Dr Dawn Polasky Blog

What Is A Dry Socket?

After a tooth has been extracted, the socket is filled with a blood clot. Slowly, the clot shrinks and fills in. That is, a skin or a covering with tissue similar to the rest of the mouth (mucous membrane) begins to cover the clot and the tissue in the clot area is ingrown by bone cells and tissue cells. Eventually, the area shrinks and the socket is eliminated and replaced by firm tissue, and the depth of the socket fills with bone. The healed area usually is narrower than the site of the original tooth.

The pain following an extraction usually lasts no more than a day or two, at the most. If the clot breaks down or is washed away, the protective covering of the exposed bone is lost and the bone can be exposed to the mouth bacteria. This painful condition is known as dry socket. One of the features of its presence is that post-extraction pain persists longer than a couple of days and can be quite severe. Though the causes are not known with certainty, some factors seem to predispose individuals towards a dry socket:

1. Those people who have gingivitis or periodontal disease.

2. Those who have had lower or mandibular extractions, particularly on posterior (back) teeth such as molars and pre-molars.

3. Those who have teeth that are difficult to extract and necessitate bone removal.

4. Those that are particularly difficult to numb and so need several cartridges of local anesthetic. Some local anesthetics contain epinephrine, which is used in preventing rapid dissipation of the anesthetic by constricting the blood vessels at the site. This perhaps may prevent good clot formation. People who smoke also are predisposed towards dry socket. Again, this may be because of the constricting effect of nicotine and tar products on the blood vessels.

Rinsing the mouth within a few hours of extraction may flush the clot out of the socket. Using a straw may have a similar effect. That is why post-operative instructions urge the patient not to smoke, rinse or use a straw for at least a day. Unfortunately, there is no sure way of guaranteeing that a dry socket won’t occur, but there is some evidence that placing a small piece (quarter of a square inch) of gel foam (a clotting agent) covered with tetracycline powder (an antibiotic) in the socket after the extraction can reduce the chance of a dry socket. This will be absorbed over a few days and has not been shown to induce allergies or have any other effect on the patient.

Fortunately, dry socket is a relatively easy condition to treat. For more information, please do not hesitate to call us.

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Reduce Swelling And Pain

We may give you a plastic ice pack to apply to your face on the way home. A cold compress helps reduce swelling. Apply either a cold compress or a cold, moist cloth periodically. Switch to moist heat (a warm wash cloth) 24 hours after oral surgery.

Check with me regarding how often and how long to use a compress. I may prescribe medication to prevent infection and control pain. Carefully follow the instructions. If you experience severe pain, swelling, bleeding, fever, nausea or vomiting, contact us for advice and assistance.

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Proper Oral Care

Your mouth should be gently rinsed (not vigorously) with warm salt water the day after oral surgery. Add ½ teaspoon salt to one-cup warm water. Be sure to rinse after eating to keep food particles out of the extraction site. Brush your teeth twice daily with a soft-bristled toothbrush. Brushing your tongue is also advised to eliminate bad breath and the unpleasant taste that often accompanies oral surgery.

Floss at least once a day, too. Follow the instructions carefully after dental surgery. Contact us if one of the following occurs: Numbness doesn’t subside within a few hours, You experience Nausea or Vomiting Or if you have severe pain, bleedng, swelling or fever in the wisdom tooth extraction area.

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Protect The Blood Clot

A blood clot should form in the wisdom tooth extraction site; this needs to be protected for proper healing. Healing is a delicate process and requires the restriction of certain activities; otherwise the blood clot can be dislodged.

You should AVOID the following:

  • Sucking or blowing motions,
  • Smoking,
  • Drinking through a straw for 24 hours,
  • Rinsing your mouth vigorously,
  • Mouthwash (until your oral surgeon approves its use),
  • Cleaning teeth next to the extracted site for the rest of the day,
  • Strenuous exercise for 24 hours,
  • Hot liquids or
  • alcoholic beverages.
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Proper Care For Bleeding

To limit bleeding after oral surgery, the doctor may place a gauze pack on the wisdom tooth extraction site. This should be left in place for 30 to 45 minutes after leaving the office. Bite down on the gauze, but don’t “chew” on it. Bleeding might continue after the pack is removed.

If it does, we recommend you follow these instructions:

  • Form a thick pad from clean gauze;
  • Dampen it and place the pad directly on the wisdom tooth extraction site,
  • Apply some pressure by firmly biting on it for about 30 minutes,
  • Replace the pad with a clean one if it becomes soaked with blood,
  • If heavy bleeding continues, call your oral surgeon,
  • Avoid sucking on the wisdom tooth extraction site.
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Partially Visible Wisdom Teeth

Partially visible wisdom teeth in Hollywood are susceptible to bacteria that can cause wisdom tooth infection. Cysts and tumors can grow on a trapped wisdom tooth, causing irritation and some pain as well as diseases of the gums. Another problem we often see occurs when the second molar, the last tooth before the wisdom tooth, is damaged as the wisdom tooth grows in without enough room.

The younger the patient, the easier the healing will be, which is another reason not to wait before removing impacted wisdom teeth. This oral surgery is often performed in the office under anesthesia, providing patients with maximum comfort while keeping the procedure efficient and cost-effective.

Local anesthetic (such as novocaine) is always used, but you may opt for additional comfort with nitrous oxide (“laughing gas”), IV sedation (twilight sleep) or deep sedation (general anesthesia.)

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Veneers For Natural-Looking Teeth

When teeth require significant changes in their shape or contour, veneers may be the answer. By placing veneers, small or misshapen teeth can be built up to regain a more natural appearance, spaces between teeth can be closed by making the teeth wider and teeth that are too short can be lengthened. The veneer is actually a thin piece of porcelain similar in size to a fingernail.

Once it is “bonded” onto the tooth it becomes extremely strong. We also blend the veneer in with the remaining tooth structure so that it is unnoticeable to the naked-eye. Once in place, it looks, feels, and functions just like a regular tooth.

We can use porcelain veneers to change the shape and color of a single tooth or, if necessary, revamp an entire smile. Porcelain veneers can also be used to correct teeth that have been worn from clenching and grinding. Please feel welcome to call us if you have any more questions about Veneers.

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Wisdom Tooth Removal

We can provide guidance whether you’re a candidate for wisdom teeth removal (extraction). The bottom line is that wisdom teeth most often don’t fit well in our mouths and they can cause other teeth to move or lead to gum disease or bone problems. Ask us to make an evaluation and suggest the best course of action.

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Why are wisdom teeth removed?

Wisdom teeth usually appear in young adults between the ages of 15 and 25. Some wisdom teeth will grow in normally; others are “impacted.” An impacted wisdom tooth allows no room for the rest of your teeth to grow.

We use X-rays to evaluate whether your wisdom teeth have any chance of coming in properly and can advise you on the best time to have wisdom tooth removal. When there is no room for wisdom teeth to come in properly or when the teeth haven’t reached their permanent location by age 25, then they’re considered to be impacted wisdom teeth.

We recommend removing the tooth early, before wisdom tooth and other dental complications can develop.

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Veneers For Discolored Teeth

There are many situations that arise that lend themselves to treatment with veneers. One indication is for restoring teeth with discoloration that have been unaffected by the more conventional tooth whitening approaches, such as bleaching. Some examples of this are teeth that have severe tetracycline (an antibiotic) staining or discoloration from a previous injury to the tooth. Veneers are considerably more durable and stain-resistant than bonding.

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