- reduce the infection, and so the swelling and pain.
- remove the tooth
But how do we get them out ? Teeth are held into the bone sockets by fibrous strands called the periodontal ligaments. These are attached at one end to the root surface, at the other to the bone wall. It is easy to sever these fibres by applying pressure or by the use of very fine cutting instruments. First, the surrounding tissue needs to be made numb, and this is done by injection of local anaesthetic agents. In some areas of the jaws, the bone is thin enough to allow these anaesthetics to permeate through the bone structure, and block the nerve tissue's ability to conduct pain messages along the fibres to your brain. In other areas, such as the lower jaw, the bone is thick, and the diffusion of the anaesthetic cannot take place. In these places, the anaesthetic has to be placed by the nerve tissue in an alternative location. The main nerve tissue path way runs down from the base of brain, down the inner aspect of the jaw bone, and then loops into a canal inside the lower jaw. The anaesthetic is placed just as the nerve loops into the canal orifice. All nerve signals are then blocked from this point down. Hence the whole of the lower side of your face goes numb with this type of injection. Alternative forms of getting the anaesthetic into the area required are to push a very fine needle between the root and the socket wall, and place the anaesthetic around the tooth we need to treat. A relatively new method of anaesthetic administration is to place a small amount of the anaesthetic in he gum tissue close to the tooth which needs treatment. A small hole is then drilled through the dense outer bone surface, into the softer bone that forms the core of the jaw bone. The local anaesthetic solution is then injected through this access. Once the tooth and surrounding tissue has been made numb, the periodontal fibres are cut, and the tooth removed. It should be done with great care, as it is important to preserve as much of the bone as possible. Again, traditional dentistry involved squeezing the empty socket so that the walls closed and the blood clot that is essential to healing was small and easily retained. Now, we try to keep this site open but clean, so that we maximise the body's ability to grow new bone into the socket. There are times when the shape of a molar tooth means that extensive bone and gum tissue would result by trying to remove it intact. In this case, the tooth may be cut into small units, and each unit removed more easily. If the root remains are buried, then the gum tissue may need to be folded out of the way, and a small amount of bone tissue removed to allow easy visualisation of the root fragment. The remains can then be more easily removed with very fine instruments. Wisdom teeth seem to have numerous horror stories attached with their removal. The vast majority are simple and symptomless. As with many other things in life, you only hear about the problems, the pain, and the dentist who did it to you. But spare a thought of the dentist faced with a decayed and fractured wisdom tooth, which caused a painful episode about 12 months earlier, and the patient attached to it decided not to seek dental help. Now the dentist is presented with an area of infection, painful to touch and difficult to get at. Not surprising then this patient probably will have a horror story to tell at a later stage, and the dentist will get the blame. If gum tissue needs to cut and folded to one side to gain access to root fragments, stitches need to be put in to hold the tissue together to allow healing to take place in a controlled way. These need to be removed, usually 3 to 7 days later, although in certain surgical procedures, they may be left up to 15 days.
(published with permission in writing from:http://www.appledore.co.uk/site.htm)
