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Dental surgery

Dental Surgery is any number of medical procedures which involve artificially modifying the dentition. Some of the more common are:

• Endodontic (Surgery involving the pulp or root of the tooth)
  • Root canal
  • Pulpotomy - The opening of the pulp chamber of the tooth to allow an infection to drain; Usually a precursor to a root canal
  • Pulpectomy - The removal of the pulp from the pulp chamber to temoprarily relieve pain; Usually a precursor to a root canal.
  • Apiectomy - A root-end resection. Occasionally a root canal alone will not be enough to relieve pain and the end of the tooth, called the apex, will be removed by entering through the gingiva and surgically extracting the diseased material.
• Prosthodontic (Dental Prosthetics)
  • Crowns (Caps) - Artificial coverings of the tooth made from a variety of materials, including CMC/PMC (Ceramic/Porcelain Metal Composite), gold or a tin/aluminium mixture. The underlying tooth must be reshaped to accommodate these
  • Veneers - Artificial coverings similar to above, except that they only cover the forward (labial or buccal) surface of the tooth. Usually for aesthetic purposes only.
  • Bridges - A set of three or more fused crowns which bridge a missing tooth (teeth). Typically used after an extraction.
  • Implants - A procedure in which a base is set into the bone (Mandible or Maxilla), allowed to heal, and months later a artificial tooth is screwed into place.
  • Dentures (False Teeth) - A partial or complete set of dentition which either attach to neighboring teeth by use of metal or plastic grasps or to the gingival or palatial surface by use of adhesive.
  • Implant-Supported Prosthesis - A combonation of dentures and implants, bases are placed into the bone, allowed to heal, and metal appliances are fixed to the gingival surface, following which dentures are placed atop and fixed into place.
• Orthodontic Treatment
  • Implants and Implant-Supported Prosthesis - also an Orthodontic treatment as it involves bones
  • Apiectomy - Also an orthodontic treatment as part of the underlying bone structure must be removed.
  • Extraction - A procedure in which a diseased, redundant or problematic tooth is removed, either by pulling or cutting out. This procedure can be done under local or general anesthesia and is very common - many people have their Wisdom teeth removed before they become problematic.

Dental Anesthesia

Agents

Forms of dental anesthesia are similar to general medical anesthesia except for the use of Nitrous Oxide, relatively uncommon outside of the dental field in the U.S.

• Nitrous Oxide (N2O) AKA "Laughing Gas" binds to the hemoglobin in the lungs, where it travels to the brain, leaving a disassociated and euphoric feeling for most patients. N2O is typically used in conjunction with Procaine.
• Local anesthetics used are Lidocaine or Xylocaine (a modern replacement for Novocaine, Procaine), Septicaine (a numbing medication which can overpower infection, which can make it difficult to get numb), and Marcaine (a long-acting anesthetic). A combonation of these may be used depending on the situation. Also, most agents come in two forms: with and without epinephrine.
• Eugenol - Made from clove oil, this is a topical anesthetic also used in the common dental material ZOE (Zinc Oxide Eugenol).
• Topical anesthetics - Benzocaine, Eugenol, and forms of Xylocaine are used topically to numb various areas before injections or other minor procedures
• General anesthesia - Drugs such as Versed, Ketamine and Fentynyl are used to put the patient in a twilight sleep or render them completely unconscious and unaware of pain.

Blocks

• Electrical Nerve Blocks - A technology that involves using electrical current to block the reception or generation of pain signals.
• Branch Block - A common form of local dental anesthesia, blocks the reception of pain for one quadrant of the mouth at a time.Typically given in the buccal surface (cheek). (IAB, MNB are types of this block)
• Dental block - Given below the tooth in question. Used usually for minor procedures such as fillings.
• Palatial Block - Given into the hard palate, useful in numbing the upper teeth.
• Intraosseous - An injection of local anesthetic given directly into the osseous (bone) structure of the tooth.
• Intrapulpal - An injection of local anesthetic given directly into the pulp of the tooth to completely desensitize the tooth.
• An alternative to chemical or electrical blocks, acupuncture or acupressure is rarely used.

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