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Pain after Root Canal? Perhaps an Apicoectomy Is the Answer

May 27th, 2020

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. Matthew Hilmi 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.

  • Just what is an apicoectomy?

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.

  • How does the procedure work?

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. Matthew Hilmi 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.

  • Why choose an oral and maxillofacial surgeon for your apicoectomy?

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 Kingston office is an option well worth investigating.

Why is replacing missing teeth important?

May 13th, 2020

When we talk about teeth, every single one of yours counts. Whether you’ve lost a tooth due to injury or poor oral hygiene, it’s worth seeing Dr. Matthew Hilmi to evaluate all your replacement options. If you don’t, you could suffer negative effects to your teeth, gums, jawbones, appearance, and self-esteem.

Depending on how many teeth are missing and where they are located, Dr. Matthew Hilmi may suggest an implant, fixed bridge, or a removable bridge.

Addressing missing teeth as soon as possible is in your best interests. If you don't, the consequences might include:

  • Shifting teeth: When you lose a tooth, the space it creates allows the neighboring teeth to drift and move out of alignment. A once-straight smile and correct bite can quickly turn into crooked teeth and a misaligned bite.
  • Tooth decay and/or gum disease: After teeth have shifted, it can be harder to reach all areas around them to brush and floss properly. The buildup of bacteria and plaque can result in periodontal disease and the loss of your remaining teeth due to decay.
  • Effect on jaws: Missing teeth alter your bite and how your teeth and jaws contact one another. This puts added strain on your jaw joint (TMJ) and can contribute to the development of TMJ disorder.
  • Change in face and appearance: When you lose a tooth, your gums and your jawbone are no longer stimulated in that area. A dental implant replaces the root of a tooth or several teeth, and provides stimulation to prevent bone loss. If the root isn’t replaced, this can lead to deterioration of the jawbone and alteration of the shape and appearance of your face. Your face, especially the cheeks, can look older and more sunken.

Replacing missing teeth is an essential step for your physical and emotional health. If they are replaced in a timely manner at our Kingston office, you’ll continue to have the same wonderful smile you’ve always had.

What is dry socket and why does it happen?

May 6th, 2020

You have probably heard of dry socket before, but have never investigated exactly what it involves. This is understandable, after all, nobody really wants to think about having complications when they have a tooth pulled. You may be surprised to learn that dry socket, medically known as alveolar osteitis, only happens to a tiny percentage (between two and five percent) of people having tooth extractions, and that it is quite easy to treat.

Dry Socket Symptoms

Dry socket symptoms generally begin with pain in the area where the tooth was pulled. Over time, untreated dry socket can result in pain that radiates to the ear area as well. Other typical symptoms include bad breath and having a consistently bad taste or smell in the mouth.

You may notice dry socket symptoms immediately after a tooth extraction, or it could take a few days. This all depends upon the formation of the protective blood clot that should exist over the area where the tooth used to be.

How Dry Socket Happens

After a tooth extraction, a small protective blood clot should form in the area where the tooth had been. The purpose of this blood clot is to cover, and thereby protect, the now-exposed bone and nerve network. Occasionally, this blood clot can dissolve prematurely or it can move away from the proper area, leaving the area fully exposed to everything that goes into the mouth. When air, food, beverages, mouthwash, and any other substances touch the delicate nerves and exposed bone, infection — and the pain that goes along with it — is often the result.

Help for Dry Socket

It is important to contact Dr. Matthew Hilmi to get help for dry socket as soon as you think there may be a problem. We can help by cleaning the socket, extracting any debris that has gotten into the area, and packing the area with a medicated paste or gauze. This medicated dressing will need to be changed regularly to promote the fastest healing.

Dr. Matthew Hilmi may also give you a prescription for antibiotics that will assist in faster healing, if necessary. Generally, you can use ibuprofen or acetaminophen for pain relief.

Sleep Apnea and Oral Surgery

April 29th, 2020

If you’re suffering from sleep apnea, you already know the short-term consequences. Your nights are marked by snoring, gasping for breath, and waking up dozens of times each sleep cycle. Your days are no more enjoyable. You might be plagued by drowsiness, morning headaches, sore throats, dry mouth, memory problems, depression, and decreased libido.

And the long-term consequences can be even more serious. Obstructive Sleep Apnea (OSA) has been linked to high blood pressure, stroke, dangerous responses to medication or anesthesia, and falling asleep while working or driving.

In other words, OSA can have devastating consequences for your health and your quality of life.

You may have already tried out various non-surgical options. Perhaps your doctor has suggested behavior modification, oral sleep appliances or splints, Positive Airway Pressure machines—these and other methods have proven very helpful for some sufferers. But if these options don’t work for you, it could be time to talk to Dr. Matthew Hilmi about OSA surgery.

Obstructive sleep apnea is caused by an obstructed airway. The throat muscles may relax as you sleep and make it impossible to inhale fully with each breath. Or you may have a physical condition such as a large tongue, enlarged tonsils or excess throat tissue that blocks the free passage of air into your lungs. The size and position of your jaw can affect breathing as well, or your nasal passages may be involved.

In other words, Obstructive Sleep Apnea can be caused by a complex set of variables as air attempts to travel from nose to lungs, so your individual OSA diagnosis and treatment will vary depending on your individual anatomy. For this reason, an oral and maxillofacial surgeon like Dr. Matthew Hilmi is the specialist you need.

Oral surgeons pursue advanced studies for a minimum of four years in a hospital-based residency program. There, they train with medical residents in the fields of general surgery, anesthesiology, internal medicine, and other specialties with a specific focus on the bones, muscles, nerves, and skin of the face, mouth, and jaw.

Because your anatomy is unique, Dr. Matthew Hilmi will first carefully assess the causes of your breathing obstruction and, if surgery is indicated, will recommend a procedure or procedures tailored to treat your specific needs.

Among the specialized surgical procedures used to treat OSA are:

  • Nasal Surgery—treats a variety of nasal passage obstructions such those caused by a deviated septum or a nasal valve collapse
  • Uvulopalatopharyngoplasty (UPPP)—removes or remodels excess tissue in the area of the soft palate and throat
  • Pillar Procedure—a minimally invasive procedure which uses small implants to reinforce the soft palate and reduce vibration in the tissue
  • Tongue Base Reduction—excess tissue can be removed surgically, or shrunk through the application of radiofrequency waves
  • Genioglossus Advancement (GGA)—the tongue muscle is moved forward and tightened to prevent the tongue from collapsing backward during sleep
  • Hyoid Advancement/Suspension—the small bone above the Adam’s apple is repositioned to expand the airway and prevent upper airway collapse
  • Maxillomandibular Advancement (MMA)—the upper and lower jaws are moved forward surgically to open the upper airway, after which the jawbone is stabilized in its new position.

These and other surgical procedures may be performed in a hospital or in our Kingston office, with traditional surgical techniques or using technologies such as radiofrequency waves, and can be minimally invasive or require a hospital stay.

It’s important to note that surgery is not always the solution to OSA, but we are uniquely qualified to diagnose the cause of your OSA and to recommend the most promising treatments, surgical or non-surgical.

If you—or a partner, family member, or friend—have noticed that you suffer from thunderous snoring, or episodes of gasping for breath, or that you wake up dozens of times each night, it’s a good time to make an appointment at our Kingston oral surgery office. It could be the solution of your dreams!

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