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Who else needs to find a Dentist open on a Saturday?

Who Else Needs to Find a Dentist


 Open on a Saturday?
Hi, welcome to this weeks toothache of the week. As one of the few dentists in Limerick, who are open on a Saturday for emergency toothache appointments, we get to see lots of patients who have problems with their wisdom teeth.
One of the main indications for third molar wisdom tooth removal is tooth decay or dental caries. Many patients find it impossible to clean around partially erupted third molar wisdom teeth. Food debris and bacterial plaque build up in this “food trap” leading to an unpleasant taste and the patient can complain of bad breath. In this environment the plaque bacteria breakdown the sugars in the food debris allowing dental decay to develop in the third molar wisdom tooth or at the back of the second molar tooth. If this decay is left untreated it may proceed to expose the nerve or the pulp of the tooth and a dental abscess may develop!!!!
Well, this Saturday morning this nice man comes in to see me for an emergency toothache appointment. He had been suffering from a throbbing pain in his right mandibular (lower) third molar wisdom tooth. This throbbing pain had been keeping him awake for the past couple of nights and pain relief medication was no longer working. He was a visitor to Limerick and I wanted to get him out of trouble as fast as I could so he could enjoy the rest of his visit to county limerick
On intra-oral examination there was a very large cavity on the occlusal (biting surface) of his third molar wisdom tooth. It was slightly loose and tender to touch.
At this point we take a radiograph called a panoral OPG x-ray.
This x-ray showed that the lower third molar wisdom tooth was vertically impacted. It was very heavily decayed and the tooth pulp was exposed. At the end of the root there was a large dental abscess sitting right on the nerve that supplies sensation to the lip. This nerve is called the inferior alveolar nerve or the inferior dental nerve (ID nerve). NO wonder this poor man was in so much pain and he wanted relief ASAP.
Can you guess what treatment we would recommend in a case like this?
The patient himself recommended the treatment. He requested that I extract the tooth.
The Advantages of this Treatment Recommendation are:
The patient suggested it himself!!
1.            Lower mandibular impacted wisdom teeth extractions can be difficult surgical procedures, requiring a general anesthetic and hospital admission under an oral and maxillofacial surgeon.
In this case, the tooth was slightly loose from the dental abscess infection around it, there was good access to the tooth and from the panoral OPG x-ray the roots pattern looked favourable. Therefore a straight forward extraction was anticipated.
2.            If a lower mandibular wisdom tooth is removed while there is still infection present there is an increased risk of post-operative complications such as pain swelling and dry socket.
In this case by removing the tooth the dental abscess infection would be allowed to drain naturally.
3.            The nerve that supplies sensation to the lip (inferior alveolar nerve) and the nerve that supplies sensation to the tongue (lingual nerve) are in close proximity to mandibular lower third molar wisdom teeth. There is a risk of damaging these nerves when extracting mandibular lower third molar wisdom teeth, resulting in a numb lip and or tongue!!!!
In this case on the panoral OPG x-ray there was a good distance between the root tip and the inferior alveolar nerve.
Once the patient understood these, informed consent was given and we were ready to begin treatment.
A good dose of local anesthetic was given and the toothache pain quickly disappeared much to the patient’s relief. The tooth was a little loose because of the dental abscess so with some gentle elevation it was a straightforward extraction. Attached to the end of the root was the dental abscess.
Post-operative instructions were given to the patient. A prescription for stronger pain relief medicine and antibiotics was also given to the patient to be dispensed by the pharmacy. Also he had some dental insurance forms which we helped him to complete. We are always happy to complete these forms (PRSI, Medical Card, VHI, BUPA, Garda Medical Aid, ESB, etc, etc) for our patients.
As the patient was a visitor to Limerick, I advised him to see his regular dentist when he got home for a routine dental check-up appointment.



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