Dental Braces

Dental braces are wire-based appliances that orthodontists use to correct crowded and misaligned teeth or jaws. Many people who need dental braces get them during their early teenage years. However, adults also may benefit from wearing braces. The goal of dental braces is to properly align your teeth and jaws to produce an even bite and pleasing smile.

For teens or adults who need minor corrections, an alternative to fixed braces is a series of clear, customized, removable appliances called aligners or "invisible braces." Clear aligners may be more expensive than fixed braces, but may have a more acceptable appearance to some adults. However, many people need fixed braces to appropriately correct their dental problem.

Modern materials and technologies make the experience of having dental braces much more comfortable than in the past.

Why It’s Done

Dental braces offer corrective treatment for:

  • Overcrowded or crooked teeth
  • Too much space between teeth
  • Upper front teeth that overlap the lower teeth too much — either vertically (overbite) or horizontally (overjet)
  • Upper front teeth that bite behind the lower ones (underbite)
  • Other jaw misalignment problems that cause an uneven bite

Proper alignment of your teeth and jaws may improve not only the appearance of your teeth, but the way you bite, chew and speak.

Adults and braces

Braces can help solve some of the same problems in adults that they do in children, including crooked teeth and misaligned jaws. If you're an adult with braces, you may need to wear them longer than a younger person would, but they can still produce similar results. Because your facial bones are no longer growing, however, there may be some problems that can't be corrected with braces alone.

Risks

Wearing dental braces is generally a very safe procedure, with the exception of a few short-term and long-term risks.

Short-term risks

Braces create tiny spaces around your teeth that can trap food particles and promote bacteria-filled plaque deposits. Failure to remove deposits of food and plaque can lead to:

  • Loss of minerals in your teeth's outer enamel surface, which can leave permanent whitish stains on your teeth
  • Cavities and gum disease

Long-term risks

Long-term risks may include:

  • Shorter root lengths. During tooth movement, some of the bone in the path of the moving tooth dissolves, while new bone is laid behind it. Permanent loss of tooth root length may occur during this process, which could lead to less stable teeth. In most cases, however, this doesn't cause any problems.
  • Loss of correction. If you don't follow your orthodontist's instructions carefully after your braces are removed, particularly when it comes to wearing a device called a retainer, you may lose some of the correction gained while wearing your braces.

Reduce your risk of damage

To reduce the risk of damaging your teeth and braces:

  • Cut down on sugary and starchy foods, which substantially contribute to plaque formation and tooth decay.
  • Brush carefully, preferably after every meal, with fluoride toothpaste and a soft-bristled brush. If you can't brush your teeth after your meal, rinse your mouth out with water.
  • Rinse thoroughly to get all particles out of your braces. Check in the mirror to make sure your teeth are clean.
  • Use a fluoride rinse if recommended by your dentist or orthodontist.
  • Floss between braces and under wires with the help of a floss threaded. Your orthodontist may also recommend a small flexible toothbrush to clean between braces and underwire.
  • Avoid sticky foods — such as chewing gum, chewy candies, caramel and taffy — that can pull off brackets, bands and wires.
  • Avoid hard foods — such as ice, hard candies, popcorn and nuts — that can break parts of your braces.
  • Visit your dentist for checkups and cleaning, as often as your dentist recommends, to keep your teeth and gums healthy.
  • Follow instructions. A lack of compliance can extend the time needed for completion and increase the chance of complications.

How you prepare

If your regular dentist notices problems with your teeth or jaws that may require treatment, he or she will likely refer you to an orthodontist — a dentist who specializes in diagnosing, preventing and treating dental and facial irregularities.

Most alignment problems become apparent once the permanent teeth begin to come through the gum (erupt). But your orthodontist may recommend waiting until enough teeth have come through before applying braces. Most children get braces between the ages of 8 and 14, while their facial bones are still growing and their teeth are more susceptible to movement.

Preparation for braces generally involves:
  • Cut down on sugary and starchy foods, which substantially contribute to plaque formation and tooth decay.
  • Oral exam. Your orthodontist conducts a full exam of your teeth, jaws and mouth.
  • X-rays. You'll get a series of X-rays to determine the position of teeth. The most common is the panoramic X-ray, which shows all the upper and lower teeth in biting position and any teeth still developing within the jaws. Special head X-rays also may help determine the size, position and relationship of jaws to teeth.
  • Plaster models. Your orthodontist typically obtains plaster models of your teeth to evaluate your bite. To make an impression of your teeth, you'll be asked to bite into soft material, which will remain on your teeth for a few minutes. From this impression, the orthodontist can create a plaster model of your teeth (dental cast). In some cases, this dental cast may be scanned into a digital format for further evaluation or treatment decisions.
  • Potential tooth extraction. If your mouth is very overcrowded, your orthodontist may recommend removing one or more permanent teeth to allow room for the remaining teeth to fit comfortably. In severe cases, where tooth movement alone will not correct a bite that's significantly out of alignment, jaw surgery is required in combination with orthodontics.

After your orthodontist has evaluated your teeth and jaws, he or she customizes a treatment plan for you. This most often involves the use of fixed braces, which are temporarily bonded to your teeth.

What you can expect

Treatment consists of three phases: the initial placement of the braces (or clear aligners), periodic adjustments and wearing of a retainer after the braces are removed.

Placement of braces

Fixed braces typically consist of these components:

  • Cut down on sugary and starchy foods, which substantially contribute to plaque formation and tooth decay.
  • Brackets attached to the outside surfaces of the premolar and front teeth. Sometimes they can be attached to the backside of teeth, hiding them from view, but this makes them slightly more difficult to access. Brackets can be made of stainless steel, titanium, polycarbonate, ceramic, or a combination of a polycarbonate base and ceramic bracket. Modern metal brackets are smaller and less noticeable than they used to be. Ceramic brackets are usually clear or tooth-colored, and are less obvious than metal brackets.
  • Ring-like bands that encircle the molar teeth. Bands are made of stainless steel or titanium. A buccal tube attached to the band of the last molar holds the end of the connecting arch wire in place.
  • A flexible wire (arch wire) that connects all of the brackets and bands, controlling movement of the teeth. Today's wires may be made of copper, nickel and titanium, which are superelastic and have shape memory, making them more flexible than stainless steel. While they are more expensive, they tend to require fewer adjustments.
  • Various accessories to help position the teeth, in addition to the fixed components. Small rubber bands (elastic ties) secure the arch wire to the brackets. Larger rubber bands also may be used to help move teeth. Headgear (usually worn at night) may be used to help hold or move teeth into the correct position.

Removable clear aligners

Instead of using fixed braces, certain people who need only minor corrections may benefit from a series of clear, customized, removable appliances called aligners or invisible braces. Each set of aligners is worn for a period of two weeks, as close to 24 hours a day as possible — except when eating, brushing or flossing — until it's replaced by the next set. You should also remove the aligners when drinking liquids that might stain the aligner, such as coffee or tea.

Periodic adjustments

IAfter fixed braces are placed on your teeth, your orthodontist adjusts them periodically by tightening or bending the interconnecting wires. This puts mild pressure on the teeth and gradually shifts them into new positions. The jaw responds to the pressure by dissolving bone in the path of the moving tooth and laying down new bone behind it.

Occasionally, the orthodontist may use tension between upper and lower jaws to help promote correct alignment. This is often done with elastic bands stretched between opposing teeth.

Your teeth and jaws may feel slightly sore for a day or two after an adjustment. This discomfort can usually be eased with an over-the-counter pain reliever. Tell your orthodontist if the discomfort is severe or becomes worse.

Retainers

After dental braces are removed, the newly straightened teeth need to be stabilized for a period of time (retention period) to prevent them from shifting back to their original position. This is usually accomplished with the use of a retainer, a custom-made appliance typically made of plastic and metal wires that help teeth stay in place. These are usually removable, but may be fixed. Or a combination of fixed and removable may be used.

Results

On average, most people wear full braces for one to three years. Retainers may be worn indefinitely to ensure that the final results remain stable.

Braces are generally very effective in realigning crooked teeth and correcting improperly positioned jaws. But the person wearing the braces has an important role to play in the success of the treatment.

Follow your orthodontist's instructions precisely, especially during the retention period. When it comes to this final phase, it's important to wear the retainer as directed or risk losing the benefits gained while wearing braces.

Dental Implant Surgery

Dental implant surgery is a procedure that replaces tooth roots with metal, screw-like posts and replaces damaged or missing teeth with artificial teeth that look and function much like real ones. Dental implant surgery can offer a welcome alternative to dentures or bridgework that doesn't fit well.

How dental implant surgery is performed depends on the type of implant and the condition of your jawbone. But all dental implant surgery occurs in stages and may involve several procedures. The major benefit of implants is solid support for your new teeth — a process that requires the bone to heal tightly around the implant. Because this healing requires time, the process can take many months.

Why It's Done

Dental implants are surgically placed in your jawbone, where they serve as the roots of missing teeth. Because the titanium in the implants fuses with your jawbone, the implants won't slip, make noise or cause bone damage the way fixed bridgework or dentures might. And the materials can't decay like your own teeth that support regular bridgework can.

In general, dental implants may be right for you if you:
  • Have one or more missing teeth
  • Have a jawbone that's reached full growth
  • Have adequate bone to secure the implants or are able to have a bone graft
  • Have healthy oral tissues
  • Don't have health conditions that will affect bone healing
  • Are unable or unwilling to wear dentures
  • Want to improve your speech
  • Are willing to commit several months to the process

Risks
Like any surgery, dental implant surgery poses some health risks. Problems are rare, though, and when they do occur they're usually minor and easily treated. Risks include:
  • Infection at the implant site
  • Injury or damage to surrounding structures, such as other teeth or blood vessels
  • Nerve damage, which can cause pain, numbness or tingling in your natural teeth, gums, lips or chin
  • Sinus problems, when dental implants placed in the upper jaw protrude into one of your sinus cavities

How You Prepare

Because dental implants require one or more surgical procedures, you must have a thorough evaluation to prepare for the process, including a:

    HELLO
  • Comprehensive dental exam. You may have dental X-rays taken and models made of your teeth and mouth.
  • Treatment plan. Tailored to your situation, this plan takes into account factors such as how many teeth you need replaced and the condition of your jawbone. The planning process may involve a variety of dental specialists, including a doctor who specializes in conditions of the mouth, jaw and face (oral and maxillofacial surgeon) and a dentist who works with the structures that support teeth (periodontist).

Tell your doctor about any medical conditions and any medications you take, including prescription and over-the-counter drugs and supplements. If you have certain heart conditions or orthopedic implants, your doctor may prescribe antibiotics before surgery to help prevent infection.

To control pain, anesthesia options during surgery include local anesthesia, sedation or general anesthesia. Talk to your dental specialist about which option is best for you. Your dental care team will instruct you about eating and drinking before surgery, depending on what type of anesthesia you have. If you're having general anesthesia, plan to have someone take you home after surgery and expect to rest for the remainder of the day.

What You Can Expect

Dental implant surgery is usually an outpatient surgery performed in stages:

  • Your damaged tooth is removed.
  • Your jawbone is prepared for surgery, a process that may involve bone grafting.
  • After your jawbone heals, your oral surgeon places the dental implant metal post in your jawbone.
  • You go through a healing period that may last several months.
  • Your oral surgeon places the abutment — an extension of the implant metal post — followed by your new artificial tooth (crown).

The entire process can take many months from start to finish — three to nine months and sometimes longer. Much of that time is devoted to healing and waiting for the growth of new bone in your jaw.

When bone grafting is required

If your jawbone isn't thick enough or is too soft, you may need bone grafting before you can have dental implant surgery. That's because the powerful chewing action of your mouth exerts great pressure on your bone, and if it can't support the implant, the surgery likely would fail. A bone graft can create a more solid base for the implant.

With bone grafting, a piece of bone is removed from another part of your jaw or your body — your hip, for example — and transplanted to your jawbone. It may take up to nine months for the transplanted bone to grow enough new bone to support a dental implant. In some cases, you may need only minor bone grafting, which can be done at the same time as the implant surgery. The condition of your jawbone determines how you proceed.

Placing the dental implant

During surgery to place the dental implant, your oral surgeon makes a cut to open your gum and expose the bone. Holes are drilled into the bone where the dental implant metal post will be placed. Since the post will serve as the tooth root, it's implanted deep into the bone.

At this point, you'll still have a gap where your tooth is missing. Usually, a type of partial, temporary denture can be placed for appearance. You can remove this denture for cleaning and while you sleep.

Waiting for bone growth

Once the metal implant post is placed in your jawbone, osseointegration (oss-ee-oh-in-tuh-GRAY-shun) begins. During this process, the jawbone grows into and unites with the surface of the dental implant. This process, which can take up to six months, helps provide a solid base for your new artificial tooth — just as roots do for your natural teeth.

Placing the abutment

When osseointegration is complete, you may need additional surgery to place the abutment — the piece where the crown will eventually attach. This minor surgery is typically done with local anesthesia in an outpatient setting.

To place the abutment:
  • Your oral surgeon reopens your gum to expose the dental implant
  • The abutment is attached to the dental implant
  • The gum tissue is then closed around, but not over, the abutment

In many cases, the abutment is attached to the dental implant metal post when the post is implanted. That means you won't need an extra surgical step. Because the abutment juts past the gumline, however, it's visible when you open your mouth — and it will be that way until your dentist completes the tooth prosthesis. Some people don't like that appearance and prefer to have the abutment placed in a separate procedure.

Choosing your new artificial teeth

After the abutment is placed, your gums must heal for one or two weeks before the artificial tooth can be attached. Once your gums heal, you'll have more impressions made of your mouth and remaining teeth. These impressions are used to make the crown — your realistic-looking artificial tooth. The crown can't be placed until your jawbone is strong enough to support use of the new tooth.

You and your dental specialist can choose from two main types of artificial teeth:
  • A removable implant prosthesis. This type is similar to a conventional removable denture. It contains artificial white teeth surrounded by pink plastic gum. It's mounted on a metal frame that's attached to the implant abutment, and it snaps securely into place. It can be easily removed for repair or daily cleaning. It's often a good choice when several teeth in the lower jaw are replaced, mainly because it's more affordable than multiple individual dental implants and yet more secure than a traditional denture.
  • A fixed implant prosthesis. In this type, an artificial tooth is permanently screwed or cemented onto an individual implant abutment. You can't remove the tooth for cleaning or during sleep. If affordability isn't a concern, you can opt to replace several missing teeth this way. Each crown is attached to its own dental implant.

After surgery

Whether you have dental implant surgery in one stage or multiple stages, you may experience some of the typical discomforts associated with any type of dental surgery, such as:

  • Swelling of your gums and face
  • Bruising of your skin and gums
  • Pain at the implant site
  • Minor bleeding

If swelling, discomfort or any other problem gets worse in the days after surgery, contact your oral surgeon. You may need pain medications or antibiotics.

After each stage of surgery, you may need to eat soft foods while the surgical site heals — as long as 10 to 14 days. Typically, your surgeon will use stitches that dissolve on their own. If your stitches aren't self-dissolving, your doctor removes them in about 10 days.

Results

Most dental implants are successful. Sometimes, however, the bone fails to fuse sufficiently to the metal implant. Smoking, for example, can contribute to implant failure and complications.

If the bone fails to fuse sufficiently, the implant is removed, the bone is cleaned up, and you can try the procedure again in a month or two.

You can help your dental work — and remaining natural teeth — last longer if you:
  • Practice excellent oral hygiene. Just as with your natural teeth, you must keep implants, artificial teeth and gum tissue clean. Specially designed brushes, such as an interdental brush that slides between teeth, can help clean the nooks and crannies around teeth, gums and metal posts.
  • See your dentist regularly. Schedule dental checkups every six months to one year to ensure the health and proper functioning of your implants.
  • Avoid damaging habits. Don't chew hard items, such as ice and hard candy, which can break your crowns — or your natural teeth. Avoid tooth-staining tobacco and caffeine products. Get treatment if you grind your teeth.

Oral Cancer Screening

Oral cancer screening is an examination performed by a dentist or doctor to look for signs of cancer or precancerous conditions in your mouth.

The goal of oral cancer screening is to identify mouth cancer early, when there is a greater chance for a cure.

Most dentists perform an examination of your mouth during a routine dental visit to screen for oral cancer. Some dentists may use additional tests to aid in identifying areas of abnormal cells in your mouth.

Medical organizations disagree on whether healthy people without risk factors for mouth cancer need oral cancer screening. No single oral exam or oral cancer screening test is proved to reduce the risk of dying of oral cancer. Still, you and your dentist may decide that an oral exam or a special test is right for you based on your risk factors.

Why It's Done

The goal of oral cancer screening is to detect mouth cancer or precancerous lesions that may lead to mouth cancer at an early stage — when cancer or lesions are easiest to remove and most likely to be cured.

But no studies have proved that oral cancer screening saves lives, so not all organizations agree about the benefits of an oral exam for oral cancer screening. Some groups recommend screening, while others don't.

People with a high risk of oral cancer may be more likely to benefit from oral cancer screening, though studies haven't clearly proved that. Factors that can increase the risk of oral cancer include:

  • Tobacco use of any kind, including cigarettes, cigars, pipes, chewing tobacco and snuff, among others
  • Heavy alcohol use
  • Previous oral cancer diagnosis
  • History of significant sun exposure, which increases the risk of lip cancer

Ask your dentist whether oral cancer screening is appropriate for you. Also ask about ways you can reduce your risk of oral cancer, such as quitting smoking and not drinking alcohol.

Risks
Oral exams for oral cancer screening have some limitations, such as:
  • Oral cancer screening could lead to additional tests. Many people have sores in their mouths, with the great majority being noncancerous. An oral exam can't determine which sores are cancerous and which are not. If your dentist finds an unusual sore, you may go through further testing to determine its cause. The only way to definitively determine whether you have oral cancer is to remove some abnormal cells and test them for cancer by a procedure called a biopsy.
  • Oral cancer screening can't detect all mouth cancers. It can be difficult to detect areas of abnormal cells just by looking at your mouth, so it's possible that a small cancer or precancerous lesion could go undetected.
  • Oral cancer screening hasn't been proved to save lives. There's no evidence that routine oral examinations to look for signs of oral cancer can reduce the number of deaths caused by oral cancer. However, screening for oral cancer may help find cancers early — when cure is more likely.

How You Prepare

Oral cancer screening doesn't require any special preparation. Oral cancer screening is typically performed during a routine dental appointment.

What You Can Expect

During an oral cancer screening exam, your dentist looks over the inside of your mouth to check for red or white patches or mouth sores. Using gloved hands, your dentist also feels the tissues in your mouth to check for lumps or other abnormalities.

If you wear complete or partial dentures that are removable, your dentist or doctor will ask you to remove them so that the tissue underneath can be examined.

Additional tests for oral cancer screening

Some dentists use special tests in addition to the oral exam to screen for oral cancer. It's not clear if these tests offer any additional benefit over the oral exam. Special oral cancer screening tests may involve:

  • Rinsing your mouth with a special blue dye before an exam. Abnormal cells in your mouth may take up the dye and appear blue.
  • Shining a light in your mouth during an exam. The light makes healthy tissue appear dark and makes abnormal tissue appear white.

Results

If your dentist discovers any signs of mouth cancer or precancerous lesions, he or she may recommend:

  • A follow-up visit in a few weeks to see if the abnormal area is still present and note whether it has grown or changed over time.
  • A biopsy procedure to remove a sample of cells for laboratory testing to determine whether cancer cells are present. Your dentist may perform the biopsy, or you may be referred to a doctor who specializes in oral cancer diagnosis and treatment.

Wisdom Tooth Extraction

Wisdom tooth extraction is a surgical procedure to remove one or more wisdom teeth — the four permanent adult teeth located at the back corners of your mouth on the top and bottom.

If a wisdom tooth doesn't have room to grow (impacted wisdom tooth), resulting in pain, infection or other dental problems, you'll likely need to have it pulled. Wisdom tooth extraction may be done by a dentist or an oral surgeon. Some dentists and oral surgeons recommend wisdom tooth extraction even if impacted teeth aren't causing problems, as a preventive measure against potential future problems.

Why It's Done
Problems with impacted wisdom teeth

Wisdom teeth, or third molars, are the last permanent teeth to appear (erupt) in the mouth. These teeth usually appear between the ages of 17 and 25. Some people never develop wisdom teeth. For others, wisdom teeth erupt normally — just as their other molars did — and cause no problems.

Many people, however, develop impacted wisdom teeth — teeth that don't have enough room to erupt into the mouth or grow normally. Impacted wisdom teeth may erupt only partially or not at all.

An impacted wisdom tooth may:
  • Grow at an angle toward the next tooth (second molar)
  • Grow at an angle toward the back of the mouth
  • Grow at a right angle to the other teeth, as if the wisdom tooth is "lying down" within the jawbone
  • Grow straight up or down like other teeth but stay trapped within the jawbone

You'll likely need your impacted wisdom tooth pulled if it results in problems such as:
  • Pain
  • Infection
  • Damage to an adjacent tooth
  • Development of a fluid-filled sac (cyst) around the wisdom tooth
  • Damage to surrounding bone
  • Complications with orthodontic treatments to straighten other teeth

Preventing future dental problems

Dental specialists disagree about the value of extracting impacted wisdom teeth that aren't causing problems (asymptomatic).

Here's the rationale for preventive treatment:

  • It's difficult to predict future problems with impacted wisdom teeth.
  • Symptom-free wisdom teeth could still harbor disease.
  • Having your wisdom teeth makes you vulnerable to gum disease and tooth cavities.
  • Removing impacted teeth lowers the risk of potential problems.
  • Serious complications rarely happen in younger adults.
  • Older adults may experience difficulty with surgery and complications after surgery.

Other specialists argue that there isn't enough evidence to suggest that impacted wisdom teeth not causing problems in young adults will later cause problems. Therefore, they suggest that the expense and risks of the procedure don't justify the expected benefit.

Risks

Most wisdom tooth extractions don't result in long-term complications. Problems that can occur include:

  • Dry socket, or exposure of bone when the post-surgical blood clot is dislodged from the site of the surgical wound (socket) — a complication that delays healing and causes pain
  • Infection in the socket from bacteria or trapped food particles
  • Damage to sinuses near the upper wisdom teeth
  • Weakening of the lower jawbone
  • Damage to nerves that results in altered sensation in the lower lip, tongue or chin

How You Prepare
Questions to ask your dentist or surgeon

Your dentist may perform the procedure in the office. However, if your tooth is deeply impacted or if the extraction is expected to be difficult, your dentist may suggest you see an oral surgeon. Questions you may want to ask your dentist or oral surgeon include:

  • How many wisdom teeth need to be removed?
  • Will I need local anesthesia (which numbs your mouth and jaw) or sedation anesthesia (which makes you unaware of the procedure)?
  • How complicated do you expect the procedure to be?
  • How long is the procedure likely to last?
  • Have the impacted wisdom teeth caused damage to other teeth?
  • Is there a risk that I might have nerve damage?
  • What other dental treatments might I need at a later date?
  • How long does it take to completely heal and return to normal activity?

Preparing for the surgery

A wisdom tooth extraction is almost always performed as an outpatient procedure. This means that you go home the same day.

You'll receive instructions from the hospital or dental clinic staff on what to do before the surgery and the day of your scheduled surgery. Ask these questions:

  • Will I need to make arrangements for someone to drive me home after the procedure?
  • When do I need to arrive at the dental clinic or hospital?
  • Do I need to avoid eating food, drinking fluids or both (fast)? If so, when do I begin?
  • Can I take my prescription medications before the surgery? If so, how soon before the surgery can I take a dose?

What You Can Expect
During the procedure

Your doctor or oral surgeon may use one of three types of anesthesia. The appropriate anesthesia for you depends on the expected complexity of the wisdom tooth extraction and your own comfort level. Your options include:

  • Local anesthesia. Your doctor or oral surgeon administers local anesthesia with one or more injections near the site of each extraction. Before you receive an injection, your dentist or surgeon will likely apply a substance to the gums that numbs the site. You're awake during the tooth extraction. Although you'll feel some pressure and movement, you shouldn't experience pain.
  • Sedation anesthesia. Your doctor or oral surgeon gives you sedation anesthesia through an intravenous line in your arm. Sedation anesthesia suppresses your consciousness during the procedure and you don't feel any pain. You will also receive local anesthesia to numb your gums.
  • General anesthesia. In special situations, you may be offered general anesthesia. For general anesthesia, you inhale medication through your nose. This type of anesthesia makes you lose consciousness, and you don't feel any pain during the procedure. Your surgical team closely monitors your medication, breathing, temperature, fluids and blood pressure during general anesthesia.

During wisdom tooth extraction, your dentist or oral surgeon:
  • Makes an incision in the gum, creating flaps to expose the tooth and bone
  • Removes any bone that blocks access to the tooth
  • Divides the tooth into sections if it's easier to remove in pieces
  • Removes the tooth
  • Cleans the site of the removed tooth of any debris from the tooth or bone
  • Stitches the wound closed to promote healing, though this isn't always necessary
  • Places gauze over the extraction site to control bleeding and to help a blood clot form

After the procedure

If you receive sedation anesthesia or general anesthesia, you're taken to a recovery room after the procedure. If you have local anesthesia, your brief recovery time is likely in the dental chair.

As you heal from your surgery, follow your doctor's instructions on:

  • HELLO
  • Activity. After your surgery, plan to rest for the remainder of the day. Resume normal activities the next day, but for at least a week, avoid strenuous activity that might result in dislodging the blood clot from the socket.
  • Beverages. Drink lots of water after the surgery. Don't drink alcoholic, caffeinated, carbonated or hot beverages in the first 24 hours. Don't drink with a straw for at least a week because the sucking action can dislodge the blood clot from the socket.
  • Food. Eat only soft foods, such as yogurt or applesauce, for the first 24 hours. Start eating semisoft foods when you can tolerate them. Avoid hard, chewy, hot or spicy foods that might get stuck in the socket or irritate the wound.
  • Pain management. You may be able to manage pain with a prescription pain medication — given by your doctor or oral surgeon — or an over-the-counter pain reliever, such as acetaminophen (Tylenol, others). Holding a cold pack against your jaw also may relieve pain.
  • Bleeding. Some oozing of blood may occur the first day after wisdom tooth removal. Try to avoid excessive spitting so that you don't dislodge the blood clot from the socket. Replace gauze over the extraction site as directed by your dentist or oral surgeon.
  • Swelling and bruising. Swelling and bruising of your cheeks usually improves in two or three days. Use an ice pack as directed by your dentist or surgeon.
  • Cleaning your mouth. Don't brush your teeth, rinse your mouth, spit or use a mouthwash during the first 24 hours after the surgery. After that time, gently rinse your mouth with warm salt water every two hours and after meals for a week after your surgery. Mix 1/2 teaspoon (2.5 milliliters) of table salt in 8 ounces (237 milliliters) of water. After the first 24 hours, resume brushing your teeth, being particularly gentle near the surgical wound to avoid disrupting any stitches.
  • Tobacco use. If you smoke, don't do so for at least 24 hours after surgery — and wait longer than that if possible. If you chew tobacco, don't use it for at least a week. Using tobacco products after oral surgery can delay healing and increase the risk of complications.
  • Stitches. You may have stitches that dissolve within a few weeks or no stitches at all. If your stitches need to be removed, schedule an appointment to have them taken out.

When to call your dentist or surgeon

Call your dentist or oral surgeon if you experience any of the following signs or symptoms, which could indicate an infection, nerve damage or other serious complication:

  • Swelling that worsens after two or three days
  • Fever
  • Severe pain not relieved by prescribed pain medications
  • A bad taste in your mouth not removed with saltwater rinsing
  • Pus in or oozing from the socket
  • Blood in nasal discharge
  • Persistent numbness or loss of feeling

Results

You probably won't need a follow-up appointment after a wisdom tooth extraction if:

  • You don't need stitches removed
  • No complications arose during the procedure
  • You don't experience persistent problems, such as pain, swelling, numbness or bleeding — complications that might indicate infection, nerve damage or other problems

If complications develop, your dentist or oral surgeon will discuss appropriate treatment options with you.