INSTRUCTION BEFORE AND AFTER TOOTH EXTRACTION AND / OR SURGERY

Before the extraction procedures:

Please follow all instructions that you will receive carefully and completely. Inform your dentist about everything that you feel is important with respect to your symptoms and disease.

Please inform your dentist about all medications that you may be taking. If you are taking medications to „thin the blood“, you may not stop taking them without discussing it with your primary care physician and the treating physician.

After tooth extraction:

Please remember that your senses will be dulled and your reactions slowed for a certain period after receiving pain medication or a local anaesthetic agent.

Arrange to be picked up after the procedure and ask your dentist for exact instructions for the period after the operation. Also arrange to have somebody stay with you on the day of the operation. In addition, you may not operate a vehicle during this same period, you should not work with dangerous machinery, nor should you make important decisions. Because of the risk of injury, please do not eat or drink anything until the effects of the anaesthesia have worn off.

Please do not smoke until the wound has healed.

As a rule, swelling occurs after the operation, which will resolve over time. If pain develops, it can be treated very effectively with appropriate pain medication. In both cases, opening the mouth may be restricted.

If post surgical bleeding occurs, it can be stopped by biting on a wad of sterile gauze or a clean handkerchief for approximately 30 minutes. If you develop symptoms which cause you to feel concerned, please contact your doctor or dentist.

If the wound is sutured with a non-absorbable material, the sutures must be removed after approximately 10 days. If packing is placed in the wound, it will have to be changed. It may take 3 to 6 months for the jawbone to completely regenerate. Complete regeneration may be necessary in order to fit a prosthesis later.

In some cases, antibiotics will have to be prescribed in addition to pain medications. Your doctor will provide you with any additional instructions and inform you about appropriate pain medications.

Have a pleasant tooth extraction / surgery experience!!

All About Teeth Extraction

Reasons for Tooth to be extracted

There are several likely reasons why a tooth cannot be saved:

• The tooth is very loose and can be made to move by applying lip or tongue pressure to it.
• The crown of the tooth is decayed. The decay extends way below the gum line. It is no longer possible to fit an artificial crown.
• Chronic inflammation of the root tip is present. The usual endodontic/surgical procedures to treat the inflammation have not been successful in effecting a cure.
• Because of absence of an opposing or adjacent tooth, the tooth has lifted out of the gum; it is out of alignment or tilted extremely severely.
• The tooth must be removed as part of orthodontic treatment.

How is tooth extraction performed?

As a rule, teeth are extracted under local anaesthesia – in isolated cases, general anaesthesia is necessary. When the local anaesthetic has taken effect, the dentist will separate the gum from the tooth with a special instrument. He/She then grasps the tooth with a forceps and either pulls it from the jawbone using slow movements or raises it out of the socket with an elevator. If inflammation of surrounding tissues is present, the affected tissue will be removed. If the wound is large or if several neighboring teeth are extracted, gum tissue will be sutured over the wound. Bleeding can be stopped by biting on a wad of gauze for approximately 30 minutes in order to compress the bleeding areas. In addition to suturing the wound, under certain circumstances a special plate (splint) may be placed over the wound and left in place for a specific time in order to protect it. If necessary, materials to stop the bleeding (packing) will be placed in the wound.

Complications

As a rule, tooth extraction is easily tolerated. Severe problems that cannot be managed hardly ever occur. Nevertheless, complications can occur in isolated cases, which will then necessitate additional measures. How likely it is that these complications will occur will depend on your general health condition, your age, your lifestyle, and other factors which can affect the treatment. Complications can occur during and/or after the operation, for example:

·        General reaction: Change in blood pressure, the pulse rate or side-effects related to the nervous system (restlessness, seizures, breathing impairment) can occur in very rare cases due to the medications (e.g. local anaesthetic agent). These side-effects usually disappear by themselves without treatment

·        Injury to the mucosa the tongue, and rarely to the bony tissue can be caused by injections that are needed and the dental instruments. This type of injury is generally harmless and usually heals by itself. In very rare cases, the damage can result in infected pockets of tissue (abscess/needle track abscess) or it can lead to necrosis (death) of tissue.

·        Foreign bodies (e.g. instruments, extracted tooth) can be  swallowed or inhaled. If a foreign body is swallowed, monitoring the patient will generally be adequate. If the foreign body is inhaled, it must be removed by a specialist – usually with the aid of a bronchoscope.

·        Bleeding and post surgical bleeding can occur. As a rule, bleeding can be easily managed; it can be a serious complication in patients who have a clotting disorder or when medications to thin the blood are taken.

·        Infection rarely develops. This can lead to impairment of wound healing or to increased pain in the treated area. Treatment with antibiotics may be necessary.

·        Mild hypersensitivity to the anaesthetic agent or other medications is rare. This is manifested as skin rash, hives, or itching. Severe allergic reaction occurs extremely rarely. In the most unfavorable case, this reaction can be manifested by, for example, life threatening circulatory collapse and necessitates hospitalisation on an intensive care unit.

·        Part of the root can break off during extraction of the tooth. If the retained root cannot be grasped with a forceps, surgical removal will be necessary. Part of the bony wall may need to be removed.

·        A communication between the oral cavity and the maxillary sinus can be created when extracting the tooth because the roots of the upper molars are frequently separated from the maxillary sinus only by a thin bony partition; If this happens, the wound will be closed firmly by a special suture to avoid development of maxillary sinusitis.

·        Fracture of the mandible can occur when extracting certain teeth in the lower jaw if the location of the teeth is unfavorable. This complication will necessitate more extensive treatment.

·        Damage to the nerve of the lower jaw and tongue occurs in extremely rare cases, caused by the injection of anaesthetic agents or the procedure itself. This leads to a loss of sensation of the tongue and the lips which persists for a prolonged period. This condition usually goes away by itself.

Safe dental extraction can be done in 

Schön Dental by Drg. Henri Mudjono.

Kehamilan dan Kesehatan Mulut

Beberapa hari yang lalu, seorang pasien hamil di trimester kedua datang karena gusi yang mudah berdarah. Dari penuturannya, jelas sekali bahwa informasi perawatan gigi dan mulut pada kehamilan sangat minim atau bahkan sama sekali tidak diperoleh. Berikut adalah permasalahan gigi dan mulut pada ibu hamil.

Tampilan Klinis Gingivitis

Penyebab Penyakit Gigi dan Mulut pada Ibu Hamil

Ibu hamil sangat sensitif terhadap perubahan yang terjadi pada tubuhnya, terutama perubahan hormonal. Hormon yang berperan adalah Gonadotropin, Estrogen dan Progesteron. Hormon-hormon ini bertanggung jawab atas terjadinya Gestational Gingivitis / Schwangerschaftsgingivitis (peradangan gusi pada ibu hamil) yang ditandai oleh gusi yang kemerahan, pembengkakan gusi, dan perdarahan dari gusi. Selain itu periodontitis marginalis (peradangan jaringan penyangga gigi) juga lebih sering terjadi dibandingkan wanita tidak hamil.

Perubahan hormonal menyebabkan perubahan keseimbangan flora mulut. Kehadiran flora normal mulut biasanya diimbangi oleh sistem imun tubuh lewat saliva dan cairan gusi. Efek imunosupresi dari progesteron memiliki andil pada meningkatnya koloni bakteri Prevotella intermedia yang memiliki korelasi kuat dengan terjadinya gingivitis. Tingginya kadar estrogen dan progesteron mempengaruhi permeabilitas vaskuler yang berpengaruh pada mikrosirkulasi di gusi sehingga menurunkan kemampuan regenerasi sel epitel gusi.

Gambaran skematis Gingivitis

Akibat Kelainan pada Gusi

Berbagai penelitian menyebutkan bahwa periodontitis pada kehamilan meningkatkan resiko terjadinya kelahiran prematur, rendahnya berat badan bayi, dan kelainan kongenital selama kehamilan. Alasan utama adalah meningkatnya jumlah bakteri dan toksinnya di dalam darah yang nantinya berkontribusi pada peradangan di plasenta.

Pencegahan

Gestational Gingivitis lebih sering terjadi pada wanita yang sebelum terjadinya kehamilan, memiliki penyakit gusi atau periodontitis. Oleh karena itu  wanita muda, terutama yang memiliki kemungkinan untuk hamil, perlu dimotivasi untuk meningkatkan kesehatan mulutnya untuk menghindari hal tersebut di atas. Berbagai metode peningkatan kebersihan gigi dan mulut perlu dilakukan seperti penggunaan benang gigi (dental floss). Dengan penggunaan benang gigi, diharapkan terjadi penurunan bakteri di daerah celah antar gigi.

Selain itu perlu para ibu hamil perlu dimotivasi untuk selalu memeriksakan gigi ke dokter gigi secara rutin selama kehamilan untuk mendeteksi adanya kemungkinan retensi plak. Sebagai contoh, adanya tepi tambalan yang tidak baik, gigi berlubang, maupun adanya karang gigi. Professional dental cleaning sangat dianjurkan dilakukan tiap trimester guna mempermudah pembersihan gigi dan mulut di rumah. Berikut ini adalah checklist untuk tiap ibu hamil.

Checklist Perawatan Gigi Ibu Hamil

1. Penentuan Resiko Karies pada ibu hamil (dilakukan di dokter gigi)
2. Konsultasi Gizi
3. Penjelasan kemungkinan dan resiko penyebaran bakteri dari mulut ibu ke janin
4. Menurunkan jumlah bakteri dalam mulut (dilakukan di dokter gigi)
5. Recall ke dokter gigi tiap trimester.

Konsultasikan perawatan gigi dan mulut Anda selama masa kehamilan Anda bersama Drg. Henri Mudjono. Selamat menikmati masa kehamilan Anda.

Schön Dental
Wir machen Ihre Zähne schön
Drg. Henri Mudjono

Molar Hemisektion and restoration (by Drg. Henri Mudjono)

A 19 years old asian female has problem with her right posterior teeth in lower jaw. She has had an unfinished treatment from another dentist because she moved to jakarta from west borneo.

Clinical examination shows that teeth 45 and 46 are necrotic and had received endodontic treatment before.

Tooth 45: no pain, and has little radiolucency in radiograph.

Tooth 46: considerable pain, moderate radiolucency around the mesial root.

clinical situation after mesial root hemisection



Endodontic and apical access for tooth 45 is quite easy to reach. But on the contrary, the mesial root of 46 is blocked (calcified). After a thorough explanation and discussion with the patient, the patient agreed to have her tooth 46 hemisected. First of all, the endodontic treatment must be finished, followed by hemisection (or premolarisation) and restoration using rigid partial denture.

For the success rate and longevity of the hemisected root to be higher, oral hygiene instruction with daily dental floss is recommended.



hemisected root



Final restoration



FAQ Implant

Belakangan ini, saya terus dihujani pertanyaan-pertanyaan seputar implant. Bentuk implant dapat dilihat di posting sebelumnya yang berjudul ‘Dental Implant: bring back the smile’. Di posting tersebut ditampilkan foto sesaat setelah pemasangan, pembukaan implant, dan kemudian pemasangan mahkota tiruan (giginya).

Artikel ini untuk menjawab berbagai pertanyaan seputar implant yang biasa ingin diketahui oleh banyak orang. Semoga bisa membantu memahami tentang implant. Selamat membaca.

Gambaran Rontgen sebuah implant

Apa Keuntungan Pemasangan Implant?

Penemuan implant gigi merupakan jawaban dari keterbatasan tehnik pemasangan gigi tiruan, baik gigi tiruan lepasan maupun cekat. Salah satu yang paling utama adalah melindungi tulang dari resorpsi. Apa itu resorpsi? Setelah gigi dicabut, tulang di sekitar gigi (disebut juga tulang alveolar) akan menyesuaikan bentuknya dimana tulang tersebut tidak perlu lagi menyangga gigi (karena sudah dicabut). Penyesuaian bentuk tersebut berupa pengurangan tinggi dan lebar tulang yang disebut juga resorpsi. Bila masih ada gigi, tulang alveolar berfungsi menerima tekanan kunyah. Sedangkan setelah pencabutan gigi, tulang tidak berfungsi (inaktivitas). Seiring berjalannya waktu, resorpsi terjadi lebih banyak akibat dari inaktivitas bagian tersebut.

Keuntungan kedua adalah mungkinnya pembentukan gigi tiruan cekat (tidak perlu dilepas) tanpa mengorbankan struktur di sekitar implant. Dengan cara konvensional, yakni dengan pembuatan gigi tiruan jembatan, kadang gigi sehat (normal) perlu diasah untuk berfungsi sebagai gigi penyangga gigi tiruan cekat.

Keuntungan lainnya adalah sebagai berikut:

1.       Resiko pemasangan implant sangat kecil.

2.       Biokompatibilitas bahan pembuat implant sudah teruji secara klinis.

3.       Prognosa (kemungkinan keberhasilan) sangat tinggi.

4.       Secara ekonomis sangat efisien dan menguntungkan karena tingkat keberhasilan yang tinggi dan daya tahan yang sangat lama di dalam mulut.

Apa saja Resiko pemasangan Implant?

Secara umum, resiko pemasangan implant sangat kecil dan jarang terjadi. Tentu saja ada rasa nyeri pada hari pemasangan implant karena dilakukan prosedur bedah minor. Kemungkinan rembesan darah atau sedikit bengkak juga hal yang sangat normal setelah tindakan. Tetapi dibandingkan berbagai tindakan invasive di kedokteran gigi, pemasangan implant dapat digolongkan sebagai tindakan dengan resiko yang minimal. Salah satu resiko berupa lepasnya implant. Lepasnya implant beberapa hari / minggu setelah pemasangan dapat terjadi pada kasus-kasus tertentu oleh karena berbagai alasan seperti kecerobohan operator atau gangguan penyembuhan. Tetapi menurut berbagai literature, resiko tersebut berada pada angka di bawah 5 % . Resiko dapat diperkirakan melalui pemeriksaan awal sebelum pemasangan implant.

Resiko lainnya adalah terbukanya kanal syaraf rahang bawah saat pemasangan implant di rahang bawah belakang. Tetapi hal ini dapat dicegah dengan pengukuran yang akurat tinggi tulang yang tersedia di rahang bawah melalui rontgen panoramik. Seperti pada rahang bawah, pada rahang atas dapat terjadi masuknya implant ke dalam sinus maxilla (rongga udara pada rahang atas). Hal ini juga tidak akan menimbulkan komplikasi kecuali pasien memiliki riwayat infeksi pada sinus maxilla (sinusitis).

Kemungkinan lainnya adalah perdarahan selama prosedur pemasangan implant. Pada keadaan yang sangat jarang, bor untuk persiapan tulang menerima implant di rahang bawah dapat salah arah dan menembus tulang di sisi lidah. Karena di daerah tersebut banyak terdapat pembuluh darah kecil, maka dapat terjadi perdarahan yang cukup banyak. Apalagi bila pasien memiliki gangguan pembekuan darah. Tetapi kejadian yang sangat jarang ini dapat diatasi dengan tehnik yang benar.

Gigi tiruan jembatan,
Kerugian utama adalah perlunya mengasah gigi yang masih baik sebagai penyangga

Berapa lama Implant dapat bertahan di dalam mulut?

Hasil penelitian selama 25 tahun belakangan ini menunjukkan hasil yang sangat baik. Lebih dari 95% implant yang dipasang, dapat berfungsi dengan baik. Setelah 10 tahun, sekitar 90% implant masih dapat berfungsi untuk pengunyahan. Bila oral hygiene (kebersihan mulut) dapat terjaga, implant dapat bertahan seumur hidup.

Coba bandingkan dengan statistik berikut:

1.       80% dari gigi tiruan jembatan masih berfungsi baik setelah 10 tahun.

2.       70-75% jacket crown masih bertahan setelah 10 tahun.

3.       Hanya sekitar 50% dari gigi setelah perawatan saluran akar masih bertahan setelah 10 tahun.

Bila dipikir-pikir lagi, implant mirip dengan gigi asli sendiri. Perasaan ini tidak dapat ditukar dengan uang yang telah dikeluarkan saat pemasangan implant. Dibandingkan dengan gigi tiruan lain (apalagi gigi tiruan lepasan) yang memiliki tingkat kegagalan yang lebih tinggi dibandingkan implant. Oleh karena itu, secara finansial, pilihan implant merupakan pilihan yang paling ekonomis.

Informasi lebih lanjut dapat menghubungi Drg. Henri Mudjono di nomor telepon yang tercantum.

Selamat menikmati Gigi Asli (implant) Anda!!!

Artikel Ringan: Tentang Merokok

Zahlreiche Studien beweisen: Raucher erkranken 2,5- bis sechsmal so oft an einer Parodontitis wie Nichtraucher. Bei Rauchern, die an Parodontitis erkrankt sind, zeigen sich höhere parodontale Sondierungswerte, mehr klinischer Attachment- und Alveolarknochenverlust und eine verstärkte Neigung zur Ausprägung gingivaler Rezessionen. Zudem verlieren sie während der unterstützenden Nachsorgetherapie mehr Zähne als Nichtraucher. Raucher zeigen auch weniger ausgeprägte Befunde als Nichtraucher. So ist bei Rauchern die klinische Entzündungsreaktion schwächer und die Blutungstendenz entzündlich veränderter Gingiva und parodontaler Taschen geringer. Infolgedessen wird die notwendige Parodontitis-Therapie oft verspätet eingeleitet. „Um bei einem Raucher eine Parodontitis frühzeitig zu erkennen, muss der Tabakkonsum bei der Anamnese genau dokumentiert werden“, rät deshalb Diplom-Biochemikerin Bärbel Kiene, medizinisch-wissenschaftliche Leiterin von Gaba, den Zahnärzten

Banyak penelitian membuktikan bahwa perokok 2,5 sampai 6 kali lebih banyak menderita periodontitis (penyakit pada jaringan sekitar gigi) dibandingkan kaum bukan perokok. Pada perokok yang menderita periodontitis, parameter penyakit periodontal seperti dalamnya poket, kehilangan perlekatan gusi, kehilangan tulang tepi rahang (alveolar) dan resesi gusi terjadi lebih parah. Sebagai tambahan, gigi yang menderita penyakit periodontal juga lebih banyak dibanding mereka yang tidak merokok. Penyebabnya adalah berkurangnya suplai darah ke daerah periodontal dan melemahnya sistem pertahanan di daerah tersebut. Apalagi ditemukan bahwa terapi untuk menangani periodontitis juga sering terlambat atau sudah dalam fase yang lanjut. "Untuk lebih awal menemukan penyakit periodontal, perlu dilakukan anamnesa yang tepat dan didokumentasikan," demikian ujar Bärbel Kiene dari Gaba.

Sumber:

gaba-dent.de

Endodontic / Root Canal Treatment

Most often, patients come to our clinic with pain in one or more of their teeth. Pain is usually associated with diseased tooth which needs to be treated endodontically (endo=inside, dentes=tooth). Endodontic treatment makes up nearly 60% of our daily works and doing a correct endodontic treatment requires training and practice in this field. This article is to explain a little bit about endodontic / root canal treatment. In Indonesian term, it is called 'perawatan saluran akar /PSA'.

What is dental pulp?

The pulp of the tooth (endodontium), consists of connective tissue, blood vessels and nerves. It is located in the root canal of the tooth (pulp cavity or chamber). The tissue surrounded by the hard tooth structures cannot expand during an inflammation, generally caused by caries (tooth decay). Without endodontic treatment, the dental pulp will die, and the inflammation can then spread to the surrounding jawbone.

1 -5: the progress of dental caries to affect the pulp chamber and periapical tissues

How is the procedure performed?
The dentist first removes the decayed areas of the tooth and accesses the pulp of the tooth by drilling (trephination). The dental pulp, or whatever is left of it, is then removed. The root canal has to be cleaned thoroughly before filling it completely. The dentist first needs to determine the length of the canal with the help of special instruments and probably an X-ray. He/She then proceeds to clean the root canal using drilling and filing equipment in conjunction with disinfectant rinsing solutions (root canal preparation). Depending on the degree of the inflammation, the final filling of the canal can take place either during this visit or at a later stage. Between dental visits, the tooth is protected by means of a temporary medicinal filling.

Various methods and materials are available for filling a root canal densely and completely. Once treatment is completed, the correct length of the root canal filling is checked by means of an x-ray and the tooth is sealed with a filling. The tooth inevitably becomes more fragile after root canal treatment. It is therefore advisable in the long term, to stabilise teeth that have been subjected to root canal treatment, e.g. by means of a crown.

The lenghty treatment time makes root canal treatment not a favourite treatment to be done. It is possible to shorten the number of visits in selected cases. Most of the cases need to be done in 2 or 3 visits, depends on the lesions and difficulties of the treatment.



Endodontic treatment sequences

Completed root canal treatment

Alternative to Root Canal Treatment

 The only alternative is extraction of the tooth, followed by closure of the resulting gap with artificial dentition (implant, bridge etc).



What are the complications?

Despite the greatest care, the following incidents may be associated with the root canal treatment – in addition to the risks involved in local anaesthetisation:

• 
  

  Injury of the mucous membrane, tongue, and bone tissue and less commonly of the bone tissue by the dental instruments, is usually of a harmless nature and heals naturally.
• In rare cases, drilling through the tooth (perforation), injury of the jawbone or breakage of dental instruments inside the root canal may occur; this would necessitate further treatment.
• In rare cases, the solution used for rinsing may escape via the tip of the root, resulting in irritation of the surrounding tissue; a subsequent swelling is treated with an antibiotic preventively.
• 
  

  Leakage of the filling material via the tip of the root, resulting in possible damage of the surrounding tissue (including nerves), is extremely rare. The filling material should be removed surgically if it gives rise to complaints.

All about Wisdom Teeth

A wisdom tooth, in humans, is any of the usually four third molars, including mandibular third molar and maxillary third molar. Wisdom teeth usually appear between the ages of 17 and 25. Most adults have four wisdom teeth, but it is possible to have more, in which case they are called supernumerary teeth. Wisdom teeth commonly affect other teeth as they develop, becoming impacted or "coming in sideways". They are often extracted when this occurs.

The Indonesian term of wisdom teeth is 'gigi bungsu'. 'Bungsu' means the youngest child. This represents that the teeth are 'younger' than the other teeth. Most of Indonesian does not aware of these teeth until they cause problems. This article is to show the reasons and complications of the extraction of wisdom teeth

Why are wisdom teeth extracted?

Wisdom teeth cause problems more often than other teeth. Therefore, for several reasons, it can be wise to remove them. Some of the reasons to extract the wisdom teeth:

1. acute/chronic inflammation/infection of the affected wisdomtooth (dentitio difficilis)
2. there is deep caries within the tooth (possibly with severe inflammation of the root) or the tooth is extensively damaged and can no longer be restored
3. it is probably the cause of your unexplained pain
4. in case of disease (cysts/tumour) of a tooth in the lower jaw has developed or could develop
5. it is interfering with prosthetic or orthodontal treatment or a surgical procedure
6. it could damage or cause resorption (loss of substance) of adjacent teeth
7. it could hinder successful treatment of periodontal disease
8. it is probably the cause of inflammation or a cyst in the maxillary sinus
9. transplantation of the tooth is planned
10. because of malalignment (tilting/displacement), the tooth is hindering proper chewing
11. because of its nearness to a fracture of your jaw
12. it could be a hazard (e.g. in the case chemotherapy, immunosuppression or radiation)
13. it could hinder dental treatment (fitting a prosthesis, fillings) of adjacent teeth.



How is the procedure performed?

The surgery is performed under local anaesthesia or under general anaesthesia. For extraction of a lower wisdom tooth, the local anaesthetic agent is injected into the lower inner side and possibly the outer side of the jaw and around the tooth; for extraction of an upper wisdom tooth, the anaesthetic agent is injected into the inner and outer surface of the jaw and around the tooth. To expose the tooth, an incision is made in the gum and the bony structure encasing the tooth is removed with a drill. The wisdom tooth can then be removed with an extracting forceps or an elevator. It some cases it may be necessary to cut the tooth into pieces.

Impacted wisdom tooth



The wound is either stitched or packed with gauze. In the upper jaw, the roots of the wisdom teeth often extend into the maxillary sinuses. When one of the upper wisdom teeth is removed, an open communication between the sinus and the oral cavity can arise which may lead to maxillary sinusitis. If this communication develops, it must be closed during the same procedure using a small flap of skin, which is generally removed from the cheek.

removal of upper jaw wisdom tooth with elevator

General Complications

Complications can occur during or after the procedure, which under certain circumstances may necessitate immediate treatment. How likely it is that these complications will occur depends on

the patient (e.g. whether he/she smokes). Those are:

• Generalized reactions: Changes in blood pressure, pulse, or side-effects that affect the nervous system (restlessness, seizures, breathing impairment) can develop secondary to medications that may be given (e.g. local anaesthetic agents). These symptoms usually go away by themselves without treatment; medical intervention (e.g. infus ions, medications) is sometimes necessary, however.

• Bleeding: If bleeding is severe, the wound may have to be reopened and sutured once again, packing to stop bleeding / medicated packing) may need to be applied, or medications or another operation may be necessary. If necessary a protective splint may also be placed.

• Damage to soft tissues (injection track abscess, necrosis of tissue, swelling, pain, nerve irritation) can occur before, during or after the procedure secondary to injections; this damage usually goes away by itself or it is easily treated. In an unfavourable case, long-persisting or even permanent damage (e.g. painful alteration in sensation, numbness) can develop. It is quite normal for a surgical wound to heal by forming scars. This sometimes leads to sensitivity to weather changes, a feeling of tension and pain due to irritation. Skin/mucous membrane damage is caused in very rare cases by sterilizing agents, protective materials and electrical current (redness, irritation, superficial burns). Compression damage occurs very rarely, despite employing standard techniques in positioning the patient.

• Infection (abscess, bone infection): Treatment with antibiotics, irrigation or a second operation may be necessary. In very rare case, infection leads to life threatening spread of micro organisms in the blood stream (blood poisoning; sepsis) or even to inflammation/infection of organs (e.g. the membrane lining the heart – endocarditis). Treatment with antibiotics and/or on an intensive care unit may then be necessary.

• Hypersensitivity reaction (allergy) to an anaesthetic agent or to a medication that may be given (e.g. antibiotics) can occur. Mild allergy is manifested by, e.g. itching; severe reaction even with circulatory collapse, seizures, and breathing difficulty, which can be critical or life-threatening and lead to permanent consequences (e.g. kidney or brain damage), necessitates hospitalisation in some cases.

• Thrombosis/embolus:Life-threatening problems are extremely rare and are more likely to occur in patients who are confined to bed for a prolonged period, in the case of lengthy operations, if certain medications are taken ( e.g. contraceptive medications – “the pill”) or in elderly patients. If you are at high risk for thrombosis and embolus (formation of blood clots and their movement through the blood stream), you will receive prophylactic medications (thromboembolic prophylaxis ) in order to prevent the consequences of this complication (e.g. stroke with permanent paralysis) . These measures that may be necessary to thin the blood can increase the risk of post-surgical bleeding or cause changes in the blood count.

• Breakage of the delicate ends of the root. Depending on the findings, the root ends are either removed or left in place

Complications in upper jaw:

• If a communication to the maxillary sinus is established or if the tip of the root breaks off and migrates into the maxillary sinus , inflammation/infection can occur. Treatment with antibiotics or an operation (e.g. removal of the root) may be necessary.

• Nerve injury: In very rare cases, e.g. when the anterior wall of the maxillary sinus is exposed and due to scar formation, damage occurs to the nerve of the upper jaw; consequences are alteration in sensation (e.g. numbness of the lip, painful alteration in sens a ion) in particular of the upper lip, the teeth, the mucous membranes, the cheek and possibly half of the nose (internal and external). This type of impairment of sensation can also occur secondary to injection of an anaesthetic agent in extremely rare cases.

Complications in Lower jaw:

• Nerve injury: Because the nerve is sometimes located very near the roots of the wisdom teeth, a mechanical injury can occur to the nerve when the wisdom tooth is being extracted. This injury can cause an alteration in sensation, mainly in the lower lip, the mucous membranes and the teeth. The (nerve supplying the tongue) is located in the inner side of the lower jaw, also near the

tooth to be extracted, and in very rare cases it can be bumped or bruised during the operation, which is manifested as symptoms such as numb sensation and a change in taste perception of the anterior part of the tongue on the affected side. The nerve damage des cribed above (e.g. numbness of the lower lip, painful alteration in s ensation) is usually of a temporary nature; in rare cases it can be permanent – despite subsequent surgical intervention (e.g. nerve suture). This injury will not affect the ability to move the tongue or the lower lip in any way. In extremely rare cases, these changes in sensation can also be due to an injury caused by the needle when injecting the anaesthetic agent.

• Fracture of the mandible. Since bone tissue must be removed to extract the tooth, the jaw is weakened in that area. During the operation, or even for a period as long as several weeks after the wisdom tooth has been extracted, a stress fracture of the lower jaw may occur if undue pressure is exerted. The fracture requires treatment, but usually heals without complication. If the teeth are located deep in the bone, there is a higher risk that the jaw will fracture.

• Bone infection: This can occur even at a later time (even years later) if the wound does not heal over and can lead to impaired sensation (e.g. numbness, painful alteration in sensation) and inhibit opening of the mouth. This complication occurs in particular in patients who have underlying disease such as diabetes , weakened immune response or after radiation treatment. If this complication occurs, major operations and prolonged treatment with antibiotics may be necessary to cure the infections.

Despite all the possibilities of complications, the extraction of wisdom teeth is suggested for many cases because of its many advantages compared to its disadvantages. 





Operative extraction of wisdom teeth could be done in Schön Dental only on appointment with Drg. Henri Mudjono. For free pre-consultation call 081389989122.