Oral surgery

Our Specialist Oral Surgeons are able to carry out a wide range of surgical procedures, including:

  • Removal of impacted wisdom teeth (third molars)
  • Surgical removal of retained roots and fractured teeth
  • Apical surgery (for treating infection around root tips/apices)
  • Exposure or removal of impacted teeth prior to orthodontic treatment
  • Soft tissue procedures (for the removal of lumps, bumps and swellings)
  • Removal of cystic lesions of the jaws
  • Repair of oro-antral (mouth to nose/sinus) communications

Wisdom teeth

What are wisdom teeth?

Wisdom teeth are the last molar teeth to come through at the back of your mouth (the third molars); this usually occurs in late teens to early adulthood. They are the most commonly absent teeth; about a third of the population do not develop wisdom teeth at all.

Why do wisdom teeth need to be removed?

Wisdom teeth should only be removed if they are causing problems; we will explore this with you during your appointment.

One of the most common problems is that wisdom teeth get stuck (‘impacted’) against the adjacent tooth or within the jawbone and are not able to come through fully into the mouth due to lack of space. If they are partially exposed in the mouth then they can be difficult to keep clean and are susceptible to infection that causes pain and swelling in the surrounding gum tissue. These infections may require treatment with antibiotics.

A Wisdom tooth can also become decayed or cause decay in adjacent teeth; your dentist may not be able to treat this decay until the wisdom tooth has been removed.

How will my wisdom teeth be removed?

This varies according to how your wisdom tooth is positioned and the way it is impacted. Some are quite simple to remove but others are more deeply impacted and will require a surgical approach that involves lifting the gum and removing some bone that is encasing the wisdom tooth.

How long will the operation last?

This varies a little from patient to patient but an appointment for surgery under local anaesthesia usually lasts 60 minutes.

Will I have stitches?

If a surgical approach is required then stitches will be used to close the wound and they are usually dissolvable.

Will it be painful afterwards?

You should not feel any pain immediately after the operation as the area of surgery will be numb from the local anaesthetic. As the numbness wears off, the area tends to become uncomfortable; we usually advise you to take painkillers before the numbness wears off in order to prevent this. We can supply you with these and inform you regarding dosages and timings.

Are there any other after-effects?

This depends on the operation; your surgeon will have discussed any specific issues of concern with you beforehand.

There may be swelling and bruising in the area of surgery and this can limit jaw opening. This is usually at its most obvious two to three days after surgery and varies between patients; it normally settles after one to two weeks.

All lower wisdom teeth are situated close to nerves supplying the lower teeth, lip, chin, cheek and tongue but some are especially close. In these cases, the nerves can get bruised when the tooth is removed, resulting in a sensation of numbness, discomfort or tingling in these areas. This change in sensation only affects a small proportion of patients and is usually temporary. It can take up to six months to fully resolve and only very rarely becomes permanent. We will discuss these issues with you during your consultation.

If appropriate, we may recommend a specialised CT scan that provides a three-dimensional image of the area to further assess this potential proximity between your wisdom tooth and the adjacent nerve. In this case, a written report of the scan’s findings would be provided and a further consultation appointment arranged to discuss the findings before deciding on surgery.

When can I return to work?

This depends on both your occupation and the extent of the operation you have had.  Many patients return to work the next day but up to five days may be required and we will advise you regarding your particular circumstances.

Surgical removal of teeth

Why do teeth need to be removed surgically?

Surgical removal is needed when simple extraction is not possible because of the condition of the tooth; the tooth may be fractured or weakened by advanced decay. Such teeth may cause chronic infection and discomfort or acute infection/abscess with pain and swelling.

How will my tooth be removed surgically?

A surgical approach involves lifting the gum and, if necessary, removing some bone that is encasing the roots of the tooth.

How long will the operation last?

This can vary a little according to both the condition and the position of your tooth or teeth but an appointment for surgery under local anaesthesia usually lasts up to 60 minutes.

Will I have stitches?

Stitches are usually required and are dissolvable. Occasionally, non-dissolvable stitches are used and, if so, an appointment will be arranged for their removal about one week after surgery.

Will it be painful afterwards?

You should not feel any pain immediately after the operation as the area of surgery will be numb from the local anaesthetic. As the numbness wears off, the area tends to become uncomfortable; we usually advise you to take painkillers before the numbness wears off in order to prevent this. We can supply you with these and inform you regarding dosages and timings.

Are there any other after-effects?

Your surgeon will discuss both general after-effects and any specific issues with you beforehand.

There may be swelling and bruising in the area of surgery and this can limit jaw opening. This varies from patient to patient but is usually most prominent two to three days after surgery and settles after one to two weeks.

There may be altered sensation in the area of surgery due to bruising of the nerves at that site; this is usually only a temporary condition but can take months to settle and, in rare cases, may be permanent.

When can I return to work?

This depends on both your occupation and the type of operation you have had.  Many patients return to work the next day but we will advise you regarding your particular circumstances.

The Exposure of Impacted Canines

What are impacted canines?

Impacted teeth are teeth that have been prevented from coming through correctly; this can be due to obstruction by bone, fibrous tissue or another tooth. Upper canine teeth (and wisdom teeth) are the most commonly impacted teeth as they are the last to come through and therefore the most likely to be affected by a lack of space.  Most impacted canines are located in the roof of the mouth (the palate) but some impact towards the cheek. Sometimes, both sides are affected.

What happens if they are left untreated?

If impacted canines are left in position there is a risk of damage to the adjacent teeth or development of cystic lesions around the crowns of the canine teeth themselves. Cysts can become infected, cause bone loss of the upper jaw or damage by putting pressure on the roots of adjacent teeth.

Treatment for an impacted canine is usually part of a course of orthodontic therapy and so your orthodontist will advise regarding your particular circumstances.

How will the tooth be exposed?

First, the position of the canine is determined by x-ray imaging. During the operation, the overlying tissues are lifted away from the tooth so that sufficient soft tissue and bone can then be removed to expose the tooth. Stitches are used to put the raised tissue back in place; these are usually dissolvable.  A healing pack is then placed over the exposed tooth and non-dissolvable stitches may be used to secure this. Sometimes the orthodontist makes a cover plate (rather like an upper removable brace) to hold the pack in place and further protect the area while it heals. The pack and stitches are quick and easy to remove and a review appointment will be arranged for this one to two weeks after surgery, usually with your orthodontist.

How long will the operation take?

This varies a little depending on the position of the impacted canine but an appointment for surgery under local anaesthesia is usually planned for 60 minutes.

Will it be painful afterwards?

You should not feel any pain immediately after the operation as the area of surgery will be numb from the local anaesthetic. As the numbness wears off, the area tends to become uncomfortable; we usually advise you to take painkillers before the numbness wears off in order to prevent this. We can supply you with these and inform you regarding dosages and timings.

Could I have any other after-effects?

This depends on the operation and any specific issues will be discussed with you beforehand.

There may be swelling and bruising in the area of surgery, as well as some discomfort. This is usually at its most obvious two to three days after surgery and varies between patients; it normally settles after one to two weeks.

After removal of the pack and stitches, the impacted tooth should be visible in the mouth and healing usually progresses quite quickly.

Apicectomy

What is an apicectomy?

This is a surgical procedure to remove an infected tooth root tip and clean out the surrounding infection. Usually, a filling is used to seal off the new end of the tooth with the aim of preventing further infection.

Why do I need an apicectomy?

You may need an apicectomy if there is persistent infection around a root tip after conventional root canal treatment has been carried out. This infection can cause pain, swelling and discharge in the gum that overlies the root of the tooth. Ideally, it is preferable to repeat the root canal treatment but sometimes this is not feasible and so apical surgery becomes the next best option to deal with the infection. Advice from an endodontist (a root canal specialist dentist) may be advisable to help make this decision.

Sometimes cystic lesions can form around the tips of roots and apical surgery may be required for their removal.

How is the apicectomy carried out?

Local anaesthesia is used to numb the area around the tooth. The gum tissue is lifted away from the tooth to access the infection and this area is thoroughly cleaned out. The tip of the tooth root (the apex) is then removed and a special cement is placed over the cut end of the root; the aim is to seal any open channels in the root which could cause recurrence of infection. The gum tissue is then replaced with stitches which are usually dissolvable.

How long will the operation take?

This varies a little depending on the position of the tooth and the extent of the surgery but an appointment for surgery under local anaesthesia is usually planned for 60 minutes.

Will it be painful afterwards?

You should not feel any pain immediately after the operation as the area of surgery will be numb from the local anaesthetic. As the numbness wears off, the area tends to become uncomfortable; we usually advise you to take painkillers before the numbness wears off in order to prevent this. We can supply you with these and inform you regarding dosages and timings.

Could I have any other after-effects?

This depends on the operation and your surgeon will discuss any specific issues with you beforehand.

There may be swelling and bruising in the area of surgery, as well as some discomfort. This is usually at its most obvious two to three days after surgery and varies between patients; it normally settles after one to two weeks. Healing of the gum can sometimes cause slight scarring and gum recession.

When can I return to work?

This depends on both your occupation and the type of operation you have had.  Many patients return to work the next day but we will advise you regarding your particular circumstances.