ORAL SURGERY

Dental extractions are often straight forward and can be done by the dentist, although there may be situations where more specialist help is required. There are several potential reasons for this such as coexistent medical conditions, the position of the tooth in the jaw or its relationship to other teeth or critical structures such as nerves. The tooth may be broken and inaccessible or weakened and therefore more challenging to remove. Teeth may require removal in younger patients undergoing orthodontic treatment to relieve crowding and allow the adult dentition to develop successfully. Patients may also be referred if they wish to have the procedure performed under general anaesthetic or IV sedation.

Wisdom teeth are also known as the third molars and the last teeth to erupt in the mouth, often between 18-22 years of age. As such, there is often limited room for them to do so, and they can become stuck or impacted. This can then cause infection, decay, pain and swelling. The surgical removal of wisdom teeth can be difficult due to the proximity of critical structures such as nerves and the extent of impaction in the jaw. Mr Gurney and Mr Sloane can give an expert clinical assessment of the position of each of the wisdom teeth and can arrange, if required, on-site Cone Beam CT scans (CBCT) to accurately assess the relationship of the sensory nerve of the lip to the tooth roots. If a wisdom tooth is straightforward to remove, treatment is often under local anaesthetic. For multiple teeth, complex cases or anxious patients, IV sedation or general anaesthetic can be offered.

As our dentition develops, adult teeth may become stuck or fail to erupt which can have negative consequences for the future, such as resorption of neighbouring tooth roots, or development of cysts. Often in conjunction with an orthodontist and brace treatment, impacted teeth may require exposure and bonding of a bracket and gold chain. The orthodontist can then use a brace to gently move the impacted tooth into the correct position in the mouth. Although a simple expose and bond can be performed under local anaesthetic, it is often more appropriate to have the procedure done under general anaesthesia in a hospital setting. 

A dental implant is a good way of replacing a tooth or teeth that have been lost from the mouth. They are normally titanium screws which replace the root(s) of the tooth by fusing with the jawbone. They are usually straightforward to place under local anaesthetic.  Once dental implants have fully healed and fused to the jaw, they are very stable and can support an individual crown, bridgework or denture. This can provide excellent function and strength like a normal tooth. 

It is sometimes necessary to build up the bone before or whilst placing a dental implant so that the implant is fully surrounded by bone and heals more effectively. This can done with bone harvested simply from the jaw, or sometimes the hip bone. There are also many alternative synthetic materials which can be useful to help reinforce and build up the jawbone to help an implant heal well.

It is important not to ignore any new lump, ulcer, white or red patch in the mouth, which is why regular dental check-ups are important. Oral biopsy of such lesions is usually straightforward under local anaesthetic and then the sample is submitted for analysis under a microscope. This will help confirm a formal diagnosis and guide further management, if required.