Multiple teeth extractions

WHY IS IT NECESSARY TO EXTRACT TEETH?

In cases of excessive dental decay, fractured tooth, or a major periodontal problem with loss of the bone surrounding the teeth, there is no alternative to extracting certain teeth.

Your dentist and your stomatologist will discuss about the teeth to be extracted, and a prosthesis will be made:

• EITHER before the surgery, it's called an immediate prosthetic, which will be put in by the surgeon immediately after the dental extractions. The advantage is that you won't look toothless. The disadvantage is that after a few weeks or months, the prosthesis can become uncomfortable and the dentist will have to readjust its inner side (rebase).
• OR after the surgery, in this case it's called a "delayed prosthesis". Its advantage is its good stability over time, but it may also require a "rebase". The disadvantage is that one waits 2 to 3 months after the extractions before putting in the prosthesis. One then remains toothless during this time.

HOW MUCH DOES IT COST?

Resin prostheses are partly reimbursed in Belgium, from the age of 50.

Simple dental extractions are reimbursed until the age of 18 and after 55-year-old.

An extraction is surgical when it's complex and the clinician has to trephine the surrounding bone to extract the tooth or the root. This type of extractions is not reimbursed by the insurance.

In any case, you must be perfectly aware of the teeth to be extracted. After the surgeon and the dentist will have discussed your case, they will explain the cost of the procedure (prosthesis for the dentist and dental extractions for the surgeon).

You must also agree on the estimate that will be prepared and sign it prior to the surgery, otherwise it will be canceled.

TESTS PRIOR TO SURGERY:

The surgical procedure is performed under local or general anesthesia and is generally an out-of-hospital procedure, at the hospital as a day-patient or in a private practice (you get in and out of the hospital the same day). It can, when it is more complex, require you to stay overnight.

If you wish to have a private room, please inform the anesthesiologist and the surgeon as soon as possible and complete the administrative formalities specific to hospitals for private rooms (those rooms must be booked in advance).

In case of general anesthesia: blood test and an appointment with the anesthesiologist are necessary.

In case of local anesthesia: prophylactic antibiotherapy is necessary (1 to 2 antibiotic tablets 2 hours before surgery as advised by your surgeon).

THE ACTUAL SURGERY:

After performing a local anesthesia and having checked that everything is numbed and that you don't feel anything, the surgeon makes an incision in the gum, takes off the mucosa and extracts the excessively decayed teeth. The alveoli are curetted and cleaned. Banked bone can be added if you wish to have dental implants in the future.

 Depending on the need, the surgeon will have to trephine the perimeter of a tooth in order to extract it more easily (the devitalized teeth often break and require a surgical extraction). Once the teeth are extracted, he stitches with absorbable suture (which will disappear within 3 weeks). All the surgery is painless. The surgeon will check the wound about 3 weeks after the surgery, depending on the surgical procedure.

POSTOPERATIVE RECOVERIES AND INSTRUCTIONS:

Directly after the surgery, you can feel that your lip, chin or tongue are swollen and numb. This is simply due to the effects of local anesthesia, which usually wears off within hours.

You will need to put ice on the cheeks (cold pack) to reduce the swelling. The swelling of the cheeks appears gradually and reaches its maximum 48 hours after the surgery. The swelling varies from a patient to another: some swell more than others. In some cases, a hematoma may occur. All this is of course temporary.

A minor bleeding may occur in the operated areas, but it stops quickly.

A temporary mouth opening limitation can also occur, but it is temporary. Physiotherapy sessions will be exceptionally prescribed if necessary.

Postoperative instructions:

• Do not smoke (smoking slows down the healing processes and increases the risks of postoperative infections)
• In case of immediate prosthesis, do not remove it during the following 48 hours, otherwise it will be very difficult for you to put it back because of the swelling. After 48 hours, you can remove it, rinse it, and reposition it with COREGA if necessary.
• Brush your teeth from the following night, after each meal, with a soft-bristled toothbrush. Good postoperative oral hygiene is essential and a guarantee of healing.
• Soft, lukewarm or cold food for 2 days after surgery (creams, soups, pasta...)
• Apply cold ice on the cheeks for 2 days after surgery, then progressively return to a normal diet, 3 days after surgery.
• In case of bleeding, bite on a gauze or on a tea bag (better), for 30 minutes: the tea has hemostatic properties. Do not spit, it stimulates salivation and increases stress and therefore bleeding.

Postoperative medication:

Carefully follow the prescription and dosage.

OPERATIVE RISKS AND COMPLICATIONS:

Any surgical procedure, even performed in the best conditions of competence and safety in accordance with the current scientific data and the regulation in force, carries risks of complication. Although very rare, the complications of the teeth extractions are:

Hemorrhagic complication:

Very rare during the surgical procedure, it can exceptionally require a transfusion of blood or blood derivatives.

Infectious complication:

It's also very rare (1 case out of 60 on average), it occurs more often during the month following the surgery. It can be an abscess in the cheek that sometimes requires surgical drain and another antibiotic therapy (it's very important not to smoke postoperatively and to brush your teeth to reduce this infectious risk!).

Nervous complication:

A partial or total loss of sensitivity (hypoesthesia or anesthesia) of the lower lip, chin, and lower incisors on the right or left side may occur. This is due to the lower dental nerve, which is responsible of the sensitivity of the lower lip and incisors, and which can be very close to the dental roots. These disorders generally disappear within a few weeks, or more rarely, a few months after surgery. A permanent loss of sensitivity is extremely rare.

Rarely, an elongation of the lingual nerve which goes along the inner side of the mandible may occur and cause a loss of sensitivity of half the tongue. Disorders disappear within a few weeks to a few months. A permanent anesthesia is exceptional. The mobility of the tongue is never affected.

Dental complications:

Very rarely, the crown or root of an adjacent tooth can be damaged during surgery and require treatment by devitalization. Exceptionally, the tip of a root can be left in place, without any consequence.

Rarely, the extraction of a higher tooth can cause a communication between the sinus and the mouth, it is called oroantral communication (OAC). This will be carefully closed by your surgeon. You will be told not to blow your nose for 3 weeks and to use nasal drops for 10 days.

Joint complications:

The occurrence or aggravation of a pre-existing dysfunction in the jaw joint (TMJ) may occur. For example, a crack and/or pain in the TMJ, or a mouth opening limitation can rarely occur. They are also usually temporary and will be treated by your surgeon, who's familiar with this kind of conditions.

In all cases, your surgeon operates and provides immediate postoperative follow-up, but also short, medium and long-term follow-up. He is trained to operate but also to manage all the possible and rare complications of surgery.

Follow every one of his postoperative advices, and know that if you have a question or face any problem, your surgeon will help you and knows how to perfectly handle the situation.

Upon admission to the hospital, the following documents will be required:

• ID card,
• Supplemental insurance documents, if you have one,
• Signed informed consent,
• Admission documents specific to the institution.