Surgical treatments

Sometimes surgical treatments are necessary to correct problems or achieve certain goals. Below are some examples:

Many people do not have enough space to properly accommodate the wisdom teeth. As a result, they are difficult to keep clean during or after eruption during adolescence. This can cause cavities not only in the wisdom teeth but also in adjacent molars! Another risk is inflamed gums around the wisdom teeth (and also the molars in front). This can be acute (abscess) or chronic. If you are also being treated for periodontitis at the same time (see dental hygienist tab), removal of wisdom teeth is regularly advised as well. We follow the existing guideline for wisdom teeth in deciding whether to keep or remove them. It is often recommended that an overview photograph be taken around age 17 to estimate the position and pattern of eruption. Following this, we provide a recommendation to wait for normal eruption or proceed to removal. So, it is common for us to remove asymptomatic wisdom teeth at a young age where future problems can be expected. In general, it can be said that the after-effects at a young age are much less than when having a wisdom tooth removed later in life.

At the end of the treatment, you will usually be given a prescription for painkillers and a flushing agent, gauze pads and a letter with instructions.

If, despite the efforts of the dental hygienist, you still have some residual pockets (areas of inflamed gums around tooth roots), a decision may be made to clean these areas after pushing the gums to one side. Lifting the gums and cleaning the roots is called flapping for short. This is done under local anaesthesia. After cleaning, the gums are reattached and a type of rubbery gum is placed around the tooth roots to promote healing and reduce post-operative sensitivity. This wound dressing is removed after one week. After treatment, the tooth roots may be partially exposed, which may temporarily cause increased temperature sensitivity. The ultimate goal of treatment is to completely cure the periodontitis.

A crown extension involves the removal of bone and gum tissue around the tooth root(s) in order to obtain relatively more tooth tissue to attach a future filling or crown. In other words: after a crown extension, more tooth tissue protrudes above the gums with which to continue working, so a reliable bond for a crown or filling is achieved.

Another reason for a crown extension is for aesthetic reasons. For example, if you show too much gum when you smile (so-called gummy smile). This may go hand in hand with tooth wear. In young people, we sometimes see that the eruption pattern is disturbed and the gums do not retract properly, making the teeth appear too short. During a consultation, it is possible to properly explain your specific situation and options.

In some patients, the canines in the upper jaw do not come through on their own. In a braces procedure, the dentist may then choose to place a bracket (clasp) on the impacted canine. After local anaesthesia, the gums are pushed aside and a clasp and wire are placed on the canine tooth. This wire is then attached to the existing braces. The gums are reattached. Over the following months, the orthodontist uses a wire to pull the canine tooth into the right place.

In some children, it becomes apparent during the braces process that the lip band between the front teeth is in the way: the front teeth do not meet despite the braces, or the orthodontist fears that the teeth will separate again if the braces are removed. The orthodontist determines the best time to remove the lip band. Under local anaesthesia, the lip band is removed and the gums are sutured.

Harmless bony swellings in the lower or upper jaw are called exostoses. In the mandible, they are usually located on the tongue side. In the maxilla, this is usually on the lip/cheek side. If these protuberances are very large, they can get in the way, especially in the lower jaw. They can also interfere with proper denture fitting in people with dentures. In these cases, the exostoses can be removed under local anaesthesia.

A mucocele or salivary gland cyst is a soft lump, usually in the cheek or on the lower lip, caused by blockage of a salivary gland. Mucoceles usually disappear on their own, but if they recur frequently, they may be removed.