When you have any teeth removed (extracted) you are left with a hole (tooth socket) in your jawbone, in which a blood clot forms first and then heals over from the bottom with stronger gum. For the first few days at least, it is important not to disturb this clot and to keep the mouth and teeth clean. Sometimes, when teeth are removed, the gum is peeled back by the dentist or oral and maxillofacial surgeon and then sewn back in place to help it heal together. Again, it is important that this gum is not damaged afterwards to allow it to heal. Things that you can do (and avoid) to help this healing include: Until the local anaesthetic has worn off: avoid biting your tongue, lips and cheeks accidentally. Avoid hot drinks (which can break down the clot). Avoid eating especially anything spiky. For the first 24 hours (after the numbness has worn off): avoid hot drinks (which can break down the clot). Take only liquid or soft foods (spiky foods can hurt and get stuck in blood clots or delicate gums). Avoid vigorous mouthwashing to prevent the clot breaking down. You will be aware of the 'hole(s)' left after removal of your teeth for several weeks, but the bone and gum will reshape and after six months it will be hard to tell you have had surgery there. Patients are often concerned about the appearance of the cheeks being sowed to the gum. They are often concerned it looks permanent, however rest assured it is just an illusion caused by the amount of swelling in the cheek. What is normal - some (not excessive) amounts of bleeding - some amounts of swelling on the mouth and cheeks Some bleeding is to be expected following surgery. If you are bleeding excessively, apply pressure by folding and placing a gauze pad directly over the extraction site and biting firmly on gauze for one hour. Excessive bleeding is defined as pooling or dripping blood out of the extraction sites within 15-20 seconds of removing the gauze. If excessive bleeding continues, apply a gauze pad for an additional 30 minutes. Don't use the amount of blood on the gauze as a guide, because minimal bleeding may persist for up to 24 hours. Occasional side effects The removal of upper wisdom teeth may cause (temporary) sinus pain.

Sinus Complications: The roots of upper wisdom teeth sometimes penetrate into the maxillary (upper jaw) sinus cavity. Sometimes an opening into the sinus with drainage or sinus pain (sinusitis) may occur following upper wisdom tooth removal. Usually these complications are temporary. If a significant opening into the sinus cavity does occur, an additional procedure may be necessary to close or repair the opening or communication.
Avoiding dry socket Do not smoke. Clean the extraction site as instructed and follow all at-home instructions. Avoid sucking action from smoking, spitting or using straws for the first 24 hours. Do not rinse mouth excessively; it interferes with blood clotting.

Reading your dental X-ray Cavities, abscess and gingivitis on x-ray cavities can be visible to the naked eye or need an x-ray. On an x-ray, cavities are darkened areas in the tooth where the bone has decayed. Tooth abscess is darkened area at the root of the tooth (it should be white normally)

Lets look at this special x ray called a Panorex. If youve been to the dentist and they took an x-ray that went around your head, then the x ray was most likely a Panorex. In the image above, which is a Panorex, we can see the following: 1) Wisdom Teeth: There are four in this Panorex, one in each of the four corners of the jaw. They are angulated in a forwards direction and are all impacted. 2) Decay (cavity): On the lower left of the panorex If you look closely, you can see two cavities. These appear as dark shadows in between the teeth. Maybe this individual hasnt been flossing Though we can see decay on the panorex, this is not the x ray that we like to use to confirm the diagnosis of a cavity. For this, we use smaller x rays called Bite Wings. 3) Sinuses: These are the large dark circular areas in the upper jaw. They are called the Maxillary sinuses and are the hollow spaces often associated with Sinusitis (congested sinuses). This can translate into tooth pain if the roots of the upper molar teeth protrude into the congested sinus.

4) Mandibular Nerve: Running along the bottom of the lower jaw, you can see a dark grey channel about 2-3 mm wide (more visible on the lower right). In this channel is a nerve which as a dentist we have to be very cautious of when doing wisdom tooth extractions.

An email of the X-ray is not enough, I need the actual film You have to look really closely at the characteristic of the bone and the very small dark areas showing cavities.

The maxillary teeth are the top row; the mandibular (or lower maxillary) teeth are the bottom row.

There are two premolars in each quadrant of the mouth. There are three molars (including the wisdom tooth) in each quadrant. There is one canine in each quadrant of the mouth. There are 8 incisors (2 in each quadrant). As the tooth grows out, it is still partly covered by soft gum tissue, forming an envelope that bacteria can live in.

Today many dentists are recommending that they be pulled before any problems arise, this would be done while the patient is in his or her teens. Preventative pulling of wisdom teeth is becoming a standard procedure. There are still some dentists out there that want to take the wait and see approach. It was done this way for years. It was done this way for years. Many people would get to their 30s and 40s and all of a sudden, they would begin to have problems with their wisdom teeth. At this age, the roots are fully set and formed making extraction a much more difficult process. You do not want to wait until you have pain to have your wisdom teeth examined, if you wait that long it will make treatment more complicated and the chance of complications rises greatly. You should get your wisdom teeth examined yearly as an adult. This way your Dentist will be able to catch any problems before they get out of hand. Most people have a wisdom tooth in each quarter of their mouth. The number can range from four to none. Do wisdom teeth always have to be removed? Not always. Often they come through straight and then they are just like any other normal teeth.

There are ones that do not experienced pain from their wisdom teeth at all, when this is the case its because they have more room, space in their mouth for these teeth to grow. In younger people (late teens and early 20s), the wisdom tooth's roots are not fully developed and the jaw bone is not as dense, so it is easier to remove the tooth. The easier it is to remove the tooth, the easier your recovery is likely to be.

Decay of partially erupted wisdom teeth I think it's fairly common with wisdom teeth for them to become decayed while they are still only partially erupted, and there's not much you can do to stop it from happening really. Pain radiating The pain is radiating because all teeth share a common big trunk of nerve called the trigeminal nerve (5th cranial nerve). The pain you are experiencing is called referred pain. That is an early sign that your tooth must be rotten. Worse, the adjacent tooth might be affected also, especially if the impaction approximates the tooth beside it.

http://www.wfdental.com.au/wisdom%20teeth%20%20About%20wisdom%20teeth%20removal.html

Formation of Teeth

Tooth eruption has three stages. The first, known as deciduous dentition stage, occurs when only primary (baby) teeth are visible. Once the first permanent tooth erupts into the mouth, the teeth are in the mixed (or transitional) dentition. After the last primary tooth falls out of the moutha process known as exfoliationthe teeth are in the permanent dentition (i.e. permanent teeth). Note there is no primary (baby) tooth for the third molar (wisdom tooth).

Linea alba (Latin for white line) is a term used in dentistry to describe a horizontal streak on the inner surface of the cheek, level with the biting plane. It usually extends from the commissure to the posterior teeth and can extend to the inner lip mucosa and corners of the mouth.

By sight, the gum looks depressed. When I bite, it feels like the gum is being embedded. Maybe the top tooth is biting into the gum of the lower maxillary jaw. Wisdom teeth dont always situate themselves in an orderly position in the mouth. If there is crowding the tooth may emerge pointing out toward the cheek and cause biting of the cheek when food is being chewed. A tooth is impacted if it has formed under the gum but hasnt presented itself in the mouth. Usually people are in their late teens or early twenties before the wisdom teeth try to come out of the gum line and into the mouth.

Most dentists recommend that patients get their wisdom teeth removed as soon as possible, when they are starting to present themselves, because waiting till later can allow some of these problems to occur. Wisdom teeth can have long, far-reaching roots that wrap themselves around the main nerve in the jaw bone, making extraction later a tricky and risky procedure. Once the wisdom teeth have begun to emerge, their progress should be monitored by your local dentist. A complete set of dental x-rays can determine if there is room in the mouth to accommodate the erupted wisdom teeth. Your dentist will be able to tell you, based on his findings, whether or not you will need a wisdom tooth extraction.

Eruption is just a fancy exaggerated word for the tooth presenting itself in the mouth. 10:00pm+ 22/8 When biting, top tooth hitting gum of wisdom tooth, but not the next morning 23/8 Inflammation Very visible inflammation on the inner side of the gum, and a small part of the surface of the gum.

Relation of surgery to the mole scar/acne - mouth wide open, stretching the scar, esp. since mouth hasnt opened that wide for a long time.

Partial Eruption Sometimes the wisdom tooth fails to erupt completely through the gum bed and the gum at the back of the wisdom tooth extends over the biting surface, forming a soft tissue flap or lid around the tooth called an operculum. The operculum of a partially erupted tooth is a small flap of tissue that covers an erupting or partially erupted molar. It is prone to getting a lot of food debris trapped in the area.

Have felt searing pain down the left side of my neck (most likely due to the strength of the nerve in the mouth connecting with the rest of the mouth and other nerves).

Only a full set of dental X-rays

X-ray and tazarotene, dental surgery (things they apply over the mouth) and tazarotene

QUESTIONS
How to prevent teeth from growing crooked Why do some teeth not grow straight? [I think due to overcrowding of the teeth] Pictures of people with wisdom teeth (so that we know its a wisdom tooth)

How does the tooth physically grow through the gum? Teeth not any other problem More concerned about dental surgery/X-ray interecting with tazarotene/the surgery scar More possible dental problems Problems/dangers of overcrowding. Why dont you wax your face? Because it gives you wrinkles, duh.

Amoxycilin and metronidazole Amoxicillin is used for the aerobic bacteria (bacteria dependent on air) Metronidazole is used for anaerobic bacteria (bacteria independent of air) These antibiotics are used in combination together to annihilate the bacteria Amoxicillin can be used on its own when there is open inflammation of the gums - after an extraction and bacteria are predominantly aerobic

Metronidazole can be used on its own when there is an abcess underneath the gums and it is not communicating with the oral cavity itself Both amoxicillin and metronidazole are used in combination when for instance a tooth has been removed and during the healing process a person gets an infection. The infection resides both on top of the healing socket and within the socket itself.

The Dental Routine The Keys To Good Oral Health Terms: gingiva, gingivitis, bleeding, flossing, cleaning, plaque, periodontitis, tartar (calculus), soft contact point (dental contact point), exposed dentine,
The steps in dental cleaning - ultrasonic scaler (just a vibrating scaler, vibrations powered by ultrasound) combined with hand scrape tools (specifically scalers and curettes) - sandblaster / this is the one and only messy tool and will spray onto your face. - air polisher - ending topical fluoride Note the dentist or hygienist will often lay their gloved hands on your face whilst cleaning. An ultrasonic scaler in combination with hand scaling is more effective than handscaling alone. Mouthwash is not essential; flossing is much more important. Different X-ray to show soft contact points and the presence of tooth decay. Food is getting trapped at the front two crowded teeth, at the top right soft contact point (more space than usual between one tooth) between the last tooth and second last tooth, and at the very back between the last tooth and the once-wisdom teeth. Floss to 3mm below tooth line, wrap string around middle fingers, use the index fingers.

Areas

where plaque will always build up between the teeth, not the surface of teeth.

Plaque bacteria gingivitis bleeding gums from inflammation of the gum due to bacteria

What is Plaque?
Picture of what it looks like

Dental plaque is seen as a dark yellow biofilm in harder-to-reach tooth surfaces. It is soft deposit on the surface of teeth. Plaque is a haven for oral micro-organisms and continues to build up in the oral cavity until it can mineralize in to calculus (also known as tartar) or cause plaque-associated gum disease. Dental plaque vs. calculus Calculus is the next stage of plaque growth it is plaque that has hardened (hard deposit), over time, by calcification. It sticks firmly to teeth. You can usually remove plaque quite easily by tooth brushing and cleaning between teeth. When plaque gets to the stage of calcification, generally, it can only be removed by a dentist or dental hygienist, with special instruments.

How common is plaque and plaque-associated gum disease? They are very common. Surveys in the UK in the late 1990s found that: Plaque and/or calculus was visible in more than 7 in 10 adults who had teeth. Plaque was visible in just over 4 in 10 of those aged 15-18. Some degree of gingivitis was present in more than half of adults and in about 4 in 10 of those aged 15-18. Periodontitis with pocketing was present in about half of adults and in nearly 2 in 10 of those aged 15-18. Most cases of periodontitis were moderate with pockets up to 4-5 mm deep. However, 8 in 100 adults were found to have severe periodontitis with pockets 6 mm or deeper. What causes plaque-associated gum disease? Most people develop some dental plaque, but not everyone with plaque develops gum disease. Dental plaque contains many different types of bacteria (germs) and some types of bacteria are associated with developing gum disease. The gums can often resist, or limit, the invasion of bacteria. It is thought that a more marked gingivitis, which leads to periodontitis, is more likely to develop if you have a lot of plaque and/or your defense or resistance against bacteria is reduced in some way. What is dental calculus? Calculus = tartar Calculus is plaque that has hardened with time

Common dental problems and diseases

The Link Between Oral Health and Cardiovascular Health There is some evidence to suggest that poor oral hygiene is associated with an increased risk of developing heart diseases such as heart attack and angina, and other blood vessel-related problems (cardiovascular disease). It is not clear if this is a direct cause and effect or simply an association or chance finding. That is, it is not proved that poor oral hygiene can actually increase your risk of cardiovascular disease. However, there is a plausible theory in that mild inflammation and infection in the mouth can get into the bloodstream to trigger mild inflammation in the blood vessels which, over time, can lead to cardiovascular diseases.