“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.
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.
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.
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!
I was recently selected to become a member of the Oregon Dental Association Leadership Academy. As a participant of this group, I am learning how to become a more effective leader at both the community and state level.
Here is my interview for the April 2018 Membership Matters, a publication for the Oregon Dental Association, about my involvement in the Academy.
1. What most excites you about being part of the inaugural ODA Leadership Academy?
I am so excited to have been selected for this inaugural class! We need more women in leadership roles and I am looking forward to learning how I can become a better leader so that I can mentor other women and lead my team better. My ODA Leadership Academy co-members are really interesting people with good ideas and I am looking forward to learning from them. They are also a lot of fun!
2. What do you think the true role of a leader is?
Strong leaders are service oriented, putting the needs of those they are serving above their own. A leader can have tremendous impact in the world through this type of humble service.
Leaders also need to have a vision for where they are leading their team. Leaders hold the map for their whole group, and the clearer the vision, the less distractions and detours on the journey. When the group hits adversity (which is inevitable), the leader’s vision will guide the team through it successfully.
Finally, and maybe most importantly, leaders need to have integrity. Without integrity, leadership does not have lasting effects and can, in fact, be harmful.
3. Who has been a primary mentor/influential person in your life and what have you learned from him/her?
It is hard for me to pick one mentor because I have had such great mentors both on the surgical side as well as the public health/epidemiology side of my career.
I have had two mentors who really helped me in my career as an oral and maxillofacial surgeon.
My first mentor was Dr. James V. Johnson, Chief of Oral and Maxillofacial Surgery, Ben Taub General Hospital at the University of Texas School of Dentistry in Houston. Ben Taub is one of the busiest trauma centers in the United States. Dr. Johnson’s belief in me and encouragement in my career really helped me to gain confidence as I progressed through my residency. He trusted me to operate the most complex cases and saw to it that I got to operate those cases. His faith in me gave me courage to persevere through adversity. I feel lucky to have trained with him.
My second surgical mentor was a cardiothoracic surgeon named Dr. Gene Guinn who I worked with while obtaining my general surgery training at the Veterans Administration Hospital in Houston. Dr. Guinn’s belief in my technical abilities as a surgeon and his encouragement in my surgical career have stayed with me all these years. I can still hear him saying to me in his Texan accent “Cut, don’t scratch!”
Both of these surgeons saw me as a surgeon first and a woman second. Their confidence in me, lack of misogyny and encouragement in my chosen career have provided me with the inner strength to keep going when times get hard. They also taught me the joy of surgery and helping others.
Finally, on the public health side, I received excellent mentoring from my doctoral advisor Professor Andy Olshan at the University of North Carolina, Chapel Hill School of Public Health. Dr. Olshan helped me develop as a scientist by improving my critical thinking skills. He taught me the importance of framing a scientific question. I learned from him that the answers that you are seeking are often found in how the question is asked. If you ask the wrong question, you are likely to get the wrong answer.
4. Would you rather be good and on time, or perfect and late?
Definitely good and on time. Perfection is seriously overrated and being late just makes everyone cranky!
5. What do you most appreciate about the profession of dentistry?
I believe that we have the absolute best profession in the world! Physician colleagues often tell me of how unhappy they are in their profession due to managed care and how much medicine has changed during the past thirty years. They feel that they don’t have a say over their practices or their patient’s needs. Many feel that they are being told how to practice by third parties and they really dislike it. The joy has gone out of their professional lives.
As oral health providers, we have an opportunity to shape where our profession is going in ways that medicine does not. There are still opportunities for us as a group to shape our future. For some of us, private practice is our calling. For others, the corporate model makes the most sense. But I believe it is in the choosing that we define our profession and protect it.
We are also extremely lucky in that we not only provide needed health services to members of our communities but also that we serve our communities by providing jobs, mentoring young people interested in the profession and giving philanthropically through participation in groups such as Medical Teams International and Mission of Mercy.
6. Any words of wisdom you’d like to share with your colleagues and/or the aspiring dentist?
Never give up on your dream! Work hard, tell the truth and put the needs of others above your own. Treat others as you wish to be treated and have fun! Learn from your mistakes and have compassion when others make mistakes. Take time each day to remember how blessed you are and you in turn will be blessed.
Clean drinking water is of primary importance for the health and prosperity of all communities. It is a precious resource which not only supports life but also leads to freedom for women, especially in developing nations.
My eyes were open to this fact while providing oral surgical care in Sub-Saharen Africa several years ago. I was shocked to learn that the countries that I was serving had an infant/child mortality rate of 30% due to diarrhea caused by drinking or bathing in contaminated water.
I learned that the task of finding potable water fell to women and children since it is uncompensated work. Women and their children must walk many miles to find water in these communities — sometimes up to eight hours a day. In addition, carrying containers of water back home weigh about 40 pounds on average.
Thus the quest for clean water is back-breaking drudgery. Women and children who must walk miles for their water don’t have time for attending school, playing games, reading or learning. This results in a cycle of poverty and disease for these communities which will have no end unless we take action.
As a female surgeon who is highly educated; who owns property; who has the right to vote and who has access to clean water every day, I urge you to come out this next weekend at the World Vision Walk for Water being held here in Lake Oswego. Come and walk with Geisler Oral and Maxillofacial Surgery. Let’s all end the long walk for water for these communities. Healthy women lead to healthier communities. Healthy children have a future. You can make a difference.
It seems everyone these days is calling themselves an expert at dental implant surgery.
Some dentists take a short course in order to learn how to place dental implants in a few months (or weeks) of training. Others learn how to place dental implants during a specialty training program yet do not have hospital based surgical training or hospital admitting privileges to take care of you if something goes wrong. Finally, there are surgeons who may have similar training experiences and qualifications but have not achieved an expert mastery level (which requires at least ten years of practice after completion of training).
How then do you determine exactly who is an expert dental implant surgeon when there are many differences in training and experience?
As a patient, you want a surgeon who not only places hundreds of implants a year but who also has many years of surgical experience with excellent outcomes. You want a surgeon who uses technology as tools to improve surgical outcomes but doesn’t rely exclusively on it in order to compensate for deficiencies in surgical technical skill or experience. You want a surgeon who works well with your dentist to optimize esthetic outcomes for the dental implant crown that attaches to the implant. You want a surgical team that is skilled and handles your type of case every day. You want a clear and precise understanding of the financial cost of your surgery. Finally, and perhaps most importantly, you want a surgeon and staff who will treat you with respect, kindness and compassion.
Not all surgeons are created equal. In an article published in the New York Times in 2013, investigators conducted a study by videotaping surgeons performing the same procedure. They found that a small group of surgeons had superior technical skills which made for better outcomes for their patients. These expert surgeons were gentle with tissues, had better hand-eye coordination and performed the procedures faster. The result was that the expert surgeon’s patients had less pain, infection and need for re-operation.
At GeislerOMS, we meet the criteria for expertise in dental implant reconstruction. Dr. Geisler is a board certified oral and maxillofacial surgeon who has over twenty-five years of surgical experience treatment planning and placing dental implants. She is known for her excellent technical skills and clinical judgement. Her complication rate for dental implant surgery is less than 1%.
Dr. Geisler is trained not only as a surgeon but also as a scientist. Using her scientific knowledge evaluating clinical evidence, she selected one implant system for use in her practice. This system has the best long-term outcomes for dental implants based on over fifty years of data and offers the most restorative options for dental implant crowns and dentures. This implant system serves as the model for all other dental implant systems.
Dr. Geisler has introduced new standards of care for the administration of antibiotics prior to dental implant placement based on her publication in the Journal of the American Dental Association in 2009. In addition, she reviews for the Journal of Oral and Maxillofacial Surgery in the Dental Implant section and has authored reviews on risk of failure of dental implants with early loading.
An excellent listener and communicator, Dr. Geisler and her staff will treat you as family and will work well with your dentist to optimize your outcome. We want you to have a beautiful smile and will work hard to make that happen.
Compassion in surgical care is a slogan that is thrown around a lot these days on the internet. What makes compassion in surgical care so important? And what is compassion, exactly? Is it even important for a surgeon and her staff to have this quality?
Other words for compassion include love, concern, sensitivity, kindness and tolerance. A surgeon who demonstrates compassion in surgical care imagines herself as a patient, with the fears and concerns that go along with being ill. It is stepping alongside a patient, acknowledging their concerns, and guiding them into an area of health and wellness through the correction of the illness.
Surgeons do not work on their own and so at it’s best, compassionate care in surgery involves a loving, professional staff that support the vision of the surgeon. Compassionate care also involves a state of the art surgical facility where the highest standards of care, including safety for patients, can be administrated. And, it includes 100% transparency related to the financial aspects of care so that financial stress is minimized.
At Geisler Oral and Maxillofacial Surgery, we strive to exhibit kindness, love, sensitivity and tolerance to all of our patients while maintaining excellence in surgical outcomes. As a female surgeon, loving kindness is what I strive for as well as technical surgical excellence. I treat others as I would wish to be treated as a patient and view my patients as family.
Compassion is the foundation for everything that we do at Geisler Oral and Maxillofacial Surgery.