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Oral Surgery
Carson Valley Oral SurgerySurgical Removal of Teeth
Many simple extractions can be performed by a general dentist. However, since an oral surgeon has special training, dentists will usually refer patients for the removal of damaged, impacted, or severely decayed teeth, including wisdom teeth.

Patients who are considering dental implants are also referred to an oral surgeon so that the teeth can be removed with techniques that preserve the bone, which creates a better site for implant placement.

In addition, patients who would be more comfortable receiving sedation or general anesthesia during surgical procedures are usually referred to an oral surgeon for surgical removal of teeth.

Removal of Wisdom Teeth
Third molars are commonly referred to as wisdom teeth. The wisdom teeth are located in the back of the mouth, one in each quadrant behind the second or 12-year molars.

Although most people develop 32 permanent teeth, often the jaws are not large enough to accommodate all four wisdom teeth. When inadequate space prevents the teeth from erupting into the proper position, they are “impacted”. An impacted tooth remains embedded in the gum tissue or bone beyond its normal eruption time (pushing through the gum tissue into place). Because they are the last teeth to emerge, the most common teeth to become impacted are the wisdom teeth, which normally emerge between the ages of 17 and 21.

As the wisdom teeth develop, the roots continue to grow longer and the jawbone becomes denser. As people age, it becomes more difficult to remove the teeth and complications are more likely. In addition, the problems associated with impacted teeth tend to occur with increasing frequency after the age of 30. Therefore, it is usually recommended to have wisdom teeth removed during the teenage years or early twenties before the root structure is fully developed.

Some of the problems that can develop from partially impacted teeth include pain, infection, crowding, and damage to adjacent teeth. More serious problems, such as damage to the jawbone caused by the formation of cysts, can occur with completely impacted teeth. Surgeons generally recommend the removal of wisdom teeth to prevent these problems from developing.
Bone Preservation and Augmentation
Many times due to progressive disease, infection, or trauma, bone and soft tissues are lost in areas around the teeth. This process is accelerated when teeth are removed and nothing is done to replace the stimulation that tooth root provides to preserve the jawbone. This is extremely prevalent in the front of the upper jaw where bone loss and shrinking gum tissue can be seen when we smile.

Placement of dental implants prevents the defect that would normally develop when teeth are missing. And, there are techniques to replace bone and gum tissue in areas where it has been lost. Depending on the size of the defect, and the location within the mouth, this can be done easily in the office, often at the same time as placement of dental implants.

Patients who are considering dental implants are also referred to an oral surgeon so that the teeth can be removed with techniques that preserve the bone, which creates a better site for implant placement.
Oral Diseases and Infections
The inside of the mouth is normally lined with a special type of skin (mucosa) that is smooth and coral pink in color. Any alteration in this appearance could be a warning sign for a pathological process. The most serious of these is oral cancer.

The following can be signs at the beginning of a pathologic process or cancerous growth:
  • Reddish patches or whitish patches in the mouth
  • A sore that fails to heal and bleeds easily
  • A lump or thickening on the skin lining the inside of the mouth
  • Chronic sore throat or hoarseness
  • Difficulty in chewing or swallowing
These changes can be detected on the lips, cheeks, palate, and gum tissue around the teeth, tongue, face, and/or neck. Pain does not always occur with pathology and, curiously, is not often associated with oral cancer. However, any patient with facial or oral pain without an obvious cause may also be at risk for oral cancer. Cancer screening and biopsy of questionable tissue is a routine part of the practice. Fortunately, bones and soft tissues damaged by oral cancer can be repaired or reconstructed surgically. Dr. Gray also treats infections of the mouth, jaw and neck.
Anesthesia and Pain Relief
For your comfort, surgery can be performed under local anesthesia, fully awake; under general anesthesia, fully asleep; or with light sedation combined with local anesthesia. What method of treatment will work best for you is something that you and Dr. Gray will discuss at the consult appointment.

As part of his residency training Dr. Gray worked as an anesthesia resident at Oregon Health and Science University, in Portland, Oregon. Our staff is highly trained and certified in outpatient anesthesia and our office has modern operating rooms equipped with state of the art monitoring equipment to allow for safe anesthesia delivery.

Dr. Gray is an Anesthesia Examiner for the Nevada State Board of Dental Examiners. In this role he visits other offices that offer, or wish to offer anesthesia services. He insures that the office has all of the emergency equipment required, insures that people on site know how to use the equipment. He reviews all the available medications insuring that the person requesting an anesthesia license knows the proper doses and usage. Dr. Gray even checks to make sure nothing is expired. Following this he watches a surgery, and takes the doctor and staff through emergency scenarios.
Carson Valley Oral Surgery. Oral and Maxillofacial Services Northern Nevada, Lake Tahoe, and the surrounding area.
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