Surgery, implants and dentures

An extraction becomes necessary when a tooth is too decayed or too fractured to be restored, when gum disease has destroyed its bony support, or when an infection will not resolve any other way. Some extractions are simple; others call for a minor surgical procedure, with the tooth sectioned and stitches placed.

Not every wisdom tooth needs to come out. Where they are well positioned, fully erupted and cleanable, monitoring them is a reasonable decision. Extraction is indicated instead when there are repeated infections of the gum covering them, decay that cannot be reached for cleaning, a cyst, or when the buried tooth is damaging the molar next to it. The X-ray settles the question.

After the procedure. Bite on the gauze for the following hour. Avoid rinsing, spitting, smoking and drinking through a straw for the first 24 hours: those dislodge the clot and cause dry socket, an intense pain that typically arrives on the third day. Apply cold, eat soft food, and call us if the pain increases rather than settles.

These treatments are provided by a general dentist. In Quebec, the title of specialist is reserved for dentists recognised by the Ordre des dentistes du Québec.

An implant is a small titanium screw placed in the jawbone, replacing the root of the missing tooth. The bone gradually attaches to it — osseointegration, which usually takes three to six months. An abutment is then fixed to it, and a crown on top.

The advantage over a bridge is that the neighbouring teeth are left untouched, and the bone is stimulated rather than left to resorb. In exchange, it is a treatment spread over several months that requires sufficient bone volume: a graft is sometimes needed first.

Certain factors affect healing and need to be discussed openly: smoking, poorly controlled diabetes, teeth grinding, and the condition of the gums. An implant cannot decay, but the tissue around it can become inflamed and detach if it is poorly maintained.

A complete denture replaces all the teeth in an arch and rests on the gum. A partial denture replaces a few teeth and is held by the ones that remain. An implant-supported denture anchors onto two or more implants: it barely moves while eating and speaking, which changes daily life considerably for anyone who has worn a conventional denture.

Allow for a period of adjustment. In the first days, speech and chewing take effort, and sore spots almost always appear: these are corrected with simple adjustments. Do not try to endure them, and do not file the denture yourself.

Over the years the bone beneath a denture resorbs and the fit changes. A reline restores it. A denture that floats is not merely uncomfortable: it injures the gum and accelerates bone loss.