Winter Park Dentistry-Wisdon Teeth Podcast (Part 2)
Now, there’s a quick clarification, when we talk about sedation, many patients are confused and they assume it’s something like in a hospital where you have an anesthesiologist that gives you medication, you stop breathing, there are tubes connected to a machine, it’s breathing for you while an operation’s done. That’s not what we do at our offices. An office is a patient setting where you’re sedated, we give you medication, and it’s just like a common colonoscopy, if any parents are watching this and have had a colonoscopy they know exactly how it’s done. We give you medication, you get very sedated, very sleepy, but you’re still breathing on your own, there’s no machine breathing for you, everything’s completely normal and your breath is fine. We still have pads on your chest, we still have a blood pressure monitor that recycles every seven minutes, there’s oxygen, you’re wired but it makes the whole procedure more smooth and enjoyable. I prefer patients to have a positive experience, which is what happens with sedation, they’re smiling when they wake up, rather than a negative experience, like “thank God I made it through that”.
Dr. Ramzi Matar (Winter Park Dentistry): I think your Labrador back there might be sedated *laughs*. That’s often times referred to as twilight anesthesia, and it’s part of your training, your oral surgeon training, your anesthesia training, and most oral surgeons, at least in my experience, will agree on having the training for that.
Dr. Jeff Beattie: We do four to six years of experience sedating patients, it’s a very safe, easy, comfortable way to do it.
Dr. Ramzi Matar (Winter Park Dentistry): When you’re coming out of it, you’re done, you wake up, and we’ve all got the classic chipmunk, everybody’s probably – I lived through it, you lived through it 30 years ago – what should you be expecting there, as far as healing, and then of course we all hear about the dry sockets? Tell me about after.
Dr. Jeff Beattie: Well, first of all, the main things patients ask is, if they had all 4 wisdom teeth out, the top 2 wisdom teeth usually are much more flexible and bendable, so being able to flex that bone, those wisdom teeth come out in one piece. So in most cases, the patient’s upper wisdom teeth come out without causing much swelling or much discomfort. So the majority of patients do very well from the top two wisdom teeth. The bottom two, depending of the depth of the eruption, are deeply embedded in the bone, and it’s a whole different scenario. If they are, impacted, we need to use the drill and saw away some bone, and remove the bone and section the teeth, and what that does is it causes the body to respond by swelling up. So it’s a classic chipmunk type approach, where you get really swollen, the swelling starts about 12 hours in and it peaks at about 72 hours, so I tell the patients to expect three to four to maybe five days of swelling. But the one thing that helps a lot is ice, and we get patients this sexy little ice pack, they wear around their head. It looks very nerdy, to be honest with you, no one likes wearing it but it helps significantly. So the more they wear that for the first three days, the less swelling they have. So that’s an important thing.
Dr. Ramzi Matar (Winter Park Dentistry): And they’re keeping it clean clearly, they’re brushing, I think you recommend brushing after the first day, the first night…
Dr. Jeff Beattie: I’ll take hygiene real quick. Besides dry socket, the second most common concern that we have as doctors is infections. Infections ironically don’t show up for about three or four weeks. And the reason they show up is that patients are not taking good care of their oral hygiene. And it gets swollen, it’s hard to get back there, and so they just kind of say “this is something I don’t want to do, I’m just going to stay away from it”. Well, it’s extremely important, we really emphasize this, patients need to get into there the day after, with salt water rinses 3 times a day, and even brushing their teeth and gum, even the back, they don’t need to use the main part of the toothbrush, but gently just brush that gum to get that bacterial film off, to minimize the amount of bacteria because if it were to get into the socket, it could cause an infection. So the more aggressive they are for the first two to three weeks, the less chance the y have to get infection.
Dr. Ramzi Matar (Winter Park Dentistry): They have to take extraordinary care, which makes sense, you have a wound.
Dr. Jeff Beattie: And it’s the lower teeth that get infected, the top ones don’t, it’s the lower ones that get infected. Back to dry socket real quick. Dry socket is where you lose a lot of blood prematurely, so usually if it’s going to happen it’s around day four or five, it’s always the lower sockets again, not the top sockets, just like infections, bottom ones are usually the culprits if they’re going to cause some issues. Dry socket is nothing but pain management, it’s not an infection, it’s just dealing with the discomfort. And dry socket can be mild, can be moderate, but it can be severe.
If it’s mild to moderate, you just kind of get it done, it helps to get the pain medications we prescribe and it gets better. If it’s severe, patients end up coming back to our office saying “hey, I have throbbing, it goes up to my ear, it feels like an ear ache, what’s going on?” and that’s because there’s a very exposed bone, and when that happens, then we can help the severe dry socket patients by packing the socket with a medicated gauze, which is gently tucked into the socket, which is placed in there and releases the medication and soothes the inflamed bone. So the bone inflammation goes down, the pain goes away from 15 to 30 minutes. The people who get it most are smokers, so anyone if you’re smoking, the smoking sucks the blood back out, it inflames the bone, and they have a very high level of discomfort.
Dr. Ramzi Matar (Winter Park Dentistry): So those are the major players in which you see it, smokers.
Dr. Jeff Beattie: Yes, the majority of patients that get it are smokers. Non-smokers can get it, so don’t get me wrong there, but if they do get it it’s much less intense than smokers. Now the other group of patients that can get it are women on birth control pills, and the reason why is, estrogen can sometimes cause dissolution or dissolving of blood clots, and that can happen, so many younger women on birth control pills will get dry socket too.
Dr. Ramzi Matar (Winter Park Dentistry): That’s good information. That’s great. I have one more question. This is the most pressing question I have here. I know you’re a big swimmer, but I know you come from a huge family of swimmers, your dad’s a swimmer, your brother’s a swimmer, they all swam in college, I know you swim regularly, and I know you did your oral surgery residency out in San Francisco. So my question for you, is it harder to take out wisdom teeth or swim from Alcatraz to the SF Bay?
Dr. Jeff Beattie: That’s a great question. I have actually been in the San Francisco Bay, and the temperature was approximately 63 degrees. Now, I never swam from Alcatraz to San Francisco, if I get brave enough, one of these decades maybe I’ll try it, but I would much rather my wisdom teeth than get my butt in the water and do an hour or two of swim from Alcatraz to San Francisco.
Dr. Ramzi Matar (Winter Park Dentistry): And I think the Anglin brothers would agree, because they are two of the three people that broke out of Alcatraz, and they’re still out there, 40 years later, nobody’s found them two and the other whose name I don’t remember. So I think they would rather take out their wisdom teeth.
Dr. Jeff Beattie: Clint Eastwood I think is the one who did the movie on that, so Clint’s probably out there swimming it, so I think he would kick my ass swimming it.
Dr. Ramzi Matar (Winter Park Dentistry): So listen I really appreciate having you, this is a big topic, I’m so grateful or your time, it’s Monday night at 8:30, you’re obviously so much of a dental geek that here you are talking about wisdom teeth. Can’t get enough of them. I really appreciate it. Thank you to anyone watching us, I hope you learned something, feel free to post some comments on this, I will do my best to answer them, or to get them in the hands of Jeff to answer them or whatever we can try to do to inform the public of what you do and what to do with wisdom teeth. Thanks again, Jeff.