Oral and Maxillofacial Surgery

As an Oral and Maxillofacial Surgeon with expertise in mouth, jaw and facial surgery, Mr Luke Cascarini operates on difficult cases, providing reassurance and peace of mind that you will have the best possible functional and cosmetic outcome.

His expertise includes problem wisdom teeth

Oral and Maxillofacial surgery procedures available include:

• Dental implants
• Tooth extraction
• Impacted tooth extraction
• Impacted wisdom tooth extraction
• Removal of retained roots
• Jaw reconstruction

Wisdom teeth

Wisdom teeth are the third set of molars to come through the gums. This usually happens between the ages of 17 and 25. They are called wisdom teeth probably because they are the only teeth to erupt when we are fully grown and supposedly wiser than when our baby teeth or second teeth came through.

Problems caused by wisdom teeth

In many people, the size of the jaw means that they have space for the 28 adult teeth that come through between the ages of 6 and 12 but not for an extra tooth in each corner. When a wisdom tooth starts to grow, it can be unable to get through the gum because it is trapped between the second molar and the jaw bone.

The lack of space can leave the tooth coming out sideways or at a strange angle, or just getting stuck. When this happens, the wisdom tooth is said to be impacted and this can become very painful.

• Wisdom teeth can come out of the gum at an angle, facing the mouth opening and pushing into the second molar
• They can try to emerge straight up but not be able to get through the gum because they get stuck against the second molar and may even push it out of position
• Some wisdom teeth start coming through horizontally, pushing through the side of the gum
• Others are angled but face the throat rather than the mouth opening

When wisdom teeth push against other teeth or the bone of the jaw, this causes inflammation and pain. Partly erupted teeth can also cause the gum to ulcerate and become infected as particles of food get stuck there and can’t be easily brushed away.

This can lead to different kinds of soft tissue problems:

• Gingivitis – inflammation of the gums.
• Pericoronitis – when the soft tissue surrounding the tooth itself gets infected. This can lead to an abscess under the wisdom tooth.
• Cellulitis – the infection spreads to the inside of the cheek or to the tongue or throat tissue.
• Osteomyelitis – the infection goes right into the jaw bone.

Treatment options for problem wisdom teeth

A wisdom tooth that causes gum problems as it emerges may take a while to erupt and does not necessarily need to be removed. The local inflammation and any infection can be treated using antibiotics and an antiseptic mouthwash.

An important part of the initial investigation will be to X-ray the jaw to find out if the wisdom tooth is impacted. A tooth that is impacted but not causing any pain or inflammation does not need to be removed but as soon as a tooth that is stuck leads to recurrent gum or soft tissue problems, wisdom tooth removal is the best option.

Retained roots

How do retained roots arise?

All adult teeth have up to four roots that anchor the tooth into the jawbone. Usually, when a tooth is removed by a dentist, the roots are taken out with it. However, if the tooth is lost through accident or decay, the root or roots may be retained within the jawbone and gums, causing problems such as mouth infections and pain. If this is the case, the roots need to be surgically removed.

Sometimes teeth, especially wisdom teeth, fail to erupt from the gums at all. This is called an impacted tooth and can also cause problems, although such teeth may remain dormant and not need attention for many years.

How are retained roots removed?

The complexity of retained root removal surgery depends on the nature of the problem. Some retained roots involve a simple extraction, which can be done quickly under local anaesthetic. Others involve a lengthier procedure, and you may be given sedation to help you relax.

In the most difficult cases, part of the gum, and possibly even a small section of the jawbone, may need to be removed to free the roots. If this is the case, you will usually be given a general anaesthetic.

What to expect after removal of a retained root?

Naturally, you will feel sore, swollen and bruised after major dental surgery such as retained root removal. You may also feel stiff around the mouth and experience an ache when eating or talking for a few days. The bruising and swelling will subside in around a week to ten days. Luke has developed information for all patients having mouth surgery so that you can take care of your mouth afterwards and make sure healing is as fast as possible.

In most cases, the wound will be sewn up using dissolvable stitches, which will melt away of their own accord and will not require a return visit for removal. You will usually have to return for a check-up after around two weeks, to ensure that you are healing properly. You may have an X-ray on this visit to check that all the root has been removed.

You will be given antibiotics to take to reduce the risk of infection, and you will be advised to rinse your mouth out with saltwater several times a day for the first week. You should only need over the counter painkillers, such as paracatemol.

You will be very aware of the hole or scars left by the operation at first, although these will eventually disappear as the gums and jawbone reshape.

Risks and complications

As with all surgery, there is a risk of complications, especially if you have a general anaesthetic. Luke will explain these in detail to you but, in brief:

• You may experience an infection at the wound site, although the use of antibiotics and the saltwater mouthwash significantly reduces this risk.
• You may also experience minor bleeding from the wound site. If this bleeding does not stop, you need to contact us immediately.
• Between 5% and 10% of patients may develop what is known as ‘dry socket’ where the blood clot at the wound site is dislodged or fails to form properly in the first place. If this occurs, you will need to have the wound packed with medicated gauze for a few days to help with the healing.