APICETOMY -TOOTH ROOT OPERATION 

What is it?

The white shiny part of each tooth is called the crown. The part that fits into its socket in your jaw is called the root. The deepest 

part of the root is called the apex. The apex of your tooth has an infection with germs in it. The infection may have ended up 

forming a cyst. A cyst is a little pocket with some liquid in it. It is about half an inch (1.2cm) across, in the jaw bone, near the 

apex of the tooth. This is called a dental cyst. The cyst and infection is cleaned out through a small opening in the gum and bone. 

The opening is then closed up. This operation is called an apicetomy. 

The operation 

You will have a local anaesthetic, a local anaesthetic with some sedation or a general anaesthetic. When you have a local 

anaesthetic, the area of the operation is numbed with an anaesthetic injection. You will not feel any pain but you will be awake 

and conscious. The sedation is sometimes added to the local anaesthetic to help you relax and allow you to go through the 

operation. If you are sedated, you will be conscious during the operation, but will not be aware of what is going on. Finally, if 

you have a general anaesthetic you will be completely asleep during the operation and you will not feel any pain. The decision 

about the type of anaesthetic will be discussed between you and your surgeon. Although most apicectomies can be done safely 

and comfortably just with local anaesthetic, it is better to have some sedation or a general anaesthetic if it is anticipated that the 

operation will be difficult. A small cut will be made into the gum over the infected apex or the cyst. The surgeon will drill or 

chisel into the jaw bone down to the apex. All the infected material, any cyst, and a small part of the root will be taken out. Some 

of the infected tissue will be sent to the laboratory to be tested for germs. The end of the root may be sealed off, using a special 

filler material, to fill the space that has been made. The cut in the gum is then closed with stitches. These are usually special 

stitches that melt away in 7 to 10 days. Sometimes the surgeon uses stitches that need to be taken out after about two weeks. Your 

operation can be done as a day case. This means that you come into hospital on the day of your operation, and go home the same 

day. 

Any alternatives 

If you leave things as they are, the infection will get worse and may form an abscess (a collection of infected fluid or pus). It 

may spread to the roots of other teeth. If there is a cyst, this will get bigger. It may seriously weaken your jaw. There is too much 

infected apex to clear by drilling through from the crown of your tooth into the root. Fillings put in by your dentist may not have 

sealed the root properly. The root may no longer be hollow enough for drilling, due to your age. Or, there is too much of a cyst 

to clear this way. Your tooth could be taken out to get rid of the infection. You would then need a false tooth to fill in the space. 

Drugs and medicines will not help at this stage to control the infection or to shrink the cyst. 

Before the operation 

Stop smoking and try to get your weight down if you are overweight. (See Healthy Living). If you know that you have problems 

with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check the 

hospital's advice about taking the Pill or hormone replacement therapy (HRT). Check you have a relative or friend who can 

come with you to the hospital and take you home. Sort out any tablets, medicines, inhalers that you are using. Keep them in their 

original boxes and packets. Bring them to the hospital with you. On the ward, you may be checked for past illnesses and may 

have special tests to make sure that you are well prepared and that you can have the operation as safely as possible. Please tell the 

doctors and nurses of any allergies to tablets, medicines or dressings. You will have the operation explained to you and will be 

asked to fill in an operation consent form. Many hospitals now run special preadmission clinics, where you visit for an hour or 

two, a few weeks or so before the operation for these checks. 

After – In Vip Dental

After the operation, you will be taken on a trolley to the recovery ward for a few minutes. After your anaesthetic has worn off, 

the nurse from the ward will take you back to your ward. If you have had a general anaesthetic, although you will be conscious 

a few minutes after the operation ends, you are unlikely to remember anything until you are back in your bed on the ward. The 

same thing happens with sedation but to a lesser degree. Some patients feel a bit sick after the operation, but this passes off 

quickly. You may be given oxygen from a face mask for a few hours if you have had any chest problems in the past. A general 

anesthetic will make you slow, clumsy and forgetful for about 24 hours. Again, the same, but to a lesser degree, happens with 

sedation. The nurses will help you with everything you need until you are able to do things for yourself. Do not make important 

decisions, drive a car, use machinery, or even boil a kettle during this time. The mouth will feel bruised and swollen. The jaw will 

be slightly stiff, usually with some discomfort. The gum with the stitches will swell a little, with slight bruising of the skin. You 

will be given painkilling tablets to help with any discomfort. The swelling, bruising and stiffness of the jaw will disappear over a 

week to 10 days. You will be able to drink two to three hours after the operation. Avoid eating until any sickness has passed, and 

after the feeling has come back to your mouth and tongue. Before you leave the ward, you may be given an appointment to come 

back to the dental outpatient clinic to see the surgeon. This will be about two weeks after the operation. The surgeon will check 

that the wound has healed. He will take out any stitches if needed. He will make sure that the infection and any cyst have settled 

down. He will have the report from the laboratory about the tissue from the apex and any cyst. You may have a further X-ray of 

your teeth. You may need to visit the outpatient clinic again for further checks. 

After - at home 

Take two painkiller tablets every six hours to control any pain or discomfort. Chewing may be painful on your tooth and gum for 

three or four days. So you should eat a softer diet and avoid very 'spicy' or 'vinegary' foods. You need to keep the mouth cleaner 

than normal to prevent infection of your wounds. Gently brush your teeth with ordinary toothpaste three times a day. Follow this 

with a warm salt water mouth bath. This is a pinch of salt to half a pint of warm water. Hold a mouthful for one minute on each 

side of the mouth. Then follow the salt mouth with the antiseptic mouthwash for one minute. You may have aches and twinges 

in your teeth for a month or two. These will settle down gradually. You will be fit to go back to work the second day after your 

operation. You will be fit to drive 24 hours after the operation. Avoid strenuous sports and swimming until the gum has fully 

healed in a month or so. 

Possible complications 

If you have this operation under general anaesthetic, there is a very small risk of complications related to your heart and lungs. 

The same is true for sedation but to a lesser degree. The tests that you will have before the operation will make sure that you can 

have the operation in the safest possible way and will bring the risk for such complications very close to zero. 

If you follow the advice given above, you are unlikely to have any problems. Complications are rare. Some slight bleeding is 

normal for a day or two after this operation. If the bleeding is heavy and carries on for more than an hour, phone the hospital 

or your GP for advice. They will tell you how to bite on a small pack of gauze for 20 minutes or so to stop the bleeding. Rarely 

patients need to come back to hospital for treatment of bleeding. 

If you experience increasing pain at the area of the operation, you feel that is getting more swollen and you have a temperature, 

it most probably means that the area of the operation is infected. This happens relatively rarely and taking antibiotics for a week 

or two usually solves the problem. In a very small number of patients the infection can be evry bad and lead to a collection of 

infected fluid or pus (abscess) at the area of the operation. In this situation you will need another operation to drain the infected 

fluid or pus. 

Sometimes, there is some numbness around the gum after any anaesthetic has worn off. This may be caused by bruising around 

or damage to small nerves near the tooth root. Usually the feeling comes back in a day or so. Rarely, it takes six weeks or more. 

In about 9 out of 10 cases, the infection and any cyst heal up. In the other cases, the tooth has to come out, or, rarely, another 

apicectomy is needed.

General advice 

These notes should help you through your operation. They are a general guide. They do not cover everything. Also, all hospitals 

and surgeons vary a little. If you have any queries or problems, please ask us.

 

 

 

 

 

WISDOM TEETH REMOVAL

 

What is it?

Wisdom teeth are the last molar teeth to develop which usually grow at the very back of the upper and lower jaw bones, one at each back 'corner' of the mouth. They usually appear when people are aged 18 to 21 years old, and they are called wisdom teeth because by that age people become 'more mature and wise'. Wisdom teeth can be as good and useful as any other teeth provided that, as they develop, they can penetrate the gums and emerge or erupt into the mouth completely and properly. Unfortunately, this is not always the case. Frequently wisdom teeth erupt only partly or they don’t erupt at all. They are then called impacted wisdom teeth and they are usually a cause of many problems that makes it necessary for them to be removed. The wisdom teeth usually need to be removed because of one or more of the following:

  • severe pain and swelling caused by the wisdom teeth themselves
  • recurrent infection of the gum around the tooth
  • serious decay of the wisdom teeth which cannot be repaired
  • helping to reduce crowding of other teeth before straightening with a 'brace' (orthodontic appliance).

Very rarely, the tissues around the wisdom teeth can develop cysts or tumours and this can be one more reason for removing them.

The operation

In some cases a wisdom tooth can be removed under local anaesthetic. In this situation, the area around the tooth is made numb with an injection of local anaesthetic. Sometimes the local anaesthetic is combined with sedation to help you relax and allow you to go through the operation. Having sedation means that you will be conscious during the operation, but will not be aware of what is going on.

Finally, the operation can also be done under general anaesthetic. Having a general anaesthetic means that you will be completely asleep during the operation and you will not feel any pain. The choice of anaesthetic depends partly on which you prefer, and partly on what your surgeon thinks is best. It is generally better to have local anaesthetic and sedation or a general anaesthetic if it is anticipated that the operation will be difficult; for example when a wisdom tooth hasn’t erupted at all and lies deep in your gum.

Your wisdom teeth will be removed from inside the mouth. The gum may need to be cut slightly at the back of the mouth and a small amount of bone removed to loosen the wisdom tooth. The tooth may need to be cut into one or more pieces to help its removal. The gum will be stitched after the tooth is removed, often with a type of stitch that is designed to dissolve. Most patients are allowed to go home in the early evening after the operation. If you have had local anaesthesia with or without sedation you will normally go home about three to four hours after your operation.

Before the operation

Stop smoking and try to get your weight down if you are overweight. (See Healthy Living). If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check the hospital's advice about taking the Pill or hormone replacement therapy (HRT). Check you have a relative or friend who can come with you to the hospital and take you home. Sort out any tablets, medicines, inhalers that you are using. Keep them in their original boxes and packets. Bring them to the hospital with you. On the ward, you may be checked for past illnesses and may have special tests to make sure that you are well prepared and that you can have the operation as safely as possible. Please tell the doctors and nurses of any allergies to tablets, medicines or dressings. You will have the operation explained to you and will be asked to fill in an operation consent form. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks.

After – In Vip Dental

Your mouth will feel bruised and swollen, the jaw will be slightly stiff and usually there is some mild to moderate discomfort. Your cheeks will usually swell a little with slight bruising of the skin. You will be given painkillers to help with any discomfort. The swelling, bruising and stiffness of the jaw will disappear over a week to 10 days. A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. The same can happen with sedation but to a lesser degree. The nurses will help you with everything you need until you are able to do things for yourself. Do not make important decisions, drive a car, use machinery, or even boil a kettle during this time. 

You will be able to drink two to three hours after the operation but eating may not be possible for a few hours. It may be hard to chew normally for a while so you should eat a softer diet and initially avoid very 'spicy' or 'vinegary' foods. A little extra daily fibre in the form of porridge or 'Ready Brek' often helps to prevent constipation whilst your diet is temporarily altered. The stitches which may have been put in usually dissolve, but you are normally asked to attend for a short outpatient visit to check healing about two weeks after your operation. The stitches may be removed if required. An after surgery –X-ray may be taken at that visit. Occasionally further visits may be arranged to monitor your progress. Some hospitals arrange a check-up about one month after you leave hospital. Others leave check-ups to the general practitioner. You will be given a 'summary discharge letter' for your doctor or dentist to let him or her know what has been done for you in hospital. The nurses will advise about sick notes, certificates etc.

After - at home

You will be given a small 'take home drug pack' containing an antiseptic mouthwash, some painkillers and some antibiotics. It is important to keep your mouth cleaner than normal to prevent infection of your wounds. A warm salt water mouth bath, three times a day (a pinch of salt to half a pint of warm water), used for one minute each side of the mouth after tooth-brushing often helps soothe the mouth. The antiseptic mouthwash given to you should also be used after the salt water for one minute. You should finish the full course of antibiotics but only take painkillers as directed. Antibiotics can affect function of the contraceptive pill and alternative precautions are advisable whilst taking the antibiotics and for about a week after finishing the antibiotics.

Possible complications

If you have this operation under general anaesthetic, there is a very small risk of complications related to your heart and lungs. The same is true for sedation but to a lesser degree. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero. 

It is generally recommended that you have the operation for wisdom teeth removal sooner rather than later because as you get older the chance of complications after this operation increases.

Bleeding after the operation occurs rarely and usually stops when the surgeon applies some pressure with a sponge on the area of the operation. Extremely rarely you will need another operation to stop the bleeding.

If you experience increasing pain at the area of the operation, you feel that it is getting more swollen and you have a temperature, it most probably means that the antibiotics that you were given to prevent an infection were not adequate and that the area of the operation has become infected. This happens relatively rarely and taking antibiotics (most likely different to the ones you were given to prevent the infection) for another week or two usually solves the problem. In a very small number of patients the infection can be very and lead to a collection of infected fluid or pus (abscess) at the area of the operation. In this situation you will need another operation to drain the infected fluid or pus.

The lower wisdom teeth are usually very close to a nerve which supplies the tongue and lip for touch sensation. There is a separate nerve like this on each side. The nerve(s) may be affected by bruising and swelling around the wound(s). This may cause some numbness of the lower lip and tongue on one or both sides. It happens in 1 to 3% of patients who are up to 21 years old but in about 10% of patients who are over 35 years old. Normal feeling usually returns but in some very rare instances permanent numbness may persist.

In 5 to 10% of cases you can have experience a problem called a “dry socket”. This happens because following the removal of the wisdom tooth a clot was not formed in the area or socket where the tooth used to be or it did form but was then dislodged. This can be painful, and often causes foul bad breath and it is something you usually experience four to five days after the operation. The socket needs to be packed with some medicated gauze for a few days to relief the symptoms until the healing process progresses and starts to fill the socket. The gauze needs to be changed every other day and most patients don’t need more than two to three changes until they feel much better and packing of the socket is no longer required. It is believed that patients who smoke or women who use contraceptive pills experience this problem more frequently. Although a “dry socket” can be very annoying, with proper care it settles completely, relatively quickly.

If you have any problems relating to your surgery whilst at home and are not sure what to do, ring your hospital and ask to speak to the senior nurse responsible for oral surgery. You may feel quite tired for one to two weeks after your operation.

General advice

You will be aware of the 'hole(s)' left after removal of your teeth for several weeks, but the bone and gum will reshape and after six months it will be hard to tell you have had surgery there. These notes should help you through your operation. They are a general guide. They do not cover everything. Also, all hospitals and surgeons vary a little. If you have any queries or problems, please ask us.