Surgery

SurgeryExtractions
Most surgery that we carry out is for the extraction of teeth.

Fortunately, this is gradually becoming much less common, as we are now keeping our teeth for longer and have successful techniques to save even badly damaged teeth.

All extractions performed in practice are done under local anaesthetic. In the rare event that a general anaesthetic is deemed appropriate, a referral to hospital would be required.

Drugs

As always, a comprehensive medical history is required before any surgery is carried out.
Of particular importance are the following two drugs:

Warfarin

In fairly common use, used to thin the blood.
Patients taking this drug will have a booklet recording their INR scores, which they should also show us.
Patients taking warfarin who need an extraction, should not stop taking the drug or alter their dose unless advised to do so.
It will be necessary to have a blood test as normal, within 24 hours of the extraction appointment.
As long as the INR is less than 4, the extraction may proceed as normal.

Bisphosphonates

These drugs are used for osteoporosis and have many different names. They are sometimes taken weekly and taken whilst sitting or standing. They are also given by injection. Their effects can persist even after stopping the drug.
In patients taking these drugs, there is a risk that extraction sites may have prolonged and difficult healing. In such cases, every effort is taken to avoid an extraction, but if it is inevitable, special measures may be necessary. Each case is assessed individually.

Other surgery

Crown lengthening

This may be appropriate if we want to even or level the visible gum in cosmetic cases, to improve the aesthetic outcome.
We may also choose this procedure to compliment the preparation of a tooth for a crown, where the damage to the tooth, is deep below the gum.
We may either trim some gum, usually with electro surgery, or additionally remove a small amount of bone below the gum line. This then allows us to accurately shape and record the necessary detail on the tooth, resulting in a better fitting crown, which is healthier and easier to maintain.