Frequently Asked Questions
Why should I remove my wisdom teeth?
Because of their location in the very back of your mouth, they are difficult to brush and floss properly, which makes them susceptible to cavities and infection. They may grow sideways, partially emerge from the gum and even remain trapped beneath the gum and bone. Impacted wisdom teeth can cause local gum infections which may cause pain and swelling around the area, damage the adjacent tooth or develops cysts. They usually do not aid in chewing or any function in the mouth.
Is it normal to be more swollen a few days after my tooth extractions?
Yes. After surgery, swelling peaks in 48 to 72 hours, after which it starts to go down. Ice has minimal effects after 36 hours, except to ease discomfort. Maintaining an upright position and sleeping with three to four pillows during the night may help to decrease the amount and duration of swelling.
It has been 3 to 4 days after my extraction and the pain is getting worse, what should I do?
Make an appointment to see your surgeon. A very painful condition known as “dry socket” may develop 3 to 4 days after tooth removal. Common symptoms include a steady increase in pain, throbbing at the extraction site, ear pain on the side the tooth was removed, and a bad taste or odor in your mouth. Treatment involves placing medication into the socket that will ease your pain until the body heals itself. Other causes of pain may be infection, a problem with a neighboring tooth, sharp edges of the tooth socket, and bone exposure through your gums.
What is a dry socket
This is a painful condition which occurs usually 2-4 days after the extraction. The normal healing of the socket results in a blood clot forming within the socket followed by the gum tissue healing over the area. On occasion, the blood clot dissolves too early leaving a socket with no covering. This can be very painful, causing jaw pain which can radiate to the ear. The treatment for this condition requires placement of a medicated jell in the socket, pain medication and sometimes antibiotics. The “dry socket” will usually resolve in 3-4 days.
How long after surgery before I can go swimming/surfing
This depends on how difficult the extractions were. Typically 2-3 weeks.
What kind of stitches do you use?
Usually Dissolving. They are usually gone about a week after the extraction.
Can I brush my teeth?
Yes. Be careful to stay away from the extraction site for the first several days
What are dental implants?
The implants themselves are precision orthopedic titanium anchoring devices, which are surgically inserted into the jawbone where teeth are missing. These metal screws act as tooth root substitutes. The bone bonds with the titanium, creating a strong foundation for artificial teeth. These posts provide stable anchors for artificial replacement teeth.
Can the implant be placed at the time of extraction?
Sometimes. The three factors that determine if this is possible are (1) local jaw anatomy, (2) amount of available bone and (3) absence of infection. Once all presurgical planning is completed, your surgeon will let you know if you are a candidate for this option
What is the implant made of?
Dr. Hiranaka places Nobel and Straumann implants. Nobel are commercially pure Titanium. This material is biocompatible and has been successfully used for >40 years in dental implants. Straumann implants are made of Titanium-Zirconium alloy.
How do I determine if I am a candidate for dental implants?
Almost every person who is missing one or more teeth and is in good general health is a candidate for dental implant treatment. Working together with your primary care physician, we can optimize treatment for patients with diseases such as diabetes so that they are candidates for dental implants. The quality and quantity of available bone is an important factor in dental implant treatment. Oral Maxillofacial surgeons can, even with significant bone loss, perform extraordinary procedures that add bone or create new bone allow people who would not otherwise have been candidates for dental implants to have successful implant treatment.
How will smoking affect my outcome?
Smoking doubles the failure rate of dental implants. Smoking reduces the blood supply to the jawbone making it difficult to heal around the implant or bone graft. Smoking leads to a higher incidence of “dry socket” after extractions. It is recommended that you cease smoking prior to having dental implant(s), bone grafting or extractions.
Who performs the implant placement?
Implants are a team effort between Dr. Hiranaka and a restorative dentist. While we perform the actual implant surgery, the restorative dentist (your dentist) fits and makes the permanent prosthesis (teeth crowns or bridge). Your dentist will also make any temporary prosthesis needed during the implant process.
What will I take for the pain after surgery
Typically, ibuprofen or Tylenol. Dr. Hiranaka does prescribe stronger pain medication (for example, Norco or hydrocodone) in case there is more discomfort. Most patients don’t need the stronger pain medication. Dr. Hiranaka attempts to do his surgeries with precision and minimal trauma to the patient. He uses local anesthesia to provide postoperative comfort. In addition, he uses pre-emptive pain control by giving patients ibuprofen or Tylenol prior to the surgery to prevent postoperative discomfort.
Who puts the tooth (crown) on the implant?
Your dentist or prosthodontist.
What type of medication do you used for IV sedation?
For patient safety, we monitor our patients under strict protocols and parameters outlined by the American Association of Oral and Maxillofacial Surgeons and the Joint Commission. A mixture of Versed (a medication similar to valium which relaxes the patient), Fentanyl (a narcotic pain medication) and Propofol (a medication which rapidly puts the patient to sleep). All of these medications are titrated or given in small increments and patient monitored for their response to the medications.
Will I be sleeping during the surgery
If you choose to use intravenous (IV) sedation you will be sleeping. If you use laughing gas (nitrous oxide) you will be awake but relaxed. Of course, you can use local anesthesia (numbing shots) without going to sleep.
How many years will dental implants last?
The implant companies Dr. Hiranaka works with (Nobel Biocare and Straumann) have life-time warranties on their implant systems. Implant-supported replacement teeth have been documented in clinical research to have lasted as long as 50 years. Typical tooth-supported bridges are known to last only 5 to 10 years; and, partials and dentures are functional for only about five years.
How long prior to my IV sedation or General anesthesia must I not eat or drink?
You may not eat or drink anything for 6 hours prior to your general anesthesia. If you must take medication, do so with a tiny sip of water 2 hours or more prior to your procedure. If you require antibiotic prophylaxis, you may take the medication with a tiny sip of water 1 hour prior to your procedure.
What is jaw reconstruction?
Jaw reconstruction, or orthognathic surgery, involves reshaping a patient’s face to correct facial or jaw abnormalities. During this specialty surgery, the doctor changes the position of the jaw to improve its function (chewing and speaking) and appearance. We often perform jaw reconstruction surgery in conjunction with orthodontic treatment
What exactly is an Oral & Maxillofacial Surgeon?
An oral and maxillofacial surgeon (OMS) is a dental/medical specialist who focuses on the diagnosis, surgical and treatment of diseases, abnormalities, defects of the mouth, and injuries in the teeth, jaws and face. Maxillofacial surgery is analogous to orthopedic surgery of the face dealing with facial skeletal and soft-tissue injuries, infections, deformities and pathology. After graduating from dental school, they have an additional four to seven years of hospital-based surgical and medical training, which enables them to perform a wide range of procedures including all types of surgery of both the bones and soft tissues of the face, mouth and neck.
Dr. Hiranaka graduated Magna Cum Laude from the Harvard School of Dental Medicine in 1988. He obtained his medical degree from Harvard Medical School in 1990. Dr. Hiranaka went on to complete a 5-year integrated internship/residency in General Surgery and Oral/Maxillofacial Surgery at the Massachusetts General Hospital in Boston. He concluded his training with a year-long fellowship in aesthetic facial plastic surgery at the Institute of Facial Surgery in Salt Lake City.
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