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No one really looks forward to a wisdom tooth extraction, even a straightforward one. Fortunately, you can be confident that your oral and maxillofacial surgeon has the experience and the skill to make your extraction experience as safe and comfortable as possible.

But what happens when your situation is not quite so straightforward? Dr. Theodotou and our team have the experience and the skill to diagnose and treat these more complex extractions as well.

One of the potential complications with an impacted wisdom tooth is its close proximity to the Inferior Alveolar Nerve (IAN) of the jaw.  When the roots of the impacted tooth are fully developed, they can rest very close to, put pressure on, or, in rare cases, even wrap around this nerve.

Why is this a problem? Because these nerves supply feeling to the lower lip, gums, chin, and teeth. If a nerve is damaged during extraction, a patient might be left with pain or numbness in these areas, which can affect sensation, speech, and eating. While this nerve damage is usually temporary, in rare cases it can be permanent.

But an impacted tooth, left alone, can also have serious consequences—pain, infection, and damage to neighboring teeth and bone. So what’s the answer in this complicated case?

Talk to Dr. Theodotou. We have the training and skill to detect any potential nerve involvement when you need a wisdom tooth extraction, and we have a procedure to help prevent damage to the nerve if it lies too close to the roots. The coronectomy is a specialized surgery used only to treat impacted teeth when the nerves of the lower jaw might be compromised.

What is a coronectomy, exactly? The tooth can be thought of in two distinct segments—the crown, which is the part of the tooth that rises above the gum when the tooth erupts, and the roots below, which anchor each tooth in the jaw. A “coronectomy” means the removal (“ectomy”) of the crown (“corona”) of the tooth.

In this procedure, we will divide the tooth into two parts. After making a small incision to expose the tooth, the crown will be removed, and the root section left in the jaw. When the procedure is completed, the incision in the gums will be closed with sutures. Recovery is much like recovery for any other tooth extraction.

Once the coronectomy is completed, you might be asking, “What happens to those roots that were left behind?” Another good question!

• Very rarely, the roots become infected or cause irritation to surrounding tissue and will need to be removed.
• Occasionally, root fragments can start to emerge through the gums, just as a whole tooth would. But since they must move away from the nerve in order to erupt, they can be extracted without endangering the nerve.
• The most common result? The remaining root segment becomes permanently encased by bone tissue within the jawbone, never to cause problems again.

Are there times when, even though a wisdom tooth is bordering on a nerve, this procedure might not be advisable? Yes. Infection and decay in the tooth, tooth mobility, periodontal disease near the tooth, a horizontal tooth (where sectioning the tooth could damage the nerve), and other conditions might mean that a coronectomy is not possible. In that case, Dr. Theodotou can discuss further options with you.

No one really looks forward to wisdom tooth extraction. Fortunately, even in complicated situations, your oral and maxillofacial surgeon has the experience and the skill to provide the answers you need for an extraction experience that is as safe and comfortable as possible.

Any more questions? Contact our Pooler office to see if a coronectomy is the answer for you.

We often have patients who ask, “Can drinking alcohol affect my oral health?” There are, in fact, a few reasons why that martini may not be good for your pearly whites.

In addition to creating an overly acidic environment in your mouth, alcohol severely dehydrates oral tissues because of its desiccant and diuretic properties. Because alcohol saps oral tissues of their moisture so readily, saliva glands can't keep enough saliva in the mouth to prevent dry mouth. In addition, saliva contains antibacterial properties that inhibits growth of anaerobic bacteria, a destructive type of oral bacterial responsible for tooth decay, gingivitis, chronic bad breath, and periodontitis.

What are anaerobic bacteria?

When there is a lack of saliva flow in the mouth and the mouth cannot naturally cleanse itself of oral debris (food particles, dead skin cell, mucous), conditions develop that promote activity of anaerobic bacteria, or bacteria that thrive in dry, airless places. These anaerobes also flourish when an unending supply of proteins (food debris) are available to consume, creating rapidly multiplying layers of plaque that stick to teeth and demineralizes tooth enamel unless removed by brushing and professional dental cleanings.

Oral Cancer and Alcohol

Acetaldehyde is a chemical compound leftover after the liver has metabolized alcohol. Capable of causing genetic mutations, acetaldehyde is also a known carcinogen that contributes to the ill feelings of hangovers. Although most metabolism of alcohol is done in the liver, evidence shows that metabolism also occurs outside the liver and that enzymes in the mouth could encourage accumulation of acetaldehyde in oral tissues.

When combined with poor oral health, smoking, and other detrimental lifestyle factors, alcohol may be considered a primary contributory factor in the development of oral cancer.

Even if you don't drink or drink only occasionally, remaining aware of symptoms that may indicate oral cancer will improve your chances of recovering successfully when you start treatment in the early stages of oral cancer. Signs include red or while speckled patches in the mouth, unexplained bleeding, lumps/swellings, chronic ear or throat pain, and areas of numbness in the mouth or on the face.

If you have any questions about alcohol and its connection to oral health, don’t hesitate to ask Dr. Theodotou at your next visit to our Pooler office.

Although using mouthwash is certainly not the equal of brushing and flossing, it does have benefits for your dental hygiene. If you use mouthwash regularly, you should find out which type is best suited for your needs. Here are some things to think about the next time you’re at the store.

The first item to weigh is why you want to use mouthwash. If the reason involves a high risk for cavities, you should focus on a mouthwash that contains fluoride. Make sure to double-check the label, because some mouthwashes do not necessarily include fluoride.

If you’re looking for a mouthwash to fight gingivitis, select an oral rinse with antibacterial properties. Make sure to read labels and avoid picking one that contains alcohol. Antibacterial mouthwash would also be best for a patient who has periodontal disease.

Another option is prescription mouthwash. These should be discussed with Dr. Theodotou and/or your pharmacist in order to avoid negative side effects. Pay close attention to the directions regarding how much to use and for how long. Keep in mind that some brands may lose their effectiveness if you use them on an ongoing basis.

For children, you can find a mouthwash that changes the color of plaque on their teeth. This is a fun way to help them understand how well they are brushing, and what areas they need to focus on. It can even be a tool for adults who have trouble reaching certain areas of their mouth.

While mouthwash is generally considered as a safe means to improve your oral health, you need to keep certain things in mind. Avoid using any mouthwash that has alcohol in it. If you are using a strong one, it can reduce your sense of taste over time. Be wary of a mouthwash that claims it can loosen plaque; this is not accurate and can mislead consumers.

We hope these simple suggestions will help you the next time you’re at the store. Make sure you pick the right mouthwash to keep that healthy smile! Feel free to contact Dr. Theodotou at our Pooler with any questions you may have.

In a perfect world, we would all jump out of bed ready to greet the day with a big smile and a toothbrush close at hand to clean our teeth immediately. But if you can’t even find your toothbrush before you’ve had your first cup of coffee, does it really make a difference if you brush and floss after breakfast? Perhaps! Let’s talk biology.

Normal saliva production during the day benefits our teeth and mouths in surprising ways. Saliva washes away food particles to keep our teeth cleaner. It contains cells which combat bacteria and infection. It even provides proteins and minerals to help protect our teeth from decay. But saliva production slows dramatically as we sleep, and the amount of bacteria in our mouths increases. While one of the nasty—and obvious—side effects of bacterial growth is morning breath, there is an invisible effect, which is more harmful. Bacteria in plaque convert sugar and carbohydrates into acids which attack our gums and enamel and can lead to both gingivitis and cavities.

• If You Brush Before Breakfast

Brushing and flossing first thing in the morning removes the plaque that has built up during the night and takes care of many of the bacteria who are ready to enjoy the sugar and carbs in that breakfast with you. If you brush before eating breakfast, rinse your mouth with water after your meal, floss if needed, and you are good to go.

• If You Choose to Brush After Breakfast

But if you decide that doughnut simply can’t wait, you should ideally postpone brushing for 20-30 minutes after your meal. Of course, these are minutes in which bacteria can make use of those new sugars and carbohydrates. So why shouldn’t you brush immediately after eating? Many foods and beverages, especially acidic ones such as grapefruit and orange juice, can weaken the surface of your teeth. If you rinse with water after eating and wait at least 20-30 minutes before brushing, your enamel will be “remineralized” (another benefit of saliva) and ready for cleaning.

No matter if you take a “seize the day” approach and brush first thing in the morning, or a “seize the doughnut” approach and brush soon after eating, the important word here is “brushing.” Dr. Theodotou and our Pooler team are happy to make suggestions as to the best morning routine for you. One thing is certain: if you give your teeth and gums two minutes of careful brushing and flossing in the morning, you can’t help but start your day off right!