Our office staff is dedicated to making your first visit a pleasant experience, and minimize the anxiety of undergoing surgery. To make the process as efficient as possible, please download and print the “Patient Registration Form” and “Health History Questionaire,” and fill these out before your first visit.
Please bring your dental and medical insurance cards to your first visit. Our staff will request your insurance information over the phone when scheduling your appointment, and we make every effort to verify insurance benefits prior to your initial visit.
If you are referred by your dentist, dental specialist, or physician please bring your Alamitos Oral Surgery referral card with you to help us understand the concerns of your referring doctor.
Our surgeons strongly recommend a consultation prior to scheduling surgery. However, if it is a true emergency and you require general anesthesia for your procedure, it is important to follow our “Pre-Operative Instructions.”
Please do not hesitate to contact our office with any questions, or changes to your schedule that require a new appointment.
Hello. I thought I’d start off this blog by writing a little about things that occasionally happen after an extraction.

Infection

Infections are marked by fever, pain, swelling, and redness. They generally occur a few days after a procedure, requiring time to evolve. However, there are also late infections that occur 3-4 weeks after an extraction.
In the healthy patient who had an extraction, infection is rare. With wisdom teeth, sometimes a bit of food debris gets stuck under the gums and develops into a small abscess. The patient experiences tenderness over the area, a bad taste, persistent swelling, and malaise. A small abscess like this is generally treated by numbing the area, opening up the surgical site, and irrigating it thoroughly with sterile saline. Typically this clears the source of the infection and the abscess resolves. Antibiotics are administered.
Receiving post operative antibiotics does not mean you will not get an infection. In fact the rate of infection after wisdom tooth extraction is similar between patients who receive antibiotics and those who do not.

Dry Socket

A dry socket (Alveolar Osteitis) is a condition where the blood clot disappears before it can turn into early stages of bone formation. The bony walls of the socket are exposed to air and cold, which are exquisitely sensitive. As with an infection, dry socket often evolves around 3 days after an extraction, and most commonly occurs in lower wisdom tooth extractions. Smoking, birth control pills, and hygiene are risk factors for dry socket.
You may have a dry socket if you experience more pain, of a different quality, a few days after the extraction. Come back in to the office. Do not wait for your post op appointment. The treatment of a dry socket is simple, consisting of packing the socket with a menthol/eucalyptus oil gauze that eliminates the pain immediately. This packing may need to be changed every other day until the gum tissue grows down and lines the socket.
Well, that’s all for tonight.
– Dr. Solomon Poyourow
Here is a topic that is relevant for extractions, especially upper (maxillary) wisdom teeth.
Bleeding is normal after a tooth extraction. However it should stop later that day. A non-wisdom tooth will typically ooze blood for under an hour, then form a clot. An upper wisdom tooth may ooze blood for several hours, even into the evening. However, it is important to understand that gauze will frequently have blood on it even though the bleeding has stopped. This is because the gauze picks up blood from the blood clot.
There are several key steps to facilitating clot formation:
1. Apply firm (slightly uncomfortable) pressure with gauze. The gauze must be directly over/under the extraction site. Pressure should be applied for 15 minutes continuously. The gauze must be the proper size to apply pressure (not too small), while enabling the mouth to be closed most of the way so the jaw doesn’t get fatigued (not too big).
2. “Bleeding has stopped” doesn’t mean there is no more blood in the mouth or saliva. It is normal to have some blood in saliva for a few days after an extraction. The key is blood is not welling up or dripping and making it difficult to talk, eat, breathe. Often the gauze will be somewhat pink but not deeply red and saturated. If it is somewhat pink this indicates bleeding is well controlled.
3. Maintain the blood clot. Once a clot has formed it is important to not disrupt it. This is accomplished by avoiding vigorous rinsing, sucking through a straw, or spitting. If bleeding resumes you can apply pressure again and the clot will re-form.
4. Black tea bag. Dipping a black tea bag in cold water, rolling it in a gauze or paper towel, and applying over an extraction socket can facilitate clot formation due to the tannin in tea.
5. If you run out of gauze you may use a paper towel cut to appropriate size.
If after trying these things you are still concerned about post extraction bleeding you should contact your doctor. If your doctor isn’t available or if you develop symptoms of lightheadedness, shortness of breath, dizziness, chest pain, or other concerning symptoms, you should go to the Emergency Department.
This blog topic is meant to be a source for educational material on bleeding after a dental extraction. It is not intended to be clinical advice. Real clinical scenarios require doctor-patient discussion, exam, and assessment.
– The Doctors of A.O.S.
CDA Cares is this weekend in Pomona. The doctors and staff of Alamitos Oral Surgery are excited to volunteer our time on Saturday (11/22). Patients under financial hardship, who are in need of free dental care, can register for the event:
CDA Cares – Pomona

California Dental Association Foundation

 
These days we are always in a hurry. We are being pulled in hundreds of directions: family, work, spouse, friends, Christmas shopping, and then… you break your front tooth! Then you see your dentist and you are told about something called a flipper (funny because it’s nothing related to a swimming animal), and your eye rolls when you find out that the tooth needs to be removed and grafted, wait for 3 months of socket healing, have an implant placed at your favorite local oral surgeon in Los Alamitos, wait four months for bony integration of the implant to bone, and then have your dentist restore the implant over a 2-3 week process. We have a hard time waiting to finish the drive home before texting or checking your emails, so how can we expect patients to wait over 8 months to get a new tooth while wearing a flipper this whole time?
Well, the conservative method is tried and true, backed with research and data leading to a very high success rates. But can we, as oral surgeons, save time for our patients? Besides saving time, there is also the added benefit of tissue preservation. When you smile you see two pink triangles on either side of your front teeth. These precious little pink triangles actually need bone to support the base. There is very good data that once a tooth is removed the bone around the tooth withers away, and thus does the support for the gingiva to form nice healthy pink triangles. We minimize this effect by grafting bone into extraction sockets to preserve the bony architecture, and we can also change the tissue quality by grafting connective tissue to plump these little triangles that we call dental papillae.
Another technique is never allowing the bone or soft tissue to lose support during the extraction phase. How can this be done? Replace a broken tooth immediately with another tooth, and thus preserve the anatomy to prevent bone and tissue loss. In one appointment, a tooth can be removed, an implant placed, and an implant supported temporary crown can be screwed into the dental implant. Overall the 8 month process takes 5 months instead, and during the 4 months it takes for the dental implant to integrate to your bone, you will have a naturally appearing and feeling temporary crown that is supported by the implant. Your friends and family won’t even know you had your front tooth removed.
In all advanced surgical cases it is about case selection. For this method you need an ideal patient, an ideal surgical experience, and an ideal implant. I won’t belabor the ideal implant, and I’m assuming all of our patients at Alamitos Oral Surgery will be receiving ideal surgery, so why do we need an ideal patient? This is important because if an implant is placed and a temporary crown is placed immediately at the beginning of the 4 month healing phase, we ask our patients not to bite into their food to prevent forces that will prevent an implant from integrating to the bone. These temporary crowns are actually made subtly short to prevent any contact on this tooth at any time.
In my experience, single rooted teeth without risk of heavy contact during biting and chewing, and without an acute infection are candidates. In addition, a close preoperative exam must show that the eggshell of bone on the entire outside of a tooth must be present before this attempted method. This can be confirmed by taking a quick dental CT in our office to show the 3D architecture. This ensures ideal esthetic results in the long run. There is very good data that if this buccal (outer side) bone is not present for an immediate implant placement and immediate temporization after an extraction, then metallic show of the implant can occur down the road, which is disastrous. Sometimes this is compromised by the trauma that injured the tooth, or from the infection of the tooth that led to the extraction, and so this method can not be used. This thin shell of bone may also be lost during the surgery in the hands on an inexperienced surgeon, and so this method must be aborted.
We often ask your dentist to fabricate a “flipper” or stay plate in the event of the implant can’t be placed or if the implant can’t be temporized immediately. This may be because of surgeon preference to have a lab make the temporary after the implant is placed, which requires a 5 day turn around time. In order for the temporary to be placed at the time of the implant surgery instead of the 5 day wait, the temporary will have to be made at chair side by your surgeon, or would require fabrication ahead of time. For the latter method, this would require guided surgery with a surgical guide designed and fabricated with the aid of our in office dental CT and virtual surgical planning.
At Alamitos Oral Surgery, our surgeons are on the cutting edge of implant surgical techniques. However, we only believe in providing the ideal surgical technique uniquely catered to each patient and to his or her presenting situation. This is determined by a thorough exam and consultation, aided by our in office dental CT. We will partner up with your restorative dentist to help you get to that perfect smile.
Happy Holidays!
Lee D. Pham, DDS, MD, MS
Diplomate, American Board of Oral and Maxillofacial Surgery
The short answer is no.
A dental implant is similar to other pieces of precision machinery and engineering. As such, implant quality is dependent on research, testing, design, quality control, manufacturing standards, and product support.
Like watches, there are hundreds of implant manufacturers arounds the world. Just as there Rolex knock-offs, there are copies of the highest quality, most expensive dental implants (Straumann, Nobel Biocare, Astra).
The doctors at Alamitos Oral Surgery use genuine Straumann and Nobel Biocare implants and components. These companies manufacture the finest dental implants available. They are some of the largest, most established implant manufacturers with decades of research and unwavering product support.
As in everything we do at Alamitos Oral Surgery, quality of care is never compromised.
– The Doctors of A.O.S.
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