Oral Surgery Sunnyvale

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Oral Surgery

Sunnyvale Dr. Nasser Antonious

 

Oral surgery encompasses dental surgery of the teeth, jaws, mouth, and even the face and neck for complex procedures. For most dental practices, including at Sunnyvale Dental Care, oral surgery focuses on extracting problematic teeth or placing dental implants. Our Sunnyvale dentist Dr. Nasser Antonious will determine if your oral surgery case can be addressed at our Sunnyvale Dental Practice (such as removing wisdom teeth), or must be treated by oral surgeons at a hospital or surgery center (such as cancerous bone removal).

Impacted Teeth

Wisdom teeth, otherwise known as third molars, are the last set of teeth to develop. Sometimes these teeth emerge from the gum line and the jaw is large enough to allow room for them, but most of the time, this is not the case. More often, one or more of these third molars fails to emerge in proper alignment or fails to fully emerge through the gum line and becomes entrapped or “impacted” between the jawbone and the gum tissue.

Impacted wisdom teeth can result in swelling, pain, and infection of the gum tissue surrounding the wisdom teeth. In addition, impacted wisdom teeth can cause permanent damage to nearby teeth, gums, and bone and can sometimes lead to the formation of cysts or tumors that can destroy sections of the jaw. Therefore, dentists recommend people with impacted wisdom teeth have them surgically removed.

It’s not just wisdom teeth that sometimes become impacted and need to be removed. Other teeth, such as the cuspids and the bicuspids can become impacted and can cause the same types of problems described with impacted wisdom teeth.

 

Wisdom Teeth Removal in Sunnyvale

 

Wisdom tooth oral surgery is a routine procedure for Sunnyvale dentist Dr. Nasser Antonious. Most patients will have their impacted wisdom teeth removed to prevent future impossible-to-reach infection or crowding and shifting of all teeth.

Dr. Nasser Antonious and many oral surgeons nationwide recommend wisdom teeth removal in your mid- to- late- teenage years. At Sunnyvale Dental Care, we understand that you may have anxiety around oral surgery and wisdom teeth extraction– that’s fine, and it’s normal! Our caring staff and experienced dentist will take the time to make sure you’re comfortable with the process, and once your wisdom teeth have been easily removed, you’ll realize there was nothing to fear.

Tooth Loss

Sunnyvale Dentist Dr. Antonious offers dental implants as an option for tooth loss due to an accident or infection or as an alternative to dentures. The implants are tooth root substitutes that are surgically anchored in place in the jawbone and act to stabilize the artificial teeth to which they are attached. Suitable candidates for dental implants need to have an adequate bone level and density, must not be prone to infection, and must be willing to maintain good oral hygiene practices.

Jaw-Related Problems

Unequal Jaw Growth – In some individuals, the upper and lower jaw fail to grow properly. This can cause difficulty in speaking, eating, swallowing, and breathing. While some of these problems – like improper teeth alignment – can be corrected with braces and other orthodontic appliances, more serious problems require oral surgery to move all or part of the upper jaw, lower jaw, or both into a new position that is more balanced, functional, and healthy.

Improve Fit of Dentures – For first-time denture wearers, oral surgery can be done to correct any irregularities of the jaws prior to creating the dentures to ensure a better fit. Oral surgery can also help long-term denture wearers. Supporting bone often deteriorates over time resulting in dentures that no longer fit properly. In severe cases, an oral surgeon can add a bone graft to areas where little bone remains.

Temporomandibular joint (TMJ) disorders. Dysfunction of the TMJ, the small joint in front of the ear where the skull and lower jaw meet, is a common source of headache and facial pain. Most patients with TMJ disorders can be successfully treated with a combination of oral medications, physical therapy, and splints. However, joint surgery is an option for advanced cases and when the diagnosis indicates a specific problem in the joint.

Other Conditions Treated By Oral Surgery

Facial Injury Repair

Oral surgery is often used to fix fractured jaws and broken facial bones.

Lesion Removal and Biopsy

Oral surgeons can take a small sample of abnormal growth or tissue and then send it for laboratory testing for identification. Some lesions can be managed medically or can be removed by the oral surgeon.

Cleft Lip and Cleft Palate Repair

Cleft lip and cleft palate result when all or portions of the mouth and nasal cavity do not grow together properly during fetal development. The result is a gap in the lip and/or a split in the opening in the roof of the mouth. Oral surgeons work as part of a team of healthcare specialists to correct these problems through a series of treatments and surgical procedures over many years.

Facial Infections

Pain and swelling in the face, neck or jaws may indicate an infection. Infections in this area of the body can sometimes develop into life-threatening emergencies if not treated promptly and effectively. An oral surgeon can assist in diagnosing and treating this problem. Surgical treatment, if needed, may include cutting into and draining the infected area as well as extracting any teeth that might be involved.

Snoring / Sleep Apnea

When conservative methods fail to alleviate this problem, surgery can be tried. Surgical procedures involve removing the soft tissues of the oropharynx (an area in the back portion of the mouth) or the lower jaw. Laser surgery is a newer treatment option. Depending on the surgical technique used, the laser is used to either slowly scar the palate, which tightens it, or to remove palate tissue.

In this day and age convenience is key, no wonder the term “dentist near me” is on top of the many search phrases used by local patients looking to find new dentist. For added convenience, Sunnyvale Dental Care tries to accommodate all walk in dental emergencies including wisdom teeth extraction walk in patients.

Sunnyvale Dental Care is located conveniently in the center of Silicon Valley with great access to many freeways and highways. Sunnyvale Dental Care is among the best reviewed and rated local dental office in the area performing oral surgery and teeth removal services. Dr. Antonious says, “For every business to succeed it has to be profitable. Dentistry is no exception, but still providing the best oral surgery procedures that are well priced and affordable should still be our top priority.

Sunnyvale Dental Care has a convenient location with easy access through Central Expressway and freeway routes 280 and 101 which allow us to serve the dental needs of cities surrounding our office and the city of Sunnyvale including zip codes 94085, 94086, 94087, 94088 and 94089. These dental needs include wisdom teeth extraction and oral surgery.

At Sunnyvale Dental Care, we see many patients on a regular basis who ask us about their dental insurance coverage and copayment for their dental treatment. We not only provide the right information but also make sure our patients get maximum benefit out of their dental PPO insurance coverage. Currently Sunnyvale Dental Care is in network with First Dental Health, Avesis, Assurant, Anthem BlueCross, Maverest, DenteMax, Geha Connection, Guardian, HealthNet, Humana, MetLife, Principal, Dentegra, Aetna, Ameritas, Dental Benefit Providers, United HealthCare, and Cigna. Dr. Antonious is a premier provider with Delta Dental insurance company.

 

 


 

Oral Surgery FAQ

 

What are impacted teeth?

The teeth that most commonly become impacted are the third molars, also called wisdom teeth. These large teeth are the last to develop, beginning to form when a person is about nine years old, but not breaking through the gum tissue until the late teens or early twenties. By this time, the jaws have stopped growing and may be too small to accommodate these four additional teeth. As the wisdom teeth continue to move, one or more may become impacted, either by running into the teeth next to them or becoming blocked within the jawbone or gum tissue.

 

What are extra Wisdom teeth?

Extra wisdom teeth are often smaller than normal third molars and may be misshapen and poorly aligned. They are present at the time the original wisdom teeth are removed, but may not be easily accessible.

So Sunnyvale dentist Dr. Antonious may wait until the extra teeth move into position before deciding to remove them.

 

What is a panoramic x-ray?

A Panorex image is an X-ray that depicts a panoramic view of your mouth, from one side to the other. This image can help Dr. Antonious understand the relationship between your teeth, jaws, and occlusion (bite, or how your top and bottom teeth fit together). A panoramic radiograph is necessary for wisdom teeth extraction surgery and panoramic x-ray equipment is available at Sunnyvale Dental Care.

 

What is Nitrous Oxide (laughing gas)?

In one form of conscious inhalation sedation, nitrous oxide gas (laughing gas) is used to induce a state of relaxation. A local anesthetic will be administered in combination with nitrous oxide sedation to eliminate pain. An escort after nitrous oxide sedation is recommended but not required. Nitrous oxide gas (laughing gas) is available at Sunnyvale Dental Care at no additional charge.

 

I do not feel any pain or suffering from any problems. Can we leave it alone?

Impacted wisdom teeth can be predictably removed with no discomfort. Our concern is that, on a regular basis, we do see the condition of the good tooth in front of an impacted wisdom tooth deteriorate due to the position of the wisdom tooth. If the wisdom tooth is deeply embedded, it may be possible to leave it and review with radiographs regularly. Occasionally, an asymptomatic deeply embedded wisdom tooth may turn into a cyst. That will require a bigger surgery to remove the tooth.

It is very common to see an impacted wisdom tooth with no significant symptoms. It is impossible to predict when an impacted tooth may flare up and cause trouble. It is likely that it will cause trouble some point.

When it becomes symptomatic, the treatment will be more complicated. There are times that your medical condition may complicate treatment too. For example, a normal course of pregnancy will make caring for an infected wisdom tooth more problematic.

 

When should I have the impacted tooth removed?

Experts recommend wisdom teeth to be removed during teenage years or in the early 20s. People in this age group recover faster. You will never miss those problematic wisdom teeth!

There are other food reasons for removing wisdom teeth. Impacted wisdom teeth can become food traps and result in bone and gum impactions and dental decay. These can also affect the good molar neighboring the wisdom teeth. Some wisdom teeth are also non-functional, i. e. they do not bite properly. Thus, removing them will not affect your chewing abilities at all.

It is generally recommended that you remove wisdom teeth when they are impacted or are difficult to clean and maintain, before problems set in. Sunnyvale dentist Dr Antonious has seen many situations where the molars in front of the wisdom teeth (that were not taken out on time) were affected and required expensive and difficult treatments.

 

I am in my late 20s and have yet to extract my wisdom teeth, which have all grown. I would like to know if extraction of wisdom teeth is necessary? I do not face any problems, but there are times where I feel that the wisdom teeth are shifting and affecting the neighboring teeth. What should I do?

The first step is to visit a dentist for a dental X-ray and thorough examination. Dr Antonious will then be able to advise whether the wisdom teeth need to be removed. The risks and benefits of wisdom teeth removal will be explained and discussed. Current scientific research tells us that there is no correlation between wisdom teeth and crowding of the teeth in front of them. There is a natural tendency for teeth to crowd toward the front with time. It happens with age, as a result of jaw growth rotations and soft tissue pressures, as well as forward-directed chewing forces, and not because of the presence of wisdom teeth.

Why do I need to come back for a re-consultation before surgery?

If  Sunnyvale dentist Dr. Antonious has requested to see you again for a consultation before your surgery, it is usually because there has been a significant period of time between your initial consult and the time which you wish to schedule surgery. In some cases there may be circumstances (shifted teeth, etc.) that may affect the surgical procedure. It is imperative that Dr Antonious knows the exact position of the tooth and the surrounding structures before the start of the surgical procedure.

 

How long does the procedure take?

Most of our procedures last anywhere from 1-2 hours.

 

What is the typical recovery time?

Normally you will be able to return to school/work 48 hours after your surgery, as long as you have not experienced any complications. In fact, you can even return to taking part in athletic activities within 7-14 days.

 

Will I have stitches?

In most cases, our patients do have stitches after their surgery. Dr Antonious often uses absorbable stitches that will dissolve on their own. Occasionally Non-absorbable types of stitches are used. Dr Antonious will remove these stitches for you at the time of your follow-up appointment.

 

What will I be able to eat?

For about two (2) to seven (7) days following extraction, we recommend liquids and soft foods only. This might include yogurt, soup, applesauce, oatmeal, pudding, etc. You may gradually start on a normal diet when you feel that your surgical area is healed enough to handle the type of food being consumed. Immediately following the surgery if your lip or tongue is numb, do not try to chew, you may bite yourself and not know it.

 

Will I be able to chew after my wisdom teeth are out?

Modern human beings retain most of our teeth. As a result, wisdom teeth are usually non-functional. You will not suffering from lack of chewing ability because of wisdom teeth removal.

 

If I’m not in pain, why do I need to come in for a follow-up?

We don’t expect our patients to have complications after an oral surgery procedure; however, a follow-up visit will ensure that healing is proceeding in the right direction. Also, if you have any stitches this would be the time to remove them.

 

What are some typical complications to watch for?

There are two relatively minor complications to watch for. First, some patients experience what’s known as ‘dry socket’ in the area of the extraction. Dry socket is characterized by a dull to severe throbbing pain in the socket area, radiating toward the entire jaw, ear, and/or neck region. Advil or other over the counter analgesics will not relieve the pain. In such cases, we urge you to call our office for a no-charge visit, so that we can pack the socket with a special medication. This provides immediate pain relief. We will need to see you again 2-3 days after to remove the dry socket dressing and see how you’re healing. The second potential complication is abnormal bleeding. You will be given some gauze to bite down on. Drugstores also sell these gauzes. It is normal for there to be oozing from the wounds for up to 24 hours. If in doubt please call the office for help. After hours, feel free to call our 24 hour answering service. Due to the location of the wisdom teeth, a rare complication is numbness of the tongue, lip or chin. This happens very rarely and when it does, it is usually temporary. Dr Antonious always does his best to perform procedures in a safe manner.

 

What is a dry socket?

A dry socket can occur when the blood clot at the extraction site is lost prematurely. This causes the bone to become exposed and can be very painful. If you are experiencing any pain, please call us for an appointment so we can treat it as soon as possible. It is very important to not rinse your mouth for 48 hours and to use the gauze as instructed. Smokers have a significantly higher incidence of dry sockets than non-smokers.

 

What should I do after my oral surgery (e.g. dental extraction or implant surgery)?

Right after the procedure, bite down on a gauze over the surgical site for one hour. Even though the bleeding has stopped when you are discharged, it is normal to taste blood.

Do not spit out or rinse your mouth for 24 hours. Rinsing and spitting may dislodge the blood clot and bleeding may start again.

The surgical site usually stays numb for approximately two hours. Food and hot drinks should not be consumed until the sensation has recovered. After that, eat a soft to liquid diet chewing away from the surgical site. It is crucial to take all the medication as prescribed and keep your follow-up appointment to ensure uneventful healing.

You may contact our office during office hours or contact our answering service after office hours.

 


 

Oral Surgery Post-Op Instructions

 

Extractions

What you should do following extractions and other oral surgery procedures.

A certain amount of bleeding, pain, and swelling is normal. Reduce your activity as much as possible for several hours. Avoid spitting, rinsing and drinking through a straw for 24 hours. Do not rinse your mouth or brush your teeth for 24 hours. These activities may hinder formation of a blood clot, which is necessary for proper healing.

Do not be alarmed if your vision is blurred for a time following anesthesia or if a “black and blue” bruise should appear at the site of an injection. The arm also may be bruised, swollen and tender to touch due to the IV.

Please follow the simple instructions below to minimize complications and help ensure prompt recovery.

To control bleeding:

Our doctors and staff will make sure that all active bleeding is controlled before you are discharged. If bleeding should develop soon after you leave our office, keep a steady pressure on the bleeding area by biting firmly on a gauze roll placed directly over the bleeding site for at least 30 minutes. Pressure helps reduce bleeding and permits formation of a clot in the tooth socket.

A certain amount of bleeding is to be expected following surgery:

Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for thirty minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.

To relieve pain:

For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours or Ibuprofen, (Motrin or Advil) 200 mg tablets may be taken every 3-4 hours. Be sure to take pain medication on a full stomach to avoid an upset stomach.

For severe pain take the tablets prescribed for pain as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.

To minimize swelling:

The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the body’s normal reaction to surgery and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 48 hours of ice, moist heat should be applied to area until all swelling is gone. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Thirty-six hours following surgery the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Oral hygiene is important:

Twenty-four hours after surgery, rinse mouth gently with a solution of one-half teaspoonful of salt dissolved in a glass of water. Repeat after every meal or snack for seven days. Rinsing is important because it removes food particles and debris from the socket area and thus helps prevent infection and promote healing. Also 24 hours after your surgery you can resume your regular tooth brushing, but avoid disturbing the surgical site so as not to loosen or remove the blood clot. Keep your mouth very clean.

Discoloration:

In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

Antibiotics:

If you have been placed on antibiotics take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions. Women please note: Some antibiotics may interfere with the effectiveness of your birth control pills. Please check with your pharmacist.

Nausea and Vomiting:

In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on coke, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine. If you still continue to experience the nausea and vomiting call our office at once.

Maintain a proper diet:

After general anesthetic or I.V. sedation, soft to liquid diet should be taken at first (Avoid milk and ice cream for the first 12-18 hours). Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away form the surgical sites. High calorie, high protein intake is very important. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 5-6 glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat. Add solid foods to your diet as soon as they are comfortable to chew. Caution: If you suddenly sit up or stand from a lying position you may become dizzy. Therefore, immediately following surgery, if you are lying down, make sure you sit for one minute before standing.

Other Complications:

If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, this is usually temporary in nature. You should be aware that if your lip or tongue is numb you could bite it and not feel it so be careful. Call our office if you have any questions about this. Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever. You should be careful going from the lying down position to standing. As you were not able to eat or drink prior to surgery, and it is difficult to take fluids, and taking pain medications can make you dizzy. You could get light headed when you stand up suddenly. Before standing up, you should sit for one minute then get up. Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots; they are the bony walls, which supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed. Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days. Stiffness of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is normal post-operative event, which will resolve in time.

Sutures:

Sutures are placed the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged; this is no cause for alarm. Just remove the suture form your mouth and discard it. The sutures will be removed approximately one week after surgery.

In Review:

The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur call our office for instructions. There will be a cavity where the tooth was removed. The cavity will gradually over the next month fill in with the new tissue. In the mean time, the area should be kept clean especially after meals with salt-water rinses. Brushing your teeth is okay just being gentle at the surgical sites. A dry socket is when the blood clot gets dislodged prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain to the ear may occur 2-3 days following surgery. Call the office if this occurs. If you are involved in regular exercise be aware that your normal nourishment intake is reduced, exercise may weaken you. If you get light headed stop exercising.

Remember your follow-up visit:

It is often advisable to return for a postoperative visit to make certain healing is progressing satisfactorily. A follow-up visit will be scheduled. In the meantime, maintain a healthful diet, observe rules for proper oral hygiene and call our office if you feel something is not going right.

Care of Mouth after Your Oral Surgery:

  • Do not rinse or spit for 24 hours after surgery.
  • Keep fingers and tongue away from socket or surgical area.
  • Use ice packs on surgical area (side of face) for first 24-48 hours; apply ice 20 minutes on – 10 minutes off.
  • For mild discomfort take Tylenol or Ibuprofen every three to four hours.
  • For severe pain use the medication prescribed to you.
  • Drink plenty of fluids. (Do not use a straw)
  • If the muscles of the jaw become stiff, you can massage and exercise your jaws. After 24-48 hours the use of warm, moist heat to the outside of your face over these muscles will help get rid of the stiffness.
  • After the first post-operative day, very gently use a warm salt-water rinse following meals for the first week to flush out particles of food and debris, which may lodge in the surgical area. (1/2 teaspoon of salt in a glass of warm water.
  • Diet may consist of soft foods, which can be easily chewed and swallowed. No seeds, nuts, rice, popcorn, etc.
  • A certain amount of bleeding is to be expected following surgery. Applying pressure to the surgical area using small rolled gauze for 30-60 minutes controls bleeding. After that time remove the gauze and then you may eat or drink. If bleeding persists, a moist tea bag should be placed in the area of bleeding and bite firmly for one hour straight. This will aid in clotting blood. Repeat if necessary. If bleeding still persists call our office.
  • We suggest that you do not smoke for at least 5 days after surgery. Nicotine may break down the blood clot and cause a “dry-socket”.

Learn more when you visit Sunnyvale Dental Care. Call Sunnyvale Dentist Dr. Antonious at 408-720-0900 to schedule a consultation today!