Intra/Extra-oral Examination

Intra/Extra-oral Examination

The intra-oral and extra-oral soft tissue examination is an essential part of all dental exams.  This examination is performed in a thorough and systematic nature to ensure that no parts of the head and neck region are missed or overlooked.

This examination can be broken down into sequential steps to review all tissues and to determine if they are within normal limits (WNL) or if there is an abnormality noted.

If an abnormality is noted in an intra/extra-oral examination, further detailed notes about the abnormality such as size, colour, location, surface texture, and consistency are made.  Information about the onset, location, duration, characteristics, aggravating and alleviating factors, related symptoms, and treatment are all considered by your dental hygienist and periodontist.

As part of a full intra/extra-oral examination for abnormalities in our oral pathology, a detailed medical history, family history, drug/medication history, and social history are taken.

As a patient, we can prepare for our intra/extra-oral examination by being aware of any abnormal colouration, bumps, textures, or sensations in our head and neck region. 

A full video of what to expect during a full intra/extra-oral examination by your dental hygienist or periodontist can be viewed below.

Oral Biopsy Post-Operative Instructions

Oral Biopsy Post-Operative Instructions

After your oral biopsy surgery, there are some steps to follow for quick and smooth recovery.  Healing after an oral biopsy can be broken into periods.

In the first 24 hours:

  • Only after freezing has completely warn off, you can apply ice to the area as needed in 10 min ON/10 min OFF for 3 cycles.
  • Do not apply heat to the area as this can stimulate blood flow and increase bleeding in the area
  • Do not brush or floss the area
  • Do not rinse your mouth
  • Rest with your head elevated to avoid blood pooling to the area, discomfort, and swelling
  • Do not do any activity that raises your heart rate
  • When sleeping, use an old pillow case in case your bleed through the night

After 24 hours:

  • Do not apply ice
  • Brush the area and neighbouring teeth very gently with the post-surgical toothbrush that was given (this toothbrush is even softer than a ‘soft’ toothbrush and is made specifically for surgical sites)
  • When using the post-surgical toothbrush, avoid the sutures and the gum line at the surgical site
  • Pool Peridex rinse at the surgical site twice per day (morning and night) for two weeks.  Peridex mouthrinse works like a “toothbrush in a bottle” and works to keep the surgical site clean without the manual disruption by a toothbrush at the sensitive site.
  • Do not spit, gargle or swallow Peridex.  Simply let it fall from your mouth.
  • Do not eat or drink for 2 hours post-Peridex rinse.
  • Do not floss the area
  • Brush and floss all other areas of the mouth with your regular electric toothbrush

After 48 hours until your 2 week post-operative appointment:

  • Apply a warm compress to cheeks as needed
  • You may begin to exercise at 50% intensity being careful to monitor for any bleeding at the surgical site
  • Eat only soft foods on the opposite side of the mouth.  A general rule of thumb is to eat foods that require 3 chews or less.
  • Do not eat extreme temperature foods as this can damage the tissues and can increase blood flow in the area – eat room temperature foods only
  • Avoid alcohol, tobacco and cannabis during the healing phase (2 weeks)
  • Do not pull at the lip to see the healing area.  This may loosen the stitches and can disrupt the healing tissues.
  • Do not use straws, whistles, wind instruments as the force applied may damage the delicate healing tissues
  • Avoid wearing a denture or flipper as much as possible as this may rub against the healing tissues

It is important to take all medications as prescribed, especially an antibiotic.

To manage pain, Ibuprofen can be taken by the clock, as necessary.  Any antibiotics prescribed are essential to take until completion.  Use the Peridex mouth-rinse twice daily for 2 weeks.

Patients report experiencing their peak discomfort immediately following surgery and experience a steady decline in discomfort through to Day 5.  However, patients report the greatest level so swelling, which can sometimes be accompanied by bruising, 3 to 5 days following surgery.

Should you experience any bleeding, swelling, bruising, or discomfort that is out of greater concern, it is important that you contact your periodontist.

Your biopsy results return from the Oral Pathology laboratory at Mount Sinai Hospital in two weeks time.  At which point we will go through the results at your post-operative appointment with you.

Post-Dental Surgery Meal Planning

Post-Dental Surgery Meal Planning

Proper care after your periodontal surgery will help your mouth to heal quickly.  This includes a healthy, soft food diet.

At first, your temporary soft food diet may seem challenging, but with some planning you can ensure that you have all of the nutrients you’ll need for your body to heal quickly.

As soon as you are able (after your local anesthetic has worn off), start drinking nutritious fluids such as real fruit juices, milk, milkshakes, and fruit and vegetable smoothies.

REMEMBER: Do not drink from a straw for at least two weeks.  The suction and force created when using a straw will be disruptive to the sutures and the delicate healing tissues.

A general rule of thumb for the first two weeks following periodontal surgery is to avoid any foods that take more than 3 chews to swallow.

Avoid hot food or drink for the first two weeks.  The heat of your food can increase the flow of blood to the area and can cause your surgical site to bleed.

Just because your diet is of a soft consistency, it is still important to eat a variety of nutritious foods.  Below are some general guidelines according to Health Canada’s Food Guide and some examples of food choices.

Fruit & Vegetables

Consume at least 7 servings of soft fruit and well-cooked vegetables per day:

  • apple sauce
  • stewed or canned fruit
  • peas
  • smoothies
  • soups
  • well cooked or pureed vegetables (potatoes, broccoli, cauliflower, carrots, turnip, other root vegetables)

Protein

Two servings of tender protein:

  • tuna
  • salmon
  • flakey fish served without a crispy coating
  • well-cooked poultry cut into small, bite-sized pieces
  • eggs
  • baked beans
  • lentils
  • Greek yogurt

Milk & Dairy

Two servings of milk or dairy products:

  • milk
  • calcium-fortified soy or almond milk
  • ice cream/frozen yogurt
  • yogurt
  • fruit sorbet
  • puddings
  • soft cheeses such as cottage cheese

Whole Grains

Chose whole grain foods over processed, simple carbohydrates:

  • porridge
  • oatmeal
  • cream of wheat
  • cereals without nuts or dried fruit
  • whole-grain pastas or noodles
  • soft bread without hard crust

Beverages

Make water your drink of choice.  It is important to stay hydrated.

Avoid alcohol and tobacco as much as possible during the healing period.

How much is my dental surgery going to hurt?

How much is my dental surgery going to hurt?

Many of our patients experience fear and extreme anxiety at the dentist and while we do our best to create a calm and tranquil environment, the fear of pain associated with periodontal treatment may still be a deterrent for some.

Therefore, to answer one of the most commonly asked questions “Is this going to hurt?”, we conducted a study that was published in the Journal of Clinical Periodontology.

Over a period of two years, we enrolled 213 patients requiring either dental implant or grafting surgery.  The average age of the patients that were recruited was 51 years, but ranged from 19-80 years.  Prior to their surgery, patients were asked to rate the amount of pain that they anticipated feeling from No Pain to Worst Pain Imaginable.  For 7 days following their surgery, patients were asked to rate the amount of pain they experienced on the same scale.

When all of the data was analyzed, we found that the actual pain that patients experienced after periodontal surgery was lower than the pain they anticipated feeling.

With these findings, we are now able to provide our patients with an evidence-based answer when they ask us “Is this going to hurt?”  Happily, we are able to put them at ease by sharing with them that in fact, periodontal surgery hurts less than they expect!

Some factors that we found did predict the amount of pain a patient would feel are:

  1. Anticipated Pain – if you expect it to hurt, you’ll report it hurting more
  2. Age – older individuals reported it hurting less
  3. Sedation – those who had their periodontal surgery under sedation with one of our Registered Nurses reported experiencing less pain

Some factors that we found did not predict the amount of pain a patient would feel are:

  1. Nervousness
  2. Gender
  3. Surgery Type (dental implant vs. soft tissue grafting)
  4. Smoking Status

Also collected as part of the study, we found that patients needed only 600mg of Ibuprofen for relief of their post-operative pain and discomfort.  This reinforces Dr. Fritz’s mandate of never prescribing narcotics to any of this patients.

This study was conducted by Jennifer Beaudette as part of her Master’s of Science research through the Faculty of Applied Health Sciences at Brock University.  Jen has since completed her M.Sc. and is currently pursuing a Ph.D at Brock University.