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Specialist Dentistry in Chichester, West Sussex

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Oral Surgery

Sometimes patients require complex surgical treatment such as the extraction of wisdom teeth, the management of complex problems involving jaw pathology or treatment as the result of facial injuries. Oral surgery is offered at our Oxford practice as part of a multi-disciplinary approach.

In circumstances that may require surgery it’s important to have complete confidence in your clinician. Our surgeons are specialists in oral surgery registered with the GDC and have a wealth of experience in oral surgery having worked for many years in the field. Transform Smiles accepts referrals for removal of difficult teeth, including wisdom teeth, and also treats patients with complicated medical histories.

From our Specialist Dental Clinic, we treat patients with a variety of complex needs. Our surgical expertise enables us to diagnose and treat the most complex of cases, in an approachable manner ensuring patients are kept informed of procedures at every stage. Our Surgeons will work closely with your regular dentist to ensure the best possible outcome.

Our in-practice sedation service means that most procedures can be carried out within the comfortable, familiar surroundings of our Specialist Dental Practice.

 

Request referral pack or appointment with our dentists


Oral Surgery - Apicectomy

Apicectomy

This is a minor operation carried out in the root end of a root treated tooth which shows signs of recurring infection. It is performed to relieve the infection and fill the tip of the root so that more infection may not egress to the surrounding bone. By this type of surgery any cysts in the area of root apex can be removed.

Indications

  • Removal of excess root filling
  • Recurrent infections at root apex due to short root filling
  • Removal of cyst

Prognosis

Apicectomy is a useful procedure if performed on selected patients. There is a high success rate of up to 80% but the success rate reduces drastically if repeated procedures are performed and the root filling itself is questionable. Also there can be presence of secondary or extra canals at the apex of the root which can lead to repeated infection.

Complications

Generally this is a simple operation to perform. It is normal to have some pain swelling and bleeding. You may also experience some shrinkage of gums after they are stitched back and therefore more of the tooth may show through. It is also prudent in view of long term stability to consider having the tooth removed and replaced with more predictable alternative like a denture/bridge/implant if repeated infections were to occur.

Oral Surgery - Complex Dental Extractions

Why Treat Infected Teeth

Tooth decay is still a problem even in the developed world and can lead to serious and life threatening complications. The microorganisms can spread from just within the tooth to surrounding bone supporting the tooth and then to soft tissues in the face. Due to the nature of human tissues there are potential tracks within the skin and adjoining tissues through which the infection can spread rapidly and reach a critical state. This can be more dangerous in people with other pre-existing diseases which affect their immunity. Therefore it is prudent to have these teeth treated promptly by your dentist. In cases where they cannot be saved they should be removed promptly.

Simple Extractions

Most extractions are done under local anesthetic and involve a needle. Lot of care is taken to make this least painful. Once your gum and teeth are numbed all you should feel is pushing and pressure. Very rarely in the presence of pus or active infection the anesthetic may not work very well.

Your surgeon may decide to peel the gums if the teeth are brittle or broken down, in which case you require stitching. Stitches should dissolve and heal away without any problem.

Be on a soft diet and take pain killers like simple paracetamol or ibuprofen which are quite useful. Some people may need codeine which is available as co-codamol over the counter. Maintain your oral hygiene as normal.

Immuno- Compromised Patients

Patients who are unable to mount a normal healing response which is preceded by inflammation to any surgical procedure can be termed immuno-compromised. There are a host of conditions which can lead to this situation and can result in delayed or even non healing areas where surgery is carried out in your mouth and may require treatment in the hospital depending on the severity.

What Conditions Can Compromise Healing?

  • smoking
  • Diabetes
  • Radiotherapy to head and neck
  • Steriod treatment for various medial conditions
  • Immunosuppressive therapy for different types of cancer
  • Chermotherapy
  • Blood disorders
  • Treatment of osteoporosis

What Precautions Needs To Be Taken?

Meticulous maintenance of oral hygiene with careful consideration of the surgical alternative should be the first step. Your surgeon will discuss the options available and pros and cons of each of these options. If you should have a tooth removed or similar surgical procedure undertaken then the risks involved will be explained. Antibiotic cover for such procedures may be useful in preventing complications.

Oro Antral Communication

Many upper molar teeth are located in close relation or even within maxillary sinus cavity. This is a hollow cavity within the upper jaw and has direct communication to your nose. It is directly under the orbit(eye shell). Prior to removal the risk of causing communication to the sinus cavity will be discussed by your surgeon. Many a times they may heal without causing much symptoms. In some situations patients may experience fluid running through the nose or even pain in the cheek. The close relationship also makes one prone for dislodgement of root into the sinus cavity.

In the event of such complications your surgeon may opt to close the defect by another simple procedure. If a root fragment needs removed or the defect is large and not amenable to be treated by simple procedure then a treatment under general anesthetic may be necessary.

Oral Surgery - Minor Lump and Cyst Removal

Lumps and Cysts

Lumps and ulcers in the mouth can occur for various reasons.

They will normally be picked up by your own dentist on routine examination and dealt with appropriately. They can be benign or cancerous in which case you will have to see the specialist as soon as possible so that the appropriate treatment can be started soon. If you feel any abnormal growth in your mouth please contact your dentist soon.

Benign lumps in the oral cavity include:

  • Polyps
  • Warts
  • Mucocele

This will involve simple local anaesthetic and excision is performed by the surgeon. You may need some stitches to control bleeding and usually they dissolve with time. A pathology report describing the nature of the lump is obtained after a microscopic exam which secures diagnosis.

If the appearance is suspicious then you will be referred to hospital for further management.

Cysts of jaw can arise in healthy adults or children. They are thought to arise from the remnants of developing tooth tissue. They can also arise out of infected tooth. Very occasionally the cysts of jaw can turn into tumors which may require aggressive treatment. Fortunately this is a rare occurrence. Many a times they are picked up as incidental findings during routine dental examination. Treatment involves removal of cyst lining , in certain types aggressive bone removal may be necessary to prevent recurrence.

Many swellings/lesions in the head and neck region are benign. However one needs to be aware of the following signs and check with your own doctor or dentist as soon as possible as they may indicate signs malignancy:

  • Lump appearing under lower jaw or neck
  • Smokers with white patch in mouth especially tongue/floor of mouth/lips
  • Non healing ulcer more than 14 days in mouth
  • Bleeding ulcer in the face
  • Difficulty swallowing associated with or without change of voice
  • Any of the above associated with weight loss, anorexia, fatigue and night sweats
Oral Surgery - Wisdom Teeth Removal

Removal of Wisdom Teeth

Adults normally have 32 teeth and wisdom teeth (3rd molars) are the last to come through at the back of the mouth. Normally there are 4 wisdom teeth, one in each side of the upper and lower jaw. If the jaws are too small to accommodate all the teeth, there may not be enough space for the wisdom teeth to come through properly and they become impacted (stuck), often causing problems.

Reasons For The Removal Of Wisdom Teeth

The most common reason is recurrent infection of the gum overlying a tooth that is part way through the gum (pericoronitis). Decay (caries) in the wisdom tooth, which your dentist cannot restore. Infection of the tooth (abscess) due to advanced dental decay. When the adjacent molar tooth is affected by gum (periodontal) disease or dental decay due to the impacted wisdom tooth. Progressive cystic (fluid filled sac) formation around the tooth. As part of other surgical procedures involving the jaw. There may be other less common reasons that your surgeon will discuss with you. There may be other less common reasons that your surgeon will discuss with you.

The Removal Of Wisdom Teeth

There is great variation in the difficulty of removing wisdom teeth. The procedure can be carried out under local anaesthesia (injection in the gum to numb the area), with or without intravenous sedation (injection in the arm or hand to reduce anxiety), or under general anaesthetic (completely asleep in a hospital). Your surgeon will discuss with you which method is most appropriate. The degree of difficulty of the surgery, any underlying medical conditions and other personal circumstances will be taken into account choosing the method. The procedure can involve an incision (cut) in the gum close to the tooth. Sometimes some jaw bone around the tooth is removed with a drill and also the procedure can be made easier by sectioning (cutting up) the tooth itself into smaller pieces.

What Can Be Expected After The Operation?

Swelling, bruising and difficulty opening mouth can occur frequently. If initial swelling settles down and after a few days a new swelling appears, it may indicate infection.

Most bleeding will have stopped shortly (within 30 minutes hour) of the operation finishing. Blood stained saliva may be noticed for a day or two. More persistent bleeding may occur which should be dealt with by your surgeon/hospital. When an adjacent tooth has a large filling or crown it is possible that this can be dislodged during surgery.

There are two nerves in the vicinity of lower wisdom tooth which may be slightly bruised during operation. One of them is lingual nerve supplying feeling to tongue and lies closer to the gums of lower wisdom tooth. The other nerve is called the inferior dental nerve which runs all along the lower jaw under the lower molar teeth. In less than 20% of patients the nerves may not work well in the immediate post operative phase leading to numbness of lip and or tongue. Most of this loss of sensation returns within few weeks to 3 months. Very rarely (less than 1%) it may persist longer or can be even permanent based on the specific risk factors discussed by your surgeon.

Request a direct referral to our Specialists today

 

 

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