When a tooth needs to be removed, it should be done correctly in order to prevent ischemic Osteonecrosis (cavitation). This is an area of dead jaw bone that can cause systemic harm throughout our bodies and impede healing. At Dr. Jay Family Dental we use a biological protocol for extractions.
This protocol includes
Local anesthesia: In our office we have local anesthetics with and without epinephrine. We use it according to the case and patient’s needs. We can discuss the best option before the procedure.
Luxation is done with luxators to keep the walls of the bone intact as much as possible.
Odontosection: Odontosection means cutting the tooth into smaller parts. Sometimes it is mandatory for easier extraction with less trauma. We use burs and laser to accomplish this.
Alveoplasty : Sometimes bone needs to be removed to make the extraction easier. This is be done with piezosurgery and laser.
Extraction of the tooth is done with luxators, elevators and forceps depending on the case.
Socket cleaning: A good cleaning is done with curetes , piezosurgery and laser in order to be sure that the granulation tissue and the periodontal ligament is out.
Disinfection of the socket is done with ozonated water and gas. We use the sweeps mode on our laser to additionally clean and disinfect. The laser helps promote healing and bone formation.
Platelet-rich fibrin (PRF): Dr. Jay Family Dental has an in house PRF centrifuge. Our office will draw your own blood and place it in a our centrifuge where it is spun. The process separates out portions of the blood into platelets which are used to stop bleeding, white blood cells which fight infection and growth factors which promote healing. These cells of our own blood so biocompatibility is guaranteed. After the socket is clean, the PFR is placed into the socket mixed with a biocompatible bone graft for socket preservation. This process promotes faster healing and increased blood flow to the area.
Clot Formation with laser: We use our laser to promote clot formation so bleeding will stop before the patient leaves the office.
Suture: We have absorbable and non-absorbable sutures which will be chosen at the time of the appointment based on the case. If the non-absorbable is used, the patient will need to come back to the office a week later for removal.
Post-instructions: verbal and written instructions are given to each patient. Results are much better when patients follow post op instructions.
Prescription: Antibiotics, analgesics, rinses, etc would be prescribed according to patient’s needs.
Benefits Of Prf, Laser And Ozone Treatment In Tooth Extraction Sites
- Faster bone healing
- Less pain after tooth extractions
- Decreased swelling during healing
- Decreased chance of dry socket and bone infection
- Increased early blood supply to tooth extraction socket
The most common post-extraction complications are pain, discomfort, swelling and development of dry socket. Dry socket develops when the blood clot dislodges from the tooth extraction socket soon after extraction of the tooth. Clot displacement is associated with lysis of fibrin and delayed wound healing. The Laser and PRF with ozone reduces the chance of dry socket and can decrease discomfort and promote healing
Some Scientific Literature On Prf
Influence of Leukocyte- and Platelet-Rich Fibrin (L-PRF) in the Healing of Simple Postextraction Sockets: A Split-Mouth Study
Clinical effects of platelet-rich fibrin (PRF) following surgical extraction of lower third molar
Efficacy of platelet rich fibrin in the reduction of the pain and swelling after impacted third molar surgery: Randomized multicenter split-mouth clinical trial
Role of Platelet rich fibrin in wound healing: A critical review
Post Extraction Instructions
The following guidelines will help you ensure the quickest healing time after an extraction. Don’t hesitate to contact us with any questions or concerns at the office
The gauze on which you are biting should be changed when you feel it very wet. We will give you extra sterile gauze. Get a cup with ice and let melt in your mouth, this will help with vasoconstriction, stopping bleeding. Remove and discard the gauze, repeating as many times as needed until the oozing stops. It is not unusual to ooze slightly up to 48 hours. Place an old towel over your pillowcase to prevent stains. If the bleeding continues you can use a dry tea bag and bite on it. This has tannin acid and that will help with vasoconstriction so consequently the bleeding will stop. If the bleeding continues please let us know to help you at the office.
Minimize swelling with ice and elevation. As soon as you arrive home and are settled comfortably, apply ice packs to the outside of your cheek over the extraction area and keep them in place for 10 minutes and then rest 10 minutes and repeat the cycle ( 10 minutes on and 10 minutes off of your cheek) for the initial 24 hours after surgery. Having those intervals of 10 minutes would prevent burning your skin. Ice cubes in a baggie or a dish towel or gel packs from any pharmacy will work fine. It is also helpful to elevate the head slightly higher than the heart. We will give you an ice bag at the time of the extraction to place on your cheek from the time you leave the office.
Rest as much as you can. Resting is therapeutic, and this helps your energy to focus on healing the extraction site. To minimize further bleeding, do not become excited or overexerted, sit upright, and avoid exercise. Do not disturb the wound. After the blood clot forms, it is important not to dislodge the clot as it aids healing.
Resume eating and drinking with caution. Once the gauze packs have been removed it is fine to eat and drink. The food should be very soft, requiring very little chewing (avocado, yogurt, pudding, scrambled eggs, etc.) and beverages should not be carbonated or hot (water is best). Do not eat or drink anything extremely hot until the numbness is completely gone so as not to burn your lip or tongue. Don’t bite your lip while is numbed, you can get a wound without noticing it.
Do not rinse, spit, smoke or drink through a straw for the first week!! This is to help avoid dislodging the blood clots that form in the extraction site/s. If the blood clot is dislodged a painful dry socket can occur.
Do not blow your nose for 4 weeks if your extraction was in the upper arch. This will allow a better healing.
Pain medication. If you are able, take ibuprofen 400-600 mg every 4-6 hours for the first 48-72 hours during the time you are awake. Please be sure not to exceed 3200 mg per day. This will help control pain and swelling. If ibuprofen is not adequate for pain control, Acetaminophen 500 mg could be taken with the ibuprofen( both tablets at the same time) please be sure not to exceed 4000 mg of acetaminophen per day. If after trying these two medications together the pain is still present please inform Dr. Jay and she can prescribe a stronger medication or an alternative one, it depends on your needs.
Saline rinses After the first 72 hours, you may begin baking soda rinses 3 or 4 times a day for 7-10 days (1/2 tsp. of baking soda in 4 oz. glass of lukewarm water). Do it very gentle, don’t swish vigorously and don’t spit, let the water run instead. This will help keep the surgery areas clean and aid in healing since it alkalinizes the PH of your mouth. Brush the rest of your teeth normally, avoiding the areas that are tender.
Antibiotics If you had an infection, you may have been prescribed an antibiotic. Be sure to take the prescribed antibiotics as directed to help prevent further spread of the infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction and notify our office or Dr. Jay directly. Otherwise, please finish your entire course of antibiotics. Antibiotics can sometimes cause an upset stomach. If this is the case, it is advisable to take acidophilus or probiotic tablets along with your antibiotic. Women taking oral contraceptives: antibiotics that you have received for your surgery may make your oral contraceptive less effective. You should use an alternate form of birth control until your normal menstrual cycle.
Wearing your Prosthesis Partial dentures or flippers should be worn only in social settings until you are fully healed. When at home, remove your prosthesis to allow the healing extraction site a chance to breathe.
Stitches(sutures) and membrane Your stitches may be the dissolving type. Do not be alarmed if they come out on their own after 3 days and /or begin dissolving out on their own 7-10 days following surgery. If you do not have dissolving stitches, you will need to return to the office 7-10 days after surgery to have them removed.
If a membrane is placed, you will be informed and should comeback in 3-4 weeks to remove it with the stitches.
Our Patient Testimonials
Dr. Jay is very thorough, a very wonderful person and easy to talk to. I would recommend her to anyone. She takes time to make sure everything is perfect before you walk out the door.
Mary M
Dr. Jay is very thorough, a very wonderful person and easy to talk to. I would recommend her to anyone. She takes time to make sure everything is perfect before you walk out the door.
Mary M
Dr. Jay is very thorough, a very wonderful person and easy to talk to. I would recommend her to anyone. She takes time to make sure everything is perfect before you walk out the door.
