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Pain after Root Canal? Perhaps an Apicoectomy Is the Answer

Happily, a root canal is usually all that you need to treat an infection in your inner tooth. But when inflammation or infection returns at the tip of the root, or in the bone surrounding the tip, your dentist may recommend that you see an oral and maxillofacial surgeon like Dr. Jenny A. Kanganis for further diagnosis and treatment.

And often when pain, inflammation, or infection recur after a root canal, we may suggest an apicoectomy—a procedure that can save your natural tooth and prevent further infection or damage to the neighboring bone and teeth.

The tip of a root is also called its “apex.” An apicoectomy means the surgical removal (“ectomy”) of the apex (“apico”) of a tooth’s root.

Often local anesthesia is all that is needed. (But if you have concerns, talk to us about your anesthesia and sedation options. We are expert in all forms of anesthesia.)

After the area is numb, an incision is made in the gum tissue to allow access to the root and any affected bone tissue.

Dr. Jenny A. Kanganis will carefully remove the tip of the root and any damaged or infected tissue from the bone surrounding it. The root end will then be cleaned and sealed.

Stitches or sutures will be used to close the incision, which will either dissolve on their own or which will be removed on a follow-up visit. We will let you know just how to take care of the site after surgery.

In general, any pain or sensitivity after the procedure can be treated with over-the-counter anti-inflammatory pain relief such as ibuprofen. Patients should follow post-op instructions carefully to reduce any swelling, and be sure to follow any dietary suggestions and restrictions.

An oral and maxillofacial surgeon has the training and skill to perform this specialized procedure. After dental school, oral surgeons pursue four to six years of additional advanced medical studies at a residency-based hospital.

They train with medical residents in the fields of anesthesiology, general surgery, internal medicine, and other surgical areas, concentrating on the bone, skin, and muscle of the face and jaw. They are uniquely qualified to diagnose and treat oral conditions that require a surgical solution, and routinely perform procedures such as apicoectomies.

Happily, a root canal is usually all that you need to treat an infection in your inner tooth. But if you have recurring or new pain or infection after a root canal, and if you want to preserve your natural tooth, an apicoectomy at our Bronxville office is an option well worth investigating.

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Does the placement of implants hurt?

If you’re scheduled to get a dental implant, it’s only natural to have questions about it. The pain involved is usually on the mind of most patients. Of course, some discomfort is possible, as with any major dental procedure. Having a well-defined plan ahead of time, which is carried out by Dr. Jenny A. Kanganis, reduces the risk of complications or side effects post-surgery.

During the procedure you won’t feel a thing, since it is performed under general or local anesthesia that totally numbs your mouth. It’s more likely that you will feel some pain or discomfort after the anesthesia has worn off.

There are usually three things that will affect the length and intensity of any discomfort:

The pain experienced from an untreated case will usually far outweigh that experienced from a dental implant. Good oral hygiene after your surgery is important to avoid infection. Salt water rinses are generally recommended 24 hours after your surgery. Brush your teeth gently around the implant.

It’s also a good idea not to eat any food that is too hot, cold, or hard. Soft or pureed foods will help you to avoid chewing for the first few days after surgery and will help your mouth to heal faster. You’ll typically be prescribed pain medication, but some patients find that ibuprofen or acetaminophen work well enough. Just remember, the most severe discomfort is usually experienced within the six hours after your anesthesia wears off.

Getting a dental implant is a big decision, and we want to make sure you get through it easily. Our Bronxville team is here to help if you have any questions about the procedure or post-surgery care.

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How to Keep Your Mouth Clean and Healthy After a Tooth Extraction

You’ve chosen Dr. Jenny A. Kanganis for your extraction because oral surgeons are experts in this surgical procedure. When an extraction is necessary, whether because of impaction, injury, or infection, for orthodontic purposes, or for any other reason, we have the skill and experience to ensure that patients have the best possible surgical outcome.

And you want the best possible outcome for your recovery as well. What are some basic steps you can follow at home to speed the healing process? Here are the ABC’s of aftercare to help make your post-extraction recovery a speedy and healthy one.

Antibiotics aren’t generally necessary after oral surgery, but, if they are prescribed to prevent infection, be sure to take them as directed. Always finish the entire prescription to ensure that the antibiotics work properly. And, if you have any allergies to medications, always tell us in advance.

Don’t brush or floss in the area of your surgical site until you get our approval. You don’t want to damage delicate tissue or sutures. Be sure to brush and floss the rest of your teeth normally, because you want your mouth its cleanest while you heal, but no swishing or spitting! After the extraction, a clot will form to protect the socket, and you’ll need to be careful to avoid dislodging it. Otherwise, a painful condition called “dry socket” can result.

The directions we will give you for cleaning the extraction site will depend on your specific surgery, but gentle rinsing is usually the recommended way to keep the area clean after oral surgery.

After 24-48 hours, depending on our instructions, you might be asked to use a salt water solution or a prescription rinse to gently cleanse the extraction area. Just remember, the “no forceful swishing or spitting” rule still applies! Rinse after eating and snacking to keep the extraction area clean and free from food particles. A good general rule is to avoid over-the-counter mouthwash for now, because the alcohol it contains can be irritating.

Even with careful attention, sometimes the wound site can become infected. If you notice any signs of infection, including severe pain, redness, prolonged swelling, pus or other discharge around the extraction, or fever or chills, call our Bronxville office immediately. Other symptoms such as nausea, heart pain, or shortness of breath should also be reported at once.

Eating a nutritious diet after oral surgery can help speed wound healing. Foods rich in proteins, vitamins A and C, and Zinc have been found to assist healing, while alcohol and smoking have the opposite effect.

And while you’re eating for health, eat for comfort, too. The traditional diet choices after an extraction are still the best. Soft, creamy foods such as yogurt, applesauce, pudding, or soft-serve ice cream are gentle on your healing tissue. Drink plenty of fluids in the days after surgery, including clear broth and non-acidic and non-carbonated beverages.

Temporarily eliminate foods from your diet that are grainy, seedy, or crunchy to keep particles out of the extraction site. Avoid sticky and chewy foods, which can dislodge the clot. And while you’re at it, take acidic and spicy foods off the menu—they can irritate sensitive tissue.

Be sure that you protect the clot that protects your socket. Foods that are too hot can interfere with clot formation over the wound, and any use of a straw or other suction can dislodge the clot completely. Use a spoon for your milkshake, and, of course, don’t smoke.

While all of the above suggestions are good generally guidelines, we will have information that has been specifically tailored to your needs. Which leads us to the most important recommendation of all . . .

You will receive detailed instructions after surgery. Following this advice to the letter is the very best way to make sure your mouth is its cleanest and healthiest.

Taking care of yourself after an extraction isn’t quite as easy as ABC (DEF), but with guidance from Dr. Jenny A. Kanganis, careful attention to the extraction site, and patience as you allow the healing process to take place, you have all the basics you need for a healthy recovery.

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Bone Grafting for Dental Implants

If you have lost a tooth or teeth, dental implants can restore your smile. Implants look natural, don’t impact the healthy teeth around them, and protect the underlying bone from the bone loss that can be caused by a missing tooth.

One important prerequisite for a successful implant: the bone in the jaw that will hold the implant must be healthy, and must be the appropriate size and strength to allow osseointegration (the fusion of the implant with the jawbone) to take place. If the bone isn’t wide enough, high enough, or dense enough, the success of the implant will be in jeopardy.

An implant, unlike a denture or a bridge, is rooted in the jaw much like your tooth. A cylinder is implanted in the bone, and will later hold the abutment which attaches to the final crown. Because a great deal of pressure is placed on our teeth with everyday functions such as chewing, the bone must be strong enough to successfully fuse with the implant.

Fortunately, Dr. Jenny A. Kanganis can actually restore the density and shape of your jawbone if the bone isn’t suitable for an implant. This reconstruction is accomplished with bone grafting.

Why Would You Need a Bone Graft?

The bone structure which supports our teeth can be compromised in a number of ways. We might recommend a bone graft if you have insufficient bone due to causes such as:

The bone tissue which supports our teeth needs the stimulation of biting and chewing to stay healthy. Without that stimulation, the bone area under the missing tooth gradually shrinks. The bone tissue is resorbed into the body, which, in a relatively short amount of time, can lead to a noticeable sunken spot where the tooth used to be. Bone grafting will rebuild this area—and a dental implant will provide the tissue stimulation that a natural tooth would, helping to prevent future bone loss in the jaw.

As gum disease progresses, the gums pull away from the teeth, leaving the bone and connective tissue exposed to infection and bacteria. Infection and the body’s own response to bacteria can cause deterioration in the bone structure supporting the teeth. Bone loss cannot be reversed, but a graft can replace lost bone and allow healthy tissue to regenerate.

In the case of bone structure that is naturally less thick or dense, or bone which has been damaged by accident or injury, a bone graft can provide a solid basis for an implant.

What Takes Place in a Bone Grafting Procedure?

Bone grafting is a type of oral surgery. Bone tissue for grafting may be taken from your own body, or a graft material composed of safe and sterile donor tissue or synthetic substitutes can be used. This second kind of graft will be absorbed gradually by the body as your own new, healthy bone tissue replaces it.

If you decide a bone graft is your best option, we will discuss the options for grafting with you during your appointment at our Bronxville office, and use imaging to map out the area of bone loss and to create the best individual treatment plan for you.

After anesthesia, an incision will be made in the gum tissue to reveal the damaged bone. Grafting material will be shaped and secured to the affected area, and sutures are generally used to close the incision. We will give you careful instructions for after care and follow-up visits. The time it takes for you to heal completely will depend on the type and size of the graft.

We recommend bone graft surgery when it will provide the best, most successful foundation for your dental implant procedure. Oral surgeons have years of medical and surgical training in the complex relationship and interaction of bone, muscle, and nerve. We are uniquely qualified to provide a skillful, safe, and effective bone grafting procedure.

When you choose an implant, one of your primary goals is the aesthetic restoration of your smile. Just as important, you are also making sure that the bones supporting your teeth will remain heathy and strong. Talk to us about bone grafting, and how we can start you on your way to a lifetime of beautiful smiles.

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