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Stacy Geisler

What Makes A Dental Implant Successful?

 

My new patient looked at me expectantly. “My best friend, who is a dentist, told me to come to you for my dental implant. My dentist said that she would pick you to place her implant, so here I am!”

For my new patient, deciding who to have place her dental implant out of all the choices available in Portland, OR, was an easy choice for her since she had “insider” information. But if you don’t have access to where a doctor would personally go for the same procedure that you need, how do you decide who to have place your dental implant so that it is a success?

Outcomes for dental implants are heavily influenced by the skill and experience of the oral surgeon who places the implant and the dentist who places the dental abutment and implant crown. Implant dentistry is a team sport and requires strong surgical skills, an orientation towards details and experience.

A skilled surgeon will not only evaluate your health and habits, but will also use technology to assess bone and gum volume. The surgeon will also be instrumental in selecting the correct dental implant width and length and will guide the dentist in the proper abutment and crown for the implant. The dental implant, which is like the root of a tooth, will be placed at the proper depth and orientation to allow the dentist to attach a life-like implant crown. The surgeon and dentist need to work well together and have excellent communication skills to ensure the best outcome for the patient.

At Geisler OMS, we begin with a detailed overall health assessment for our patients seeking dental implant reconstruction.  Most patients are very healthy and will heal uneventfully after dental implant surgery. However, patients who have trouble with wound healing could have problems with the integration of the dental implant to the jaw bone. These patients may also be inclined to lose bone around the implant leading to a later failure. Identifying these concerns prior to surgery can change a potential dental implant failure to a success by addressing and treating health issues prior to surgery.

Dr. Geisler also makes an initial assessment for sleep disordered breathing or sleep apnea for her dental implant patients. Patients who have undiagnosed sleep apnea have increased risk of breaking their implants and/or losing bone volume around them due to tooth grinding (bruxism) and clenching. Referring indicated patients for a sleep medicine evaluation prior to dental implant reconstruction will often prevent the dental implant, abutment and implant crown from failing in the future.

Assessing oral hygiene habits is also important since patients with gum disease can lose bone with their dental implant — which can lead to failure of the dental implant and crown. Educating patients prior to dental implant placement on proper hygiene helps to ensure that the dental implant, abutment and crown all last.

The assessment of bone volume is very important for the correct placement of dental implants as well as assessing the gum tissue volume and thickness. Advanced technology exists that allows for 3D printing of surgical guides for dental implants. In some selected cases, at GeislerOMS, we are able to use 3D data for braces (Invisalign) to treatment plan the placement of future dental implants. And, 3D printing of the dental abutment and crown is an emerging technology that allows for esthetic outcomes and shorter treatment times. Working closely with the restoring doctor on digital data collection and treatment planning is extremely important.

Finally, perhaps the most important variable for a healthy dental implant, is the overall experience of the oral surgeon placing the implant. An experienced surgeon places hundreds of dental implants a year and is skilled in identifying potential sources of failure prior to surgery. She will have a broad experience with bone grafting as well as gum tissue reconstruction.  She will also have extensive knowledge of handling complications related to dental implant surgery and will have an evidence based practice using clinical trials to guide her dental implant surgical practices.

A skilled surgeon will set up your dental implant reconstruction for a successful outcome for the dentist placing the crown. The beauty of a dental implant abutment and crown will often depend on how well the surgery has been done. It is in the details that dental implants remain healthy and look great.

 

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The Amazing Platelet

 

Did you know that you have a special cell within your blood that has amazing regenerative ability? It’s called a platelet and it has the ability to promote bone and soft tissue healing in the body. Platelets have hundreds of growth factors which encourage the body to produce new tissue. In the mouth, the ability to growth bone and gum tissue is important, especially if reconstruction with dental implants is desired.

At GeislerOMS, platelets are concentrated from your whole blood by spinning a blood sample in a centrifuge. This process concentrates the platelets into something called Platelet Rich Plasma or PRP for short. PRP can then be applied in the mouth to areas where soft tissue and bone regeneration are needed.

Numerous medical studies have shown that PRP can increase healing of bone as well as soft tissue. It is being used to treat osteoarthritis in the hips and knees to good effect, has been demonstrated to increase hair regrowth in patients suffering from hair loss as well as stimulate collagen production in scarred skin. Athletes with injury to muscle groups often will have PRP injected into the site of injury to speed up healing.

In oral and maxillofacial surgery, PRP has shown great promise in the areas of bone regeneration such as sinus lifting in preparation for dental implant reconstruction, treatment of deep jaw bone infections caused by a class of drugs called bisphosphonates, and for patients with cleft lip and palate. We have also found that PRP decreases pain and also increases the rate of healing in our practice.

If you are considering dental implant reconstruction, ask us about PRP. It is truly a wonderful, natural adjunct to healing.

 

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It Takes A Team

Since 2007, I have been voted by Portland Monthly Magazine as a TopDentist in the speciality of Oral and Maxillofacial Surgery. The magazine sends out a survey to my peer group each year asking, “If you or your family member needed oral and maxillofacial surgery, who would you go to?”  Voting clinicians are asked to take into consideration years of experience, continuing education, manner with patients, use of new technologies and physical results. Once survey results are finalized, the nominated oral and maxillofacial surgeons are then checked to ensure that they are in good standing with the Oregon Board of Dentistry.

I am incredibly flattered to have been selected for the past twelve years by dentists, hygienists and physicians in Oregon as a provider of excellent surgical care in my field. Each year I am given a beautiful plaque to place in my office. But even though the award has my name on it, the recognition and credit for excellent care doesn’t entirely belong to me.

Recent publications have shown how surgeons who are more experienced have better outcomes, and my previous blog post discussed how several studies have demonstrated that female surgeons have better outcomes as compared to male surgeons. But, a new set of studies published by Forbes magazine this week have shown that if that surgeon begins working with a new team, patient outcomes often drop.

Teamwork determines the best care for surgical patients according to new studies and therefore drives surgical outcomes.

The researchers of this study looked at other teams and found similar results: no matter what type of team (graphic design, Navy SEALs, surgery), shared experience trumps individual experience and talent – and the longer a team is together, the higher they tend to perform. 

Studies have shown that it takes on average five years for a surgical team to reach peak performance. Peak performance in surgery means that patient safety is a top priority and the team works to ensure this. This critical support allows the surgeon to focus on what she does best–operate.

For a team to reach excellence, three things need to be present: belonging, bonding and believing.

Belonging is the state where every team member has a voice and feels free to express themselves. This work culture creates safe connections between team members and allows for every member to have a voice. This is particularly important in surgery as bonding helps to prevent errors such as wrong tooth extractions and errors in medication administration. To foster an environment of belonging, I ask my team to run our safe surgery checklist prior to each procedure for each patient. My surgical assistant and anesthesia assistant have the voice to notify and stop the team if they have a concern prior, during or after a surgery.

Bonding refers to creating an environment where vulnerability is allowed. Humility is fostered for all of the team members which allows the team to examine errors and discuss near misses in patient care. We bond at GeislerOMS each morning as we huddle to discuss each patient prior to the day beginning. We also hold monthly medical emergency drills which allow us to train together and make errors together in non-critical settings. The process of making errors in training allows for us to make improvements in patient care in order to keep patients safe. We also conduct our annual Advanced Cardiac and Pediatric Life Support certifications in our facility rather than in a classroom. We  invite our local first responders (Lake Oswego Police and Lake Oswego Fire) on site in order to make sure our facility is in top working order and to learn how we can best interact with them in the event of an emergency. New technologies, procedures and techniques are often incorporated into our routine from these round-robin training sessions.

Believing is the act of striving for something other than bettering one’s own situation. It involves identifying a shared purpose and focusing one’s energy on that shared goal. At GeislerOMS, we believe that we are here to serve patients with compassion, surgical excellence and integrity. We believe that each patient we treat is precious  and deserves all the best that we can provide for them. Our patients come first, period.

Any success that I have achieved as Oregon’s first female oral and maxillofacial surgeon, I proudly share with the members of my team who work with me both in the operating room and in my private practice in Lake Oswego. I am incredibly blessed to have PJ, KD, Aurora and Sarah to help me. They make my job a pure joy. And the next time you visit GeislerOMS, know that there is a competent, highly skilled team waiting to care for you.

 

 

 

 

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How Adversity Has Made Me A Better Surgeon

 

If you asked me what my favorite thing to do is, I would have to answer: “Operate!”

Maybe that sounds weird to you, but I truly love what I do. I feel incredibly blessed to get to remove disease that causes pain and suffering and put things right for my patients. It is deeply satisfying to help people heal.

I love taking something that is broken and making it beautiful with my hands.

This love of creating wholeness out of brokenness sustains me in my daily practice as an oral and maxillofacial surgeon. It pushes me through the difficult times–especially when I encounter obstacles in my practice.

Much has been written about the obstacles that women face as surgeons.

A recent article in the Wall Street Journal describes how referrals to all female surgeons in the same specialty dropped 54% after the death of patient cared for by a single female surgeon. The researchers were shocked to discover that referrals to all female surgeons in the same specialty dropped dramatically even if they did not have adverse outcomes. Male surgeons in the same study did not experience any drop in referrals when they experienced the death of a patient. The authors concluded “men appear to be treated as individuals while woman are not.”

As I thought about these results, I was saddened. Moving past the sadness, I began to think about what positive things can come out of this type of bias for a female surgeon. One possible result is that female surgeons have little margin for error in their clinical practice. This means in practical terms that if you are a female surgeon, you need to make fewer mistakes than a male surgeon. This can lead to better outcomes for patients.

A report published last year in the British Medical Journal found that female surgeons have lower death rates, less complications and fewer readmissions to the hospital a month after their procedure as compared to male surgeons. Another study published by the Harvard School of Public Health attributed the superior outcomes that female surgeons enjoy to the female surgeon’s ability to communicate with their patient and to engage the patient in order to ensure compliance with medications and postoperative instructions.

The challenges that I have faced in my career due to bias have produced a profound sense of gratitude for the patients I operate on each day and the physicians, dentists and others who entrust their patients and loved ones to me for care. Their trust and overwhelming support gives me courage. Each patient, family member and referral relationship is precious and not to be taken for granted.

I can say that out of the suffering that I have endured as a female surgeon emerges a great gift: a heart of compassion for others who suffer.

And my heart of compassion is what nourishes and drives me to be the best that I can be technically and emotionally for my patients, their families and the referring doctors that I serve.

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Our Golden Rule

 

It’s easy to imagine the discomfort of walking into a new healthcare provider’s office. You may have a referral. You may be walking in blindly, trusting you receive the proper care you think you need.

You’re afraid because you don’t know what to expect. You’re apprehensive because it’s an unfamiliar environment. Perhaps you have not been treated well at another office or have been caused physical or mental pain by past experiences. Maybe you are worried about the cost of your care.

These fears are compounded when you walk into an oral surgeon’s office.

All of this seems to be a logical product of human nature or past experiences, but it doesn’t have to be.

You can put aside your fears when entering Geisler OMS located in Lake Oswego and serving Lake Grove as well as Portland, Oregon.The guiding principle of the practice is caring for others like we’d like to be cared for: with compassion, surgical excellence and integrity. You can get the oral healthcare you need from a team that genuinely cares about you as an individual and wants to escort you to optimal health.

When you walk into the office of Dr. Stacy Geisler, a friendly, smiling team member greets you and asks what you need, whether or not you have an appointment. You will immediately be put at ease and discuss why you’re there and what you hope to achieve through your visit.

All steps of your care with Dr. Geisler are explained to you with as much, or as little, detail as you need to make informed healthcare choices. Consultation appointments average 45 minutes with Dr. Geisler while surgical appointments range from 30 to 60 minutes depending on the complexity of the case. Families are encouraged to attend these appointments to insure that all aspects of care are discussed and any questions parents may have are answered. Additional consultations are offered at no additional charge.

Decisions regarding oral and maxillofacial imaging and radiation exposure, medications such as narcotic use as well as choice of sedation (if desired) are explained to you with risks and benefits of your choice as well as cost. You are never required to choose an option that you are not comfortable with or don’t understand.

Surgical care is provided within our state of the art facility as well in an outpatient surgical center with a medical anesthesiologist. Dr. Geisler is also credentialed with both the Providence and Legacy healthcare systems so options for hospital based care are also available.

Whether searching for a surgeon to place a dental implant, perform complex corrective jaw surgery or perform impacted third molar extractions on your child, Geisler OMS will listen to your concerns and will address them honestly as well as professionally.  Our goal is to perform your care (or your loved one’s) to the highest standards available at reasonable cost.

We operate by the Golden Rule: care for others like we’d like to be cared for.

 

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My Greatest Reward


July 7th  began like any other day for me. I remember that there was a beautiful sunrise that morning. I had a compressed, busy schedule in my oral and maxillofacial surgery practice in Lake Oswego. “We have a trauma patient coming in, Doctor” my front staff informed me when I arrived at my office. We already had fifteen patients scheduled that morning for me to see, three of whom were surgery patients. How would I find the time to see this other patient?
My add on trauma patient turned out to be a wonderful woman named Sunny. From my first meeting with her, I could see why her friends had given her this affectionate nickname. Sunny has a type of effervescence which surrounds her. Joy bubbles out of her. You canʼt help feeling good just by being in her presence. At this first meeting, I was struck by her amazingly positive attitude. It was hard for her to speak clearly because part of her upper right jaw was missing. She kept holding up her hand to hide the right side of her face. Slowly she was able to tell me her story.
Sunny had been at an outdoor function with her soon to be husband on a Saturday afternoon. As she was walking along an unfamiliar path, her foot slipped and she went down. This happened so quickly that she was not able to break her fall, but landed on her right face against a curb. Stunned and bleeding profusely, she sat up. Part of her upper jaw was missing. Looking down, she saw what she thought were bits of bone and tooth on the ground.
Sunnyʼs partner took her immediately to the closest emergency room for care. They were hoping to have a diagnosis made and treatment. An exam was performed as well as imaging studies. Since this hospital was not part of Sunnyʼs health maintenance organization (HMO), she was told by the emergency room to contact the HMO for definitive care. When she called the HMO that evening, she was told that she would have to wait a week for an exam and treatment (she was told this is their policy to allow for swelling to resolve). When Sunny was finally able to see a surgeon at her HMO hospital, it was six days later. The surgeon told her that she had a dental injury and would need to follow up with her dentist. There wasnʼt anything he could do for her. She was sent home with a prescription for Amoxicillin.
Sunny called her dentist from the parking lot of the HMO in tears. She knew that something was seriously wrong with her and she was struggling to understand why she couldnʼt get the care she needed. Her dentistʼs receptionist asked her to come in to his office immediately. When the dentist saw Sunny, he knew that this was more than a dental injury. He could see that part of her upper jaw appeared to be missing, as well as teeth in the anterior maxilla. His office called my office, thus the “add-on” patient for an already busy morning.
Examination of Sunny demonstrated a severe, avulsive injury involving the right anterior maxilla. Computed tomography scanning performed at the emergency room six days previously demonstrated fractures extending through the frontal process of the right maxilla, including the anterior nasal spine and vomer. She had fractured teeth #7 and #8 which were displaced into the right maxillary hard palate and not visible in the oral cavity. Tooth #9 also was extruded and was in hyperocclusion with her mandibular dentition.
Sunnyʼs dentist had sent electronic records for me to review and I was able to review her CT scan. I was stunned by the severity of her injury. At this point in my career, I have seen many, many things. Not much surprises me any more when it comes to the maxillofacial skeleton. But I was not prepared for how bad this injury was given the mechanism of injury. What Sunny had was more similar to a gun shot wound without the accompanying soft tissue devastation seen with a high velocity injury.
I knew that Sunny needed surgery and that she needed it soon. I also knew that she needed to be asleep for what I was planning for her. Since she had eaten that morning, we scheduled her for surgery the next day. I explained to her the nature of her injuries, that the wound needed to be cleaned, the broken bones stabilized and the damaged teeth removed. I explained that she might need root canals on some of her other teeth, and that she might require more extensive reconstructive surgery to rebuild the missing part of her jaw. I told her that she would also probably require dental implants since her teeth were damaged beyond repair. I prescribed antibiotics and pain medication for her to begin immediately. Sunny agreed to everything that I suggested. One concern was her upcoming wedding. Could I have all the reconstruction done in time for her wedding which was scheduled for next December? I told Sunny that I would try my best.
Over the next year Sunny underwent several surgeries to rebuild her maxilla. We began with debridement and fixation of broken bones. As I suspected, the right anterior maxilla had been pulverized by her fall and her wound was quite dirty. I found pebbles and asphalt at that first surgery. I confirmed that Sunny would require a large bone graft to reconstruct her upper jaw if she ever had any hope of having a normal facial appearance. Hip grafting to the right maxilla was completed in February and three dental implants were placed in June.
Sunny handled all aspects of her year long reconstruction with grace and humor. She is a third grade teacher and saw an opportunity to use her injury to teach her class of eight year olds about anatomy and jaw reconstruction. She told me on one follow up visit, “I took out my prosthesis and showed my students how I was missing teeth, just like them. The kids loved it and had all kinds of questions about how my teeth would be put back. They couldnʼt believe that part of my hip would become my new jaw!”
It was an amazing privilege to provide surgical care for Sunny following her facial injury. I feel so grateful that things went well: healing progressed as expected and we achieved the outcomes we were hoping for. I canʼt claim sole responsibility for her healing. Sunnyʼs reconstruction was brought about by a dedicated group of professionals whose sole goal was to restore her to health.
Sunnyʼs health maintenance organization initially denied medical benefits for her reconstruction. Several letters were written from those involved in Sunnyʼs care and eventually she received the benefits needed to cover the cost of her reconstruction. Martha, my front office insurance expert, was instrumental in making this happen. I am grateful to Sunnyʼs dentist who recognized that she needed speciality care. I also feel lucky to have such a positive working relationship with Dr. Scott Dyer, who handled Sunnyʼs prosthodontic reconstruction.
Sunny recently stood before her friends and family as a bride and made a commitment to her partner just a few weeks ago. She told me via email “The wedding was spectacular and everything that we had both hoped for.” For a surgeon, there just isnʼt any higher reward than that.

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How to Minimize Pain after Oral Surgery


“How bad is it going to hurt?” At only sixty pounds, and with big blue eyes, my little patient looked at me asking me a fundamental question that I have been asked many times before. Jack was only seven years old but he knew what he was most frightened of about his upcoming surgery and had the courage to ask me about it.

Patient’s fears about pain following oral surgery are well founded. Removal of teeth, with the often necessary cutting of jaw bone, is one of the most painful surgical procedures that can be done to a human being. I think that almost everyone has heard a horror story regarding wisdom tooth removal. And we have all heard the expression “It was harder than pulling teeth.” No wonder everyone is so scared.

Oral surgery doesn’t have to be a horrible experience. It can, in fact, be a very good experience with the right set of circumstances. The first circumstance is that you need a highly skilled surgeon. The second circumstance is that you need to know a few things about how to take care of yourself after the procedure.

Surgeon selection is probably one of the most critical aspects of care that will determine if you have a good experience or a bad one. The “rougher” the surgeon, the more tissue damage at the surgical site created by that surgeon. Tissue damage leads to inflammation (swelling). Inflammation and pain share many of the same chemical pathways in the body. Thus, the more inflammation, the more pain following the surgery. Numerous studies have demonstrated that a more skilled surgeon’s patients will have better outcomes and will return to normal function more quickly. A gentle surgeon creates less tissue damage so her patients have less inflammation and thus less pain. So lesson number one is to pick a good surgeon.

Pain perception is dependent on a series of chemicals signaling within the body as well as reflexes. Minimizing post operative surgical pain requires minimizing inflammatory signaling within the body. At Geisler OMS, we utilize several techniques to achieve this. Non steroidal anti-inflammatory medications for patients who can tolerate them are prescribed. We also include acetaminophen in our protocol for pain management (again for patients who can tolerate the medication). We also recommend the use of topical anti-inflammatories such as Arnica. Cannabidiol (CBD) is a promising anti-inflammatory agent which can be used topically as well as systemically for the management of pain and swelling.  So lesson number two is to use the medications that your surgeon prescribes as recommended. Listen to what they have to say and follow their advice. They want you to have a great outcome.

Other simple tips for minimizing pain following oral surgery include the application of ice for the first twenty-four hours to minimize swelling. We recommend following icing with heat for twenty-four hours. Oral hygiene is also very important and will help in minimizing infection. Infection increases inflammation.

Finally, one of the simplest tips that I can share with you is to use moistened gauze when changing your oral pads following extraction(s). Using dry gauze can cause you to pull out a blood clot which will lead to dry socket, a very painful condition that is best avoided.

 

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What Firefighting Taught Me About Integrity


Before I was a surgeon, I was a firefighter. I learned many things from my first profession, including how to change the oil on a fire engine!  But one of the most important lessons that I still carry with me today and use daily as a surgeon concerns the relationship between personal integrity and patient safety.

I became a firefighter for the California Department of Forestry at the age of eighteen. My first profession was something of a necessity for me. I was an academically gifted student and did well in high school earning several scholarships to attend college. Unfortunately, there still wasn’t enough money to cover the costs of my education. Working for the California Department of Forestry during the summers seemed like a good option: I could earn sufficient money to pay for my education at the University of California, Davis and could serve the state of California through my work during the summer.

To earn my certification, I attended a fire academy where there was a strict schedule of physical training as well as classroom work. Each day recruits were dismissed if they failed any of that day’s tests and activities. A typical day for me would include three hours of lectures with written testing in the morning to be followed by a six mile run in full protective gear. After lunch, we would work in teams with the fire engines and hoses, learning how to connect and lay out firehose in order to fight a wild fire or a structure fire. We would finish our day by pulling 100 feet of charged (100 pounds psi) cotton double jacket 1 3/4  diameter inch hose by ourselves within a five minute time span. To say that the work was physically and emotionally exhausting is an understatement.

Some of my co-candidates looked for easier ways to pass the rigorous examination process since it was so difficult. Some tried cheating on exams by sharing answers. Others tried cheating on the physical tests by taking shortcuts on the long runs. In the end, all of the cheaters were caught. Our final examinations involved working in teams and this is where the shortcuts some had taken demonstrated itself for all to see. Those who had cheated on written exams did not know the names of the various types of connections required for laying firehose and could not hook up hose to fire hydrants or engines. Those who cheated by running shorter courses did not have the physical stamina to complete the required group testing and physically collapsed after twenty minutes or so.

I learned from these early experiences that integrity was critical to not only becoming a technically proficient firefighter but was also important for developing endurance and character. I learned that the lives of others depended not only on my actions but also on my character and attitude.

Integrity is paramount in surgical care. Patients and their families rely on me to provide a safe environment for them or their loved ones when they ask me to be their oral and maxillofacial surgeon. Safety includes not only technical excellence but also a culture of honesty within the practice as well as an attitude of service.

We prioritize a culture of safety at Geisler OMS. The practice emergency drills that I run in my facility allow for all members of my team to learn how to work together and communicate more effectively in an emergency.  Our drills with our emergency medical team in Lake Oswego allow for feedback when we invite them into our facility for inspections. Finally, the safe surgery checklists that I have developed and are run by my staff hold me accountable at surgery for the procedures that I am performing as well as the anesthetics I am administering.

I have learned from being both a firefighter and a surgeon that there are no shortcuts to excellence but tremendous joy in knowing that you have honestly and humbly served another.

 

 

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Do I Really Need My Wisdom Teeth Removed?


As a surgeon, I am commonly asked by my patients and their families “Do I really need to have my wisdom teeth removed?” Everyone is hoping that my answer will be “No, of course not! Who gave you that crazy idea?!”

If only it were so simple.

How I decide whether you need to have your wisdom teeth removed is dependent on several things that have to do mainly with: 1.)  the size of your jaws;  2.) whether you are having pain with the teeth and 3.) whether there is pathology associated with the teeth. This post is meant to help you understand what I am looking for when I am evaluating wisdom teeth and why I may make a recommendation for their removal.

Wisdom teeth are also known as third molars. Most patients have four third molars, one on each side of the upper and lower jaws. They are located behind the last tooth in your mouth.

The majority of problems associated with third molars arise from a lack of space in the jaw. Both the upper and lower jaws need to have enough length to accommodate the length of the third molar (which is on average about 12 mm long) in order for the tooth to be able to erupt into the mouth. Most people do not have enough room for this to happen.

Lack of sufficient length of the jaw will cause impaction of the developing third molar. Impacted teeth can cause many problems for patients including infection, bone loss around the second molar, decay in either the third or second molar and in the worst cases, loss of the second molar tooth. In certain circumstances, cysts can also arise from impacted teeth.

Teeth, like people, come in different sizes. Some people have smaller than average teeth with longer than average jaws. These folks probably won’t need to have their third molars removed. They have won the oral surgery jackpot! Other patients however have very large teeth with very small jaws. These patients tend to have the most severely impacted third molars and may need to have them removed at an earlier age than average. In general, I like to remove third molars when there is little root development as this minimizes risk of complications associated with surgery.

If you are having pain with your third molars, I will check to see if you are developing an infection. Infection is caused by bacteria that builds up around the third molar and the back surface of the second molar. Bacteria will build up if you can’t keep the area clean. It is almost impossible to perform adequate oral hygiene if the third molar doesn’t have space to erupt into the mouth properly. Infection can lead to bone loss that affects the back surface of the second molar which can lead to eventual loss of the tooth.

Sometimes, patients report that they are feeling pressure and they are worried that their teeth are shifting. Their bite is changing. If the third molar is close to the roots of your second molars, removal may be indicated in order to prevent damage to the roots of the second molars.

Finally, all third molars that have pathology, such as cysts, need to be removed. If I see cystic changes associated with a third molar, I am going to recommend it’s removal. Cysts associated with impacted teeth can cause bone loss and lead to jaw fracture.

Happily, not all third molars require removal. If the tooth is completely covered by bone, it will be protected from the bacteria of the mouth and will most likely not need to be removed.

 

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How To Keep Your Mouth Clean After Oral Surgery

Perhaps one of the most common questions we are asked at Geisler OMS is:

“How do I  take care care of my mouth after oral surgery?”

No one wants an infection or dry socket!

Here are a few tips from Dr. Geisler that should make your recovery smoother and less painful:

1. Make sure and bite on moistened gauze after surgery for at least 45 minutes at a time. If you use dry gauze, you may pull out your blood clot when you change the gauze pad. Don’t change the gauze too frequently during the first twenty-four hours. Changing the gauze too frequently can pull out a blood clot from the extraction socket. You want to have a stable blood clot in the extraction site which will help prevent a dry socket from forming.

2. Don’t perform oral hygiene for the first twenty-four hours. I know that this sounds gross but there is a reason! You want a stable blood clot to form in the socket and if you are using a syringe to irrigate (we will get to that later) or spitting, you may dislodge your blood clot. This can cause a dry socket.

3. At our practice, we give patients a syringe and medicated rinse to use for the first week after surgery. We want you to start using this the day after surgery to help keep the area clean and also to disinfect your surgical wounds. Salt water rinses are also helpful with wound healing and can be used three to four times a day to aid in healing. You can swish and spit with salt water.

4. It is good to brush your teeth following surgery. The fuzzy stuff that forms on your teeth are actually colonies of bacteria (gross!), so you want to remove them. Just don’t brush the surgical sites for the first week. You will use your syringe instead to irrigate the surgical sites to keep that area of the mouth clean.

5. Flossing is great! Keep doing this after surgery but you might want to avoid the back molars for a few days following surgery.

6. We give our patients a special healing gel that really helps speed up healing. Use this as we instruct and you will find that your sockets heal quickly.

7. Finally, and most importantly, let us know if you are having a hard time with your oral hygiene. We have lots of tips on how to best take care of yourself and we like coaching our patients so that they receive the best outcomes!

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