Atkinson and Associates - Oral Surgery

Information sheets for specific procedures can be found under the Treatments page.

Disclosing your medical history

Your health practitioners will often ask you to disclose your medical history. This can include present or past information such as medical conditions, medications or previous surgery/treatments. It is your decision to disclose this information however it is strongly advised that you do. Some patients think that disclosing all information is not relevant and won't affect your mouth. The truth is that it may potentially impact your clinical presentation, the treatment provided, drugs administered or prescribed, or information needed in case of an emergency. All information disclosed is strictly dealt with as Medical-In-Confidence in accordance with our Privacy Policy. Your General Medical Practitioner will be able to provide a summary report to assist you.

Do all wisdom teeth need to be removed?

Although removal of wisdom teeth is one of the most common surgeries carried out everyday around the world, not all need to be removed. Wisdom teeth may be symptomatic or asymptomatic with the presence or absence of disease. The presence of disease is an indication for removal. Examples include recurrent infection, deep decay, damage to adjacent teeth or cyst development. Teeth may be symptomatic (painful) yet still be disease free, and teeth with disease may be asymptomatic. It is therefore advisable to discuss your clinical findings with your dentist or surgeon. Wisdom teeth usually present between ages 16-25. Regular check ups and radiographs during this time is recommended.

Do you need a 3D image?

The gold standard for medical imaging diagnosis and surgical planning in the large majority of surgical procedures in the mouth is using a 'orthopantomogram' or OPG. An OPG provides a good overview of both the top and bottom jaws, your maxillary sinuses, jaw joints, teeth and position of your wisdom teeth. The majority of general dental practitioners will take an OPG during your routine check-ups every few years. In very specific circumstances you may require a 3D image such as a 'Cone Beam CT' or 'Medical CT'. 

An example when a 3D image is needed is when your lower wisdom teeth show signs on your OPG that the teeth lie in close proximity to the nerve that runs through your lower jaw. However, a 3D image is definitely not needed for every case. It is unnecessary exposure to ionising radiation for no clinical benefit. Experienced surgeons are aware of the signs that show which teeth have a closer association with the nerve and will then order the 3D image. After reviewing the 3D image, it may be recommended to still remove the entire tooth or perhaps carry out a different procedure called a 'Coronectomy'.

Other examples include during the planning phase of dental implants whereby volumetric analysis of your jaws is needed to ensure that there is sufficient bone to place the appropriate fixture, or using the information provided by the 3D image to get a better understanding of pathologies of the jaws including large cysts, tumours, or following trauma.

Do wisdom teeth cause crowding?

There is a no definitive answer in the literature to support or refute this claim. However, general consensus is that the evidence is more suggestive that retention does not cause crowding. As we age our teeth tend to drift forwards physiologically. Additionally, this drift still occurs in those whose wisdom teeth did not develop or were removed. Special warning should be emphasised on patients who have had orthodontics. Unless permanent retention or retainers are worn, teeth crowding will relapse regardless of wisdom teeth presence. There may still be other indications for the removal of your wisdom teeth; however, the decision will always be based on weighing up the risks and benefits of the surgery. If dental crowding is a chief concern of yours, please discuss this will your Oral Surgeon, Orthodontist or dental practitioner.

Do missing teeth need to be replaced?

Teeth can be lost for various reasons including deep dental decay, periodontal disease, infection, cracks or trauma. Not every missing tooth needs to be replaced, but sometimes it may be recommended due to aesthetics or increasing function within your mouth. There are different treatment options for replacing teeth including removable dentures, bridges or dental implants. Every patient is unique and priorities for everyone differ. If you would like some options to replace teeth that you have lost, please discuss this with your Oral Surgeon or dental practitioner.

How long is the recovery after surgery?

Post-operative recovery is based on three factors:

1. Health status of patient

2. The type of surgery carried out

3. Compliance with post-operative instructions

For minor surgery in an otherwise healthy person, recovery is short. Mild tenderness and swelling for a few days. This may include removal of one or two teeth or a biopsy. For more involved surgery, such as removal of four deeply impacted wisdom teeth, recovery will be one to two weeks. This does not mean you will be bed bound for two weeks. However, it is advisable to not have any rigorous activities or important events on during this time. For case specifics, discuss this with your Oral Surgeon.

What to do if you are anxious about having surgery

It is completely normal to have some nerves when it comes to having surgery especially in your mouth. However, many horror experiences and myths do circulate that do not reflect what should occur. Some anxiety may stem from treatment being carried out in an inappropriate setting. If you are anxious, it is advisable to book for a consult first and talk through your concerns with the surgeon. Other alternatives may be more feasible such as treatment under nitrous oxide, oral anxiolysis, IV sedation or general anaesthetic. This will be safer for all involved. Other horror stories have arisen by treatment being carried out by those with lack of experience. For an experienced surgeon, predictable timings for the procedure can be given. Oral surgery procedures are normally less than 60 minutes and this includes removal of four impacted wisdom teeth. Oral Surgeons are Specialists who have had years of rigorous formal surgery training after their primary dental qualification. It is guaranteed that knees will be nowhere near your chest!

Do you require antibiotics?

Antibiotic prophylaxis is a broad term used to describe the administration of antibiotics (drugs that target bacteria) to patients who do not have an active infection. It is used to prevent an infection from occurring both at the surgical site or at a distant site in the body. They may be taken at the time of surgery or a course afterwards.

There are specific medical conditions where this has been indicated in the past including certain cardiac conditions or patients with joint prostheses. The guidelines behind these have changed over the years and it is best to discuss this with your surgeon, or medical specialist. Other times may be due to patients with a compromised immune system (for example; poorly controlled diabetics, patients undergoing chemotherapy, patients taking immuno-suppressant drugs such as prednisone or methotrexate).

Most fit, healthy patients do not require antibiotics after surgery as long as other oral hygiene instructions are carried out. Your surgeon should not prescribe antibiotics after surgery unless it is absolutely necessary. Inappropriate prescription can lead to an increase in microbial resistance, but more immediately the risk of allergy or gastro-intestinal upset. What is better practice is to have an appropriately timed review appointment and if there are any signs of infection, to then commence antibiotics. This will be dependent on many factors including your medical history, surgery carried out and oral hygiene. Discuss this with your Oral Surgeon if you have any concerns.

What pain relief will you be prescribed after surgery?

A common question with surgery is, “How much pain will I be in afterwards?” Pain itself can be quite subjective but surgery anywhere on your body will have post-operative tenderness and limitation of function as you heal. This is a protective measure from your body against further injury. You will be prescribed appropriate analgesics (pain killers) after surgery. This will be dependent on many factors including your medical history and the surgery carried out. Appropriate pain relief will be prescribed.

What makes surgery in your mouth unique in comparison to other parts of your body (for example your foot) is that it is very difficult to rest your mouth. You need to eat, speak, and show emotions such as smile. You are normally more conscious of discomfort in your facial region because it is so personal. But, it is advised to go about your routine as best as you can. This puts the discomfort at the back of your mind. It is recommended to restrict yourself a little in some activities such as eating softer foods and no intense exercise for a week.

The World Health Organisation pain ladder advises the use of paracetamol with a non-steroidal anti-inflammatory drug as first line therapy for pain relief. Many patients think that this will not be enough and request ‘something stronger’ to begin with. The WHO outlines that as you climb the ladder to a higher rung, stronger drugs are then implemented, not as first line therapy.

There have been many randomised controlled studies (highest evidence) looking at the addition of opioids (for example; codeine, oxycodone) to the post-operative regime after oral surgery procedures. The findings have revealed that in most cases this is not necessary and in fact does not improve the analgesic effect. Opioids themselves have many issues with use including addiction and side effects such as drowsiness, constipation, nausea and vomiting. In a reasonable percentage of the population opioids have no effect at all, and some people are more susceptible to the side effects. This is another reason why safer drugs are usually prescribed first. Best practice is to have an appropriately timed review appointment and monitor the pain, and commence stronger drugs if necessary. Discuss this with your surgeon if you have any concerns.

What is a biopsy?

There are times when a health practitioner may notice an area that looks different in comparison to the surrounding tissues. In the mouth, this may occur on the soft tissue such as the gums, tongue, roof of the mouth, cheeks or lips, or in the hard tissues such as the jaw bones. It may be your presenting complaint or an incidental finding during a routine examination. Your health practitioner may refer this to someone who has more experience in handling these rarer lesions. There are hundreds of different conditions that can present in the mouth. Just because you have been referred for a biopsy does not mean that is necessarily sinister but it is always worthwhile to get these things checked out for peace of mind.

A biopsy is a medical test commonly performed by a surgeon that involves removing a small sample of the tissue for examination by a Pathologist to determine the presence or extent of a disease. With experience, clinicians develop a surgical sieve to compartmentalise what a presenting lesion could potentially be. They will rule out others carrying out simple tests, but ultimately will require a biopsy for confirmation of their differential diagnoses. The sample may be one, multiple or the entirety of the lesion. The surgeon will then send this to a Pathology Laboratory with notes outlining their clinical findings.

The Pathologist will use particular chemical tests and look at the sample under a microscope to finalise their diagnosis. They will then write a report and return this to the surgeon. Your surgeon will discuss the Pathologist’s findings and whether any further treatment is necessary.

Your surgeon will take your Medicare details for submission of the sample and the Pathologist will bill you directly. You may receive some monies back from Medicare for their report.