Many patients feels discomfort and even a little fear when the anesthesia remains for hours after extraction or root canal. Normally the numbness will remain for 2-4 hours in lower teeth and 1-2 hours in upper teeth. Some times the tingling may remains a little longer if the case needs more than one injection.

general speaking if the numbness remained for more than 6-8 hours you should call your your dentist although in the vast majority of cases it will heal shortly. If the tingling remained more than 12 hours you should see your dentist immediately specially if the extraction is on the lower jaw.

Some times during lower wisdom surgical extraction the nerve may get pressed a little which may cause temporary nerve injury or even complete nerve cutting in rare cases which can be the cause of prolonged tingling.  But generally this type of complication is not common in any extraction except the lower wisdom surgical extraction and still very rare even with wisdom extraction.

In these cases you should see your dentist immediately to treat the case before the temporary damage becomes permanent.

Denture adhesives refer to a category of commercial products that used to increase the retention and stability of  different types of complete dentures. Denture adhesives are usually introduced in the form of powder, glow or adhesive  tapes.

Denture stability  is the first requirement needed to gain the patient satisfaction, No one wants to wear a denture that is not fixed in place or even fall during speaking or eating, It can be really embarrassing and can lead to denture phobia.

Dentures don’t need adhesives  if the patient has enough ridge height and healthy salivation . But sometimes the patient spend much time eating on he toothless ridge which may cause ridge bone  loss. Also there are many other causes  that can prevent  denture stability, In these cases may be you will need the assistance of denture adhesives.

Denture adhesives types and forms :

Denture adhesive  is a bio-compatible glow that used to keep the denture in place during function. There are many types and forms available today like powder, paste and tape.

So what is the best type for you??

Lets say that we can not favor one of the previous forms for every case,  it depends on the case. Some people like the paste form as it gives a good retention while the others hate it because the excess paste is spilled in the mouth and need to be cleaned. Many patients like the powder form as the excess powder is not a  problem because it is very easy to be cleaned, But we have to mention that some patients find it “Not retentive enough”.

So you should try some of the available brands until you discover the one that can give you the best results,  sure consulting your dentist will shorten the road.

Do i need denture adhesives:

First we have to concentrate on a very important point “Adhesives are not the solution for ill fitted rocking denture “.  It is very important for you to know that adhesives should only be used with properly manufactured, good fitting  and non rocking dentures. If you have a new denture and it is not fitting, rocking or cause sores and ulcers then you should  see your dentist quickly to fix it. If you neglected the problem and tried to use adhesives the jaw bone will shrink  which will be very hard for the dentist to repair and sometimes you will need to make a new denture that can be worse than the first one.

What if you have an old denture that was retentive and stable then after 2-5 years  it becomes loose, falling or rock during speaking or eating. Unfortunately denture adhesives are not the solution here this old denture needs what we call “relining”. Relining is needed when the dimension of the jaw bone under the denture shrinks  as a response to the mastication force falling on it.  In this case you have to see your dentist to take a new impression  to add a thin layer compensating the lost bone.

So it is indicated to use adhesives only when you have a properly manufactured denture, that accurately fits your gum but has a bad retention due to insufficient height of ridge bone or insufficient salivation.

Some times the denture is  fixed in place but you just need more confidence that it will not fall during speaking or eating. This fear is common among new denture wearers so it is OK to use it but you have to concentrate more in training your self to stabilize the denture in place as the muscles coordination has a great role in denture fixation.

How to use denture adhesives:

1-First clean your denture with tooth brush or denture brush.

2- If you will use powder adhesive keep the fitting surface a little wet then shake the powder container lightly to spread the powder to the fitting surface then wear your denture. Don’t eat for the next 15-30 min.

In case of paste adhesive apply a separate pea sized pieces  from the tube to the fitting surface and keep the adhesive away from the denture base periphery not  to expel the excess in your mouth. Then put the denture in place. Using too much adhesive won’t be useful and will be hard to clean .

With the tape adhesive you will just adheres the tape to the denture base and put it in your mouth after customizing it and cutting the excess.

Generally use the least amount of the adhesive first then gradually increase the amount every day till you reach the best sufficient amount needed to stabilize your denture.

Some adhesives may cause some kind of allergy that is usually presented as gum burning or redness,  in that case stop using it and call your dentist to prescribe you a different brand .

There are many denture adhesive brands  in the market. Cushion grip, Equate Firm grip, Super poli grip, Fixodent, Sea bond and Ends lip. The selection is yours you can use any of them according to your preference. The prices range from 3$ to 25&.

The human body is one unit so you have to help your dentist to record carefully a full medical history for you. Liver problems are of the medical conditions that needs special care in dental clinic. liver diseases has many types but the most common are liver fibrosis as a result of viral infection or parasitic infection (belharizeases in some countries).

Dentist usually give extra care to liver patients because Liver is responsible of producing most of the factors that are essential for blood clotting. So viral hepatitis or any other distructive liver diseases can impair the normal coagulation mechanism and the patient of the uncontrolled liver disease tend to bleed more after surgery or tooth extraction. There is also an crossinfection risk if viral hepatitis(The most common liver problem) is present.

bleeding tendency: The diagnosis should be confirmed by a physician and the severity of liver affection should be taken into consideration by arranging for a coagulation screen tests  before any surgical treatment like extraction. Patients may need vitamin K or freshfrozen plasma to gain enough coagulation and, therefore, should be managed in hospital and the dentist also will concentrate on local methods of reducing post extraction bleeding like stitching or mesh supported dressing.

Drugs & medications: Drugs prescription is really dilemma as liver is responsible for the breakage and excretion of many toxic chemical materials including many drugs. Also there is some drugs that considered liver toxic and can really hurt the liver in compromised patients. so many drugs should be used with caution or avoided completely in severe liver disease. Paracetamol, NSAIDs, sedatives that usually prescribed after extraction or surgery  are the most common. Any drug prescribing should include reference to a drug formulary.  As some drugs even with normal dose can be txic to liver patient because he fails to break and excrete the drug so it accumulate in the body.  It is difficult to estimate the impairment of drug metabolism even with liver function tests so adjusting the doses of drugs can be very hard even for the experienced physician .

Cross viral infection:The most common form of liver disease is the A,B and C viral hepatitis caused by HAV, HBV AND HCV  so the routine precautions for infection control is essential which  means that all patients who needs extraction or any other oral surgery treatment, whether known high risk or not, should be managed in the same strict way to eliminate the risk of transmission of infectious agents like viruses and bacteria.

Many patients suffering from impacted wisdom molars. Molar wisdoms are the last molars in each arch side if you didn’t extracted any molars wisdom should be after the LAST  two permanent molars. Many patients ask if the wisdoms or 3rd molars are erupted in their mouth and i will give you a simple way to know, If you can count three large molars in the end of jaw side then it is erupted if you only find two large molars then it is not erupted. I use the word large molars to distinguish between the small premolars that is located just after the canines and the larger molars that present near the end of the jaw .

So why wisdoms get impacted?

There is many theories explaining this phenomena but it will be overkill to go deep here so we will keep the explanation simple a possible. The wisdoms impacted simply because there is no jaw enough space for them to erupt . This space problem is explained in many ways some authors say that the western soft cooked food is not grinding the teeth from its sides, this grinding was enough to offer space for the wisdoms. Others saying that if the jaw size is small (inherited from one parent ) and the teeth sizes are large (inherited from the other parent  ) this may cause this problem. Any way it just happened

Impaction can be full when the molar is completely under jaw gums or partially  impacted if a small part of it is out in the mouth. The symptoms vary according to the impaction type.

Symptoms of impacted 3rd molars or wisdoms:

Lets say that most of people won’t have any problems with their wisdoms they just erupt in place with no problems and even you won’t notice it. Sometimes the 3rd molars are impacted and not erupted and also not causing any problems and may still silent for years.

some times impacted wisdoms start to make troubles and symptoms this problems includes

1- Pain : pain that is related to the end of the jaw or even sometimes not localized and may extend to the whole face side. The pain type change according to the the case, presence of infection and impaction type .

2-gums swelling, tenderness and redness :

Some times especially in partial impaction  Gums around the area become swollen , red ,tender and hot as a result of infection. Some times in partially impaction a small gum piece (flap) remain over the molar crown and the opposing molar if present bite on this flap causing severe pain on chewing and more inflammation.

3-Face swelling:

some times the inflammation spread and cause swelling in the side of impacted wisdom even the swelling may extend to the eyes which become almost closed(don’t panic we see this every day, but you should see your dentist in the moment) .

4-Food impaction or wedging:

Some times especially in partial impaction when the wisdom is erupt in a anterior angulation food may become impacted between impacted 3rd & second molar which may cause severe pain and gum pocket.

5-fever :

in some severe cases of infection the body temperature may raise as a reaction to infection.

6-bad breath and bad taste :

impacted food, pus formation and some anaerobic bacterial products can cause a salty bad taste and also the breath smell may change.

7-sometimes pus or blood oozing from gums.

8-Inability to open the mouth widely:

Muscles that is responsible of mouth opining lies close to the end of the jaw so any infection in this area can cause muscle stiffness.

9-lymph node tenderness and pain with swallowing food:

the lymph nodes under the lower jaw react to infection and become enlarged and tender which may cause pain with swallowing.

after all once you feel any of the previous symptoms you should visit your dentist quickly to start the treatment early because if you delay the infection may become very annoying and dangerous. till you go to your dentist you may take over the counter pain killers to decrease pain also peroxide mouth wash may help in removal of impacted food  and killing anaerobic bacteria that cause the infection.

Before you take the decision you fist have to know what will happen after you extract this tooth:

1-Less chewing capability:

when you extract a tooth (especially molars)  your mastication force is affected badly because you are not only losing the tooth you extracted only but the opposing tooth in the other jaw become nonfunctional because it is biting on air so it can’t chew. also when you chew food the food must fall under pressure to be chewed. The tongue from inside, the check from outside and the upper and lower teeth above and below when you extract a tooth food escape to the empty space.

2- Appearance or Aesthetics:

when you get your tooth pulled and especially if the tooth is in your smile area it gives a really bad looking smile even the teeth after the canines will be apparent from the side profile.

Also extraction of posterior molars will affect you face symmetry and make you look older ??now you are asking  why doc.

Teeth act as a support for your lip and check if you removed one or more molars the check and lip will be depressed which can give a aging look. Also as long as the teeth in place it stabilize the face bone in place once you extract many teeth the face bone may start to shrink which also give a older look.

3-Phonetics or speaking  affected, You even can have a lisp:

Tooth pulling can really affect your phonetics especially if the removed tooth is on the anterior part of the jaws  and it is very challenging to you dentist to restore the normal phonetics even with a good false tooth.

4-Tooth gaps may formed in the extraction side of the jaw:

sometimes the teeth in the same side  rotate or slide in the empty space which may cause teeth gaps which can be very annoying as food get impacted inside it and sometimes cause gingival problems and even caries.

5- the opposing tooth in the other jaw may need to be extracted also:

when a tooth is extracted the opposing tooth in the other jaw start to over erupt or going out from the gums which may cause looseness and sensitivity to clod the looseness may increase with the time till the tooth need removal.

6- Stop pulling save your money :

This may look wear as extraction is usually cheaper than filling and root canal but this is the true PULLING COAST MORE MONEY. I can say that we “the dentists” are rich because of people who like extraction. Once you start to eat after tooth removal you will start to think in making false teeth to fill the space you just will feel bad and start to look for a treatment for the empty space. You go to your dentist and ask him to solve your problem. You will just find that all the options available are really really expensive (implant, bridges or even removable denture)

after all just stop the nonsense and keep your teeth where it should be and don’t start to think about pulling unless your dentist say that there is no other solution if root canal or simple filling treatment can be done in your case do it don’t hesitate.

Taking care of your  extraction socket wound after tooth extraction is very important for extraction socket healing and also to restore normal oral functions quickly.

Instructions for the first day after tooth extraction:

The most important thing in the first day is to keep the blood clot in place inside the socket  till the clot become fixed and mature. The blood clot that is formed inside the socket is very important to prevent bleeding and to start the healing process.

First thing you have to keep light pressure on the gauze pad  the   that the dentist has  put over the wound and keep it in place by light biting on it  for about an hour if the bleeding continue put another sterile pad for extra 30 min.

Don’t touch the  wound with tongue or finger not to dislodge the clot or infect the wound.

Avoid hot food and beverages because hot food will cause more bleeding from the  wound  .

Avoid eating on the side of extraction for the first day.

Avoid rinsing your mouth or using mouth wash  forcibly not to remove the displace blood clot from the socket  and to reduce bleeding.

It is normal to have some  swelling on the extraction site, To reduce the swelling use ice bag on the extraction site for  30min on and 30min off .

It is normal to have some pain after tooth pulling you can use analgesics to relief the pain after the extraction as your dentist discripe.

Smoking is forbidden in the first day after extraction because the suckling and the hot smoke can increase bleeding and retard healing.

any type of suckling that can cause negative pressure inside the mouth can lead to more bleeding.

Instructions after the first day of tooth extraction:

After the first 24 hours from the extraction the blood clot that is formed inside the  socket become mature and fixed to the socket wall and the healing process start  so the main concern after the first day is to keep the wound over the extraction  clean and prevent the possibility of infection espicially that the extraction socket wound  is exposed in the mouth to the oral bacteria and food and can’t be isloated.

From the second day after extraction you should brush your teeth allover the mouth even the teeth on the extraction side but eithout over force.

Use salted water or any mouth wash  to rinse your mouth to clean the food depris that may cause  infection of the  socket wound and repeat this process 4 – 5 timed daily to keep the extraction wound clean.

I prefer that the patient avoid eating on the same side of the extraction for 3-4 days to give the extraction  socket  a chance to heal without food impaction inside the wound.

When to call your dentist :

It is normal to have little blood oozing for the first 6-12 hours even a little more will be normal but if you have a severe bleeding that continue more than 2 hours you should call your dentist.

If you have swelling on the side of extraction that last more than 48 hours you should call your dentist.

If you have fever, or any other symptoms of infection like redness lymph node enlargement then you should contact your dentist.

If you felt that the  socket is empty with a bony white  wall or greenish walls  then contact your dentist.

If you felt that you have any drug reaction or sensitivity you should contact your dentist.

It is normal to have some pain in the first or even second day that respond well to analgesics  , also the tenderness will remain for about 4-7 days but if the pain is severe or remain more than expected call your dentist.

If you felt that you have persistent tingling in your face skin that remain more than 6-7 hours you should contact your dentist .

last thing if you extracted an upper tooth behind the canine and  you feel that the fluids you drink is getting out from your nose  you should contact your dentist.