Dental surgery

When is dental surgery needed?

Surgical tooth extraction usually takes place when a tooth can no longer be saved and a simple extraction (tooth extraction without surgery) is not possible without major trauma to the surrounding tissue.

For teeth with severe decay affecting the root, a root canal treatment or apicoectomy is usually carried out first. If this does not achieve the desired result, and the tooth cannot be preserved, it must be removed.

Particularly when teeth are misaligned or severely tilted, they may need surgical removal. Wisdom teeth are particularly prone to this. Even wisdom teeth that are not yet visible can cause unpleasant shifts in the front teeth due to lack of space in the jawbone, making surgery necessary.

A complicated tooth fracture can also make a simple tooth extraction more difficult, and the risk of infection always has to be considered. Longitudinal tooth fractures often require surgical tooth removal. If a tooth extraction results in multiple fractures of the tooth and the damage to the surrounding gum and bone appears too extensive, the procedure will be switched to a surgical tooth removal to prevent further complications.

How does dental surgery work?

As the surgical extraction is a specialized procedure, you will be referred to an oral surgeon. Before the procedure, a detailed consultation takes place, where the patient's medical history is discussed. After examining the teeth, an X-ray of the patient's teeth is taken for better planning and a precise overview.

The operation itself takes place under local anesthesia. To avoid having to follow every step, you can be put under conscious sedation (analgosedation). For the removal of multiple teeth, general anesthesia may also be appropriate. Typically, a dental surgery is an outpatient procedure lasting about 0.5 to 2 hours.

After checking that the anaesthetic has worked, the first step is to cut open the mucous membrane in the area of the tooth that is being removed. After folding away the mucous membrane and exposing the tooth using special instruments, the oral surgeon can remove the tooth. To achieve better access to the tooth and tooth root, it is sometimes necessary to remove part of the bone. However, it is important to preserve as much of the bone as possible for any future tooth replacement.

After the tooth is removed, the sharp bone edges are smoothed with a drill, the bone cavity is cleaned, and filled with bone graft material. This aims to prevent microbial colonization and inflammation of the surgical area. This procedure is only possible if there is no active inflammation in the area.

The wound is closed either with a tamponade (filling the bone cavity with absorbent material), directly or with a strip insert. The latter allows the wound secretion to drain away and at the same time protects the wound from germs. In this context, antibiotics are mostly given. Depending on the secretion flow, this strip may need to be changed over the next few days. Once the strip has been removed, the wound can be closed permanently.

What should you do following dental surgery?

The wound site will swell up the first few hours following the surgery. This swelling should usually subside in 2-3 days, but can vary depending on the patient and the severity of the operation. Decongestants, cooling compresses and painkillers can be very helpful. You should never take over-the-counter painkillers without first consulting your doctor, as some painkillers can increase the tendency to bleed (aspirin).

If blood accumulates in the wound, (hematoma), specific ointments can be applied to the swelling to promote healing of the hematoma, since there is otherwise a risk of wound infection.

Avoid the following stimulants and activities after dental surgery:

• alcohol
• nicotine
• caffeine
• acidic drinks such as cola or fruit juices
• physical exertion
• heat from sauna or sunbathing

Keep the surgical site cool with cold compresses and drink plenty of cold drinks such as water or cooled chamomile tea.

Risks of dental surgery

Any surgery may have side effects, and this includes surgical tooth extraction. Bleeding, inflammation and nerve damage can occur. In particular, there is a nerve in the lower jaw that supplies the lower lip and part of the oral mucosa with sensitivity. If this nerve is damaged, numbness can occur in these areas. This can be temporary, but in rare cases it can also be permanent.

Surgical tooth extraction is usually the last option to relieve pain and contain the risk of spreading infection. When performed by an experienced oral surgeon, it provides a good foundation for the later placement of dental implants.

Which doctors are specialists for dental surgery in Germany, Switzerland and Austria? 

Dental surgeries are performed by specialists in oral and maxillofacial surgery or dentists with advanced training in oral surgery.