Dento-alveolar surgery for Third Molars

Referral for dentoalveolar surgery e.g. surgical removal of impacted wisdom teeth or dental cysts form a significant portion of the department's work and comes mainly from general dental practitioners.

When making a referral sending your radiographs is greatly appreciated and decrease the dose patient will receive - your radiographs will be returned once treatment is complete.

NICE regulations issued in 2000 have found evidence that prophylactic removal of pathology free impacted third molars provides no health benefit to patients.
National Institute for Clinical Excellence - Wisdom Teeth

NICE recommend that surgical removal of impacted third molars should be limited to patients with

• Unrestorable caries, pulpal or periapical pathology
• Cellulitis, abcess or osteomyelitis
• Internal/external resorption of the tooth or adjacent teeth
• Fracture of the tooth
• Disease of the follicle including a cyst or a tumour
• Tooth impeding surgery or reconstructive jaw surgery
• Tooth involved in the field of tumour resection

Post operative complications for dento alveolar (in particular third molar surgery) include:

• Pain
• Swelling
• Trismus
• Haemorrhage
• Infection
• Alveolar osteitis (dry socket)
• Temporary/permanent paraesthesia

All patients receive counselling about potential complications, in particular paraesthesia (temporary or permanent numbness of lip, chin and tongue).

 

Dental extractions on the severely medically compromised patients e.g. anti-coagulated patients or severe cardiopulmonary disease are often carried out in the hospital but many less sever conditions can be treated quite satisfactorily by general dental practitioners under local anaesthesia.

Patients who are very anxious about treatment may be referred more appropriately to the community dental services.

If in doubt, a phone call may spare the patient an unnecessary outpatient appointment.

Dental Abscess

INDICATIONS FOR ADMISSION

Spreading infection

• Dehydration
• Severe trismus
• Potential airway obstruction

Restorative dentistry is NOT part of the department's work and will need to be undertaken by a general dental practitioner or the community dental services.

After dentoalveolar surgery all patients are given written instructions and appropriate drugs.

Below is a copy of the post-operative instruction sheet given to patients.

INSTRUCTIONS FOR PATIENTS FOLLOWING EXTRACTION OR SURGICAL OPERATION TO PREVENT BLEEDING AVOID; Mouthwashing Hot drinks, hot food and alcohol Exercise or effort Smoking FOR THE FIRST 24 HOURS If bleeding occurs, apply pressure by biting on to a clean rolled handkerchief and rest, sitting in an upright position (as shown in the clinic) If in PAIN, take regular dose of painkillers you would normally take for a headache. This should be repeated at the timing stated on the packaging. Examples: Ibuprofen 400mg can be taken three times daily Paracetamol 1000mg can be taken four times daily. DO NOT EXCEED THE STATED DOSE AND ALWAYS READ THE LABELS TO ENSURE THE PAINKILLER IS SUITABLE FOR YOU AFTER 24 HOURS DO AS FOLLOWS HOT MOUTH WASHING Mix one level teaspoon of ordinary table salt in to a tumbler of moderately hot water Take a large mouthful and tilt head to the painful side so that the hot solution floods to the inflamed operation area Hold it there for a minute before spitting it out. Repeat this until the tumbler is empty Do this OFTEN throughout the day WARNING: DO NOT hold anything hot against the outside of the face AFTER AN EXTRACTION, never use a hot mouthwash on the same day.

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