What is a soft tissue impacted tooth?

impacted wisdom tooth ChicagoYou may be familiar with the concept of an impacted tooth, which occurs when a tooth fails to fully erupt through the gums. Teeth can become impacted in different ways, however, and are categorized differently.

If a tooth remains fully embedded in the bone, it is referred to as a complete bony impaction. When the tooth is covered partially by the bone, it is called a partial bony impaction. When the tooth is covered only by gum tissue, which impedes it’s eruption, it is referred to as a soft tissue impacted tooth.

Chicago patients with an impacted wisdom tooth can find themselves in any of these three scenarios. Additionally, the wisdom teeth can be impacted horizontally, vertically or at an angle.

Wisdom teeth are the most likely of all the teeth to become impacted. They are the largest teeth (molars), and the human jaw has evolved in a way that minimizes the space available to accommodate these teeth.

Impacted teeth should be removed only by an oral surgeon because the extraction in such cases is a complex procedure and general dentists do not know how to manage any complications.  In most cases, bone must be removed in addition to the tooth. Even with a soft tissue impacted tooth, the extraction can be complicated by other factors, such as an angled or horizontal tooth.

Regardless of whether they are lodged in the bone or soft tissue, impacted wisdom teeth become problematic. They can develop infections or be the source for tumors, lead to abscesses, destroy neighboring teeth and cause significant discomfort.

Even if your impacted wisdom teeth are asymptomatic, you should proactively have them removed, ideally before age 25. Issues can arise at any time, and the procedure is generally simpler for younger patients, who also heal more quickly and tend to face a lower risk of complications.

A soft tissue impacted tooth can be just as problematic as a bony impacted one, so patients who have no sign of the wisdom teeth erupting by their late teens should schedule an evaluation, including x-rays, with an oral and maxillofacial surgeon. This will give you an opportunity to discuss the procedure, as well. To schedule your consultation in the Chicago Loop and surrounding Chicago suburbs, contact the office of the wisdom tooth expert – Dr. Steven Koos.

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Sedation Options For Tooth Extraction

sedation for tooth extractionIt’s bad enough to be facing a tooth extraction to begin with. You shouldn’t have to worry about enduring a painful procedure on top of the prospect of having a gap in your smile.  Most people do not want to endure the painful injections, the pressure, the sounds of cracking and popping and the cutting and digging.  If an oral surgeon performs the procedure your worries can disappear.  Not only are they the most skilled at exodontia, otherwise know as tooth removal, but they are the only specialists truly qualified to safely and properly offer comfortable sedation.

Our downtown Chicago Loop oral surgeons can take steps to maximize patient comfort when extracting a tooth, both by creating a calming environment in the office and providing medications that put you at ease during the procedure.

Oral and maxillofacial surgeons have unparalleled training and experience in administering various forms of anesthesia and sedation for tooth extraction, and the medications involved are safe and effective.

Patients have a number of sedation options for tooth extraction. Your oral surgeon can discuss the advantages and disadvantages of each type to help you choose the one that is most suitable in your case.

Anti-anxiety medications, often benzodiazepines, are commonly used as sedatives for dental care. Those drugs are delivered intravenously for a nearly instantaneous effect.  Another sedative option is nitrous oxide, sometimes called “laughing gas.” This method also takes effect quite rapidly and is administered in conjunction with intravenous medicine for an amazingly smooth and easy experience.

With those sedation techniques, the patient remains somewhat conscious, although deeply relaxed. This allows the patient to respond to the oral surgeon’s directions during the procedure.

General anesthesia, which renders patients unconscious, is also often used with surgical tooth extraction, and its in-office use has a tremendous margin of safety.  Patients often request that they “do not want to see, feel, or hear anything”, and this is the preferred method to accomplish that.

When choosing a sedation method, keep in mind that the strength of anesthetic needed will vary by the circumstances of the extraction. Some patients may be able to tolerate a basic extraction with only local anesthetic or a very mild sedative. On the other hand, extraction of an impacted tooth, such as a wisdom tooth, will require general anesthesia.

In addition to anesthesia during the extraction, your oral surgeon will also prescribe narcotics (painkillers) to improve your comfort as you heal in the first few days following the procedure.

In advance of a tooth extraction, be sure to make an informed choice about the comforts that sedation offers. Call 312-328-9000 and talk with our Downtown Chicago oral surgeons to get all of the information that you need.

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What is an abscessed wisdom tooth?

A wisdom tooth abscess is a potentially painful condition in which an infection develops in the tooth’s root or between the gum and the tooth, leading to a pocket containing purulence (pus) and other byproducts of the infection. In the case of partially erupted wisdom teeth, an abscess may also be present within the flap of tissue that in many cases covers a wisdom tooth.

An abscessed wisdom tooth can cause significant discomfort and swelling in the area. If left untreated, abscesses can lead to the loss of bone and surrounding teeth.

Abscesses are also a serious concern because they can give the toxic bacteria an opportunity to transfer within muscle spaces of the face, which can lead to dangerous swelling and blockage of the airway.  Also, the bacteria from the tooth abscess can enter the bloodstream and can cause a serious systemic infection. 

Ideally, patients should have their wisdom teeth removed by an oral and maxillofacial surgeon before problems develop.

Because they often are impacted, wisdom teeth may be more prone to developing abscesses than the other teeth. It’s particularly difficult to keep a partially erupted wisdom tooth clear of bacteria since the microscopic bacteria migrate into spaces that a patient can not possibly keep clean, creating suitable conditions for a wisdom tooth abscess.

Ideally, patients should have their wisdom teeth removed by an oral and maxillofacial surgeon before problems develop. All patients should have their wisdom teeth extracted before age 25 for the best chance of preventing issues like abscesses and other infections.

When an abscess is already present, though, extraction will still be the most effective treatment in eliminating the infection. An oral surgeon may also be able to drain the abscess, but extraction is still the preferred and definitively curative treatment in the case of wisdom teeth because they are so problematic.

The structures of most people’s mouths encourage abscesses and other wisdom tooth-related issues to emerge. Modern-day humans rarely have enough room in their jaws to accommodate the wisdom teeth, so they become stuck in the jaw or only erupt partially.

Impacted wisdom teeth can cause a variety of problems beyond abscesses, such as knocking the rest of the teeth out of alignment. If your wisdom teeth are still in place and you are older than your mid-teens, contact ORA® Oral Surgery & Implant Studio, serving the Chicago Loop, to learn more about the extraction procedure.

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What is the best age and time to have wisdom teeth removed?

tooth extraction ChicagoThe third molars, or wisdom teeth, are the last to erupt, which typically happens by late adolescence. However, in a large number of patients, those teeth become impacted, which means that they must be removed by an experienced oral surgeon before significant problems with these impacted teeth occur.

When wisdom teeth fail to erupt properly, a number of problems can result. Because it is particularly challenging for patients to keep the gums around a wisdom tooth and third molar teeth clean, they can create a haven for infection-causing bacteria.

Impacted wisdom teeth may also cause patients discomfort and develop cysts and tumors. In their attempts to push through the gums, the wisdom teeth may also force the other teeth out of alignment.

To prevent such problems, patients should schedule a wisdom tooth extraction well before reaching age 25.   Patients who wait to pursue wisdom tooth extraction until they are older may face a greater risk of complications. As the patient ages, the roots of the wisdom teeth grow longer and more entrenched in the jawbone, making the process of removing them more complex.

In younger patients, the roots are shorter and less developed. As a result, the wisdom tooth extraction procedure is more straightforward in teenagers and young adults.

Most patients have their wisdom teeth removed in their late teens or early twenties, but the need for extraction becomes clear earlier. Dr. Steven Koos, your Downtown Chicago oral surgeon, may identify a need for wisdom tooth extraction in patients as young as 12 years old in some cases. By that point, evidence gathered from x-rays and visual examination will often clearly demonstrate the case for wisdom teeth removal.

Over the years, the human jaw has become smaller and our teeth remain in our mouths for decades, rather than falling out periodically from extensive use in chewing a very rough diet. These changes have limited the modern-day jaw’s ability to accommodate the wisdom teeth, necessitating extraction in most patients.

In rare instances, the wisdom teeth may emerge in the proper alignment and extraction may not be necessary. However, it’s important for patients with wisdom teeth to be evaluated by an oral surgeon during their teen years to determine the status of the third molars.  The “watch and wait” plan that some general dentists take can actually prove to be very harmful, misguided advice.

To learn more about wisdom tooth extraction in Chicago, and surrounding Chicago-land suburbs, contact ORA® Oral Surgery & Implant Studio at 312-328-9000.

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On March 21st, 2012, posted in: tooth extraction by

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What is a Mal-erupted Tooth?

When a permanent tooth emerges through the gums at an improper time, position, angle, or level, that tooth is referred to as mal-erupted or mal-positioned. You may be more familiar with the term impacted, which relates to lack of room for a tooth to come in normally and there are several different types of impactions, but a mal-erupted tooth is different. 

Any permanent tooth can become malerupted, but the most common teeth to suffer this fate are the wisdom teeth or the third molars.

Similarly, a mal-eruption can occur when a permanent tooth does not come in at the expected time. For example, if a deciduous (primary) tooth is lost prematurely or too late, the eruption of the permanent tooth slated for that spot may be thrown off course.

Your Chicago oral surgeon will be involved in the treatment of a mal-erupted tooth when an extraction is warranted. For example, if a tooth has only emerged in an misaligned position, the patient will probably face a surgical intervention because the tooth can cause bite discrepancies, hygiene challenges, and plaque traps and must therefore be removed to protect the neighboring teeth.

Any permanent tooth can become malerupted, but the most common teeth to suffer this fate are the wisdom teeth or the third molars. Those teeth are particularly misaligned, and the jaw may have limited room to hold them.

A malerupted tooth can result from a number of causes. As noted above, an untimely loss of a baby tooth can cause the permanent tooth to erupt too early or too late, potentially wrecking the alignment of the other teeth in the vicinity.

Crowding may also be at fault, leaving the tooth with inadequate room to emerge in the right spot.

Malerupted teeth can cause a host of problems. They may be more prone to infection or decay. They can cause pain and provide an environment that promotes the formation of decay on adjacent normally erupted teeth too. They may come in crooked, negatively impacting the smile’s appearance.

Patients with malerupted teeth should seek treatment as soon as possible to avoid all of the aforementioned negative outcomes. Even if they are asymptomatic, mal-erupted teeth can be identified through radiography, and a thorough clinical examination will be valuable in such cases.

If you are diagnosed with a malerupted tooth, consult with Dr. Steven Koos, your oral surgeon serving Downtown Chicago IL and the surrounding Chicagoland suburbs, to explore the possibility of extraction.

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On March 7th, 2012, posted in: oral surgeon by

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What are the first 24 hours like after wisdom tooth removal?

wisdom tooth ChicagoThe initial 24 hours after your wisdom teeth are removed should be an emotional relief.  If you, like most patients, are nervous or apprehensive about the procedure, you should be able to relax.  It’s all behind you. Fortunately, these teeth will never grow back!

When you elect to have our skilled oral surgeons remove your wisdom tooth in Chicago, you can be assured that the doctor and staff will hold your hand every step of the way.  Our team wants to make sure that you are informed and comfortable, two details that will make the next 24 hours much more relaxing.

It is recommended that you plan to rest for at least a day or two following your procedure. Strenuous activities should be postponed for about 72 hours, when the extractions sites have begun to heal.  You should also plan ahead and have a selection of soft, mild foods on hand so that you may eat comfortably and maintain your energy. Drinking out of straws, excessive or forceful spitting, and smoking should be avoided for the first 4-7 days, as these activities are known to disturb the healing process.

Following the removal of your wisdom teeth, our oral surgeons will send you home with a prescription for a narcotic pain medication like Tylenol#3, Vicodin, or Percocet and will also send you with prescription strength Ibuprofen 800mg.  If necessary, you will be able to use these together for the most comprehensive pain management regimen. Some patients will only have minimal discomfort and need to take only the Ibuprofen 800mg or just over-the-counter medication like Alieve and Tylenol.  Initial post-op discomfort is based on each patient’s pain tolerance, and the complexity of their case with degree of tooth impaction.  Be sure to closely follow the recommendations of the doctor and stick to a schedule when taking the medication for the most effective pain control.

Ice also plays a crucial role within the first 24 hours post surgical tooth extraction of wisdom teeth to minimize discomfort as well as reduce potential swelling.  With any surgical procedure, the less post-operative edema means less tenderness and discomfort.  The first 48 hours using an icepack will be of great benefit.  Our Chicago oral surgery practice will provide you with a re-usable gel ice pack along with several other items to help you through the recovery process.

It is common to experience varying levels of tenderness and/or swelling at the extraction site and a dull ache.  The jaw joint might feel stiff and muscles of the cheeks sore within the first 24 hours of having your wisdom teeth removed and persist for a few days.  During your consultation appointment, or at the end of the tooth extraction appointment, your oral surgeon may be able to predict the level of discomfort that you can expect and choose the particular medication for you that is most appropriate. This prediction is typically related to the difficulty of the extraction and the estimated healing time. Strictly following your oral surgeon’s post-operative instructions can help to reduce or alleviate your discomfort.

Our experienced team at ORA® Oral Surgery & Implant Studio in Chicago understands that each patient and each wisdom tooth removal procedure is unique. Experience and expertise on the part of the surgeon and staff can help to make your first 24 hours and the following days as pleasant as possible. Schedule your appointment today for a wisdom teeth consultation.

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On February 20th, 2012, posted in: wisdom tooth by

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What is a Supra-Erupted Tooth?

oral surgery ChicagoAs you move along throughout your day, and even as you slumber at night, your teeth are in a constant battle for their position. The teeth are subjected to a number of forces that help to maintain a delicate balance. The tongue, cheeks, lips, and the neighboring teeth must all work together in order to maintain the position of even a single tooth. When even one of these factors is altered or removed, all of teeth can be affected.

When you are considering oral surgery in Chicago, whether it involves the removal of teeth or replacing missing teeth, it is important to understand the chain reaction that accompanies your decision. When our oral and maxillofacial surgeons remove one or more teeth, it is important to explore the impact to the remaining teeth. 

Preventing supra-eruption can be as simple as discussing tooth replacement with our experienced dual-degreed Chicago oral surgeons.

In a phenomenon known as supra-eruption, a tooth will continue to migrate outward unless it is stopped by an opposing force.  Essentially, a tooth needs an opposing tooth to keep it from growing right out of the socket! An upper tooth with no lower tooth to contact it will continue to grow down into the space once occupied by another tooth. A lower tooth with no upper opposing tooth will also continue to grow upwards until it meets some form of resistance.

The risks of ignoring a supra-erupted tooth can be significant. Most patients begin to notice more frequent cheek biting or biting the gums due to the “overgrown” tooth.  As the tooth continues to grow, it begins to lose the support of the surrounding bone. The relationship between the supra-erupted tooth and its neighbor also changes. You may notice new food traps or difficulty cleaning the gap between the teeth, leading to gum disease.  Additionally, the lack of adequate access to clean between a supra-erupted tooth and its normally positioned neighbor usually leads to decay involving both teeth where they contact each other.

Preventing supra-eruption can be as simple as discussing tooth replacement with our experienced dual-degreed Chicago oral surgeons. A dental implant, which can be placed when your natural tooth is removed, is a popular and the best solution. The implant, which will be the same size, shade and shape as your natural tooth, can restore your biting surface and help to maintain the healthy position of any surrounding or opposing teeth.

If you are facing tooth loss, or have lost one or more teeth, contact ORA® Oral Surgery & Implant Studio at 312-328-9000 today to learn how you may be able to prevent supra-eruption.

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On February 6th, 2012, posted in: oral surgery by

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What is a dry socket after a tooth extraction?

If you’re a Chicago patient facing a tooth extraction, your oral surgeon may have mentioned the possibility of dry sockets as a complication of the procedure.

The term “Dry Socket” sounds scary, but let’s delve into exactly what it is and how your Chicago oral surgeon can remedy the problem rather easily.   Just after your oral surgeon has removed a tooth, a blood clot should form in the now empty socket as part of the healing process. That clot protects and insulates any nerve connections that were separated from the tooth during its extraction and provides an initial framework for new bone to eventually form as a patient heals from the extraction. 

Dry sockets are often associated with wisdom teeth extraction, but they can occur after any permanent tooth is removed from the mouth.

When the blood clot fails to form, or if the clot is dislodged or breaks down during the first few days after the tooth extraction was performed, the nerve is no longer shielded. Patients can experience severe pain as a result of the nerve’s exposure to the oral cavity and everything that enters it.

The technical term for a dry socket is fibrinolytic alveolitis, or alveolar osteitis.  Fibrin is fibrous protein involved in the clotting process.   The alveolus is the bony area (osteo –Greek meaning from bone) of a tooth socket that surrounds the roots of teeth.    “Lytic” – means dissolution, dissolving or breaking apart and “itis” refers to inflammation or irritation.  So a dry socket is the premature loss or breakdown of a blood clot in the tooth socket resulting in an inflammatory, irritating response to the surrounding bone, and the release of chemical pain mediators.  All of these factors result in throbbing, radiating, and difficult to manage pain.

Dry sockets primarily occur in the posterior back region and predominately with lower teeth.  Although dry sockets are among the most common issues that arise from a tooth extraction, patients can take steps to avoid the condition. For the first 48 hours after your extraction, avoid strenuous activity or high aerobic activity.  Do not smoke, drink through a straw, swish vigorously or expectorate forcefully for 4 days.  Additionally, you should avoid carbonation for 4 days as well.. Stick to pureed foods immediately after the extraction while the effects of the local anesthetic are still present and slowly advance the consistency of your diet as tolerated.

Dry sockets are often associated with wisdom teeth extraction, but they can occur after any permanent tooth is removed from the mouth. Be on the lookout for symptoms following any extraction. The onset of pain typically occurs around 72 hours after an extraction, and it may intensify without relief form medications like Ibuprofen 800mg or even narcotics.  A certain amount of discomfort, sometimes significant, can be expected with any tooth extraction, but dry socket pain is persistent and severe, and the telltale sign is that it does not respond to prescription narcotic painkillers. If you have such pain, schedule a follow-up appointment with your oral surgeon as soon as possible for evaluation and definitive treatment.  Dry socket is a self-limiting condition, meaning that even if it is not treatment you would go on to heal normally, however, you would have persistent intense pain for 10-14 days.

Fortunately this Chicago oral surgeon utilizes a few things to help prevent and also treat dry socket.  First, he usually dispenses an oral hydrocolloid gel called “Sock-it” which soothes the socket, promotes healing, decreases the incidence of dry socket, and is bactericidal.  Second,  if you were to develop a dry socket, he utilizes a special dissolvable dry socket medicated dressing that gets placed within the socket that alleviated the discomfort within a few hours.  The key is, prevention first, but if you develop a dry socket then you shouldn’t “wait it out” or be stoic about it.  Relief is just a phone call away to this Chicago Oral Surgeon at ORA Oral Surgery & Implant Studio at 312-328-9000.

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On January 18th, 2012, posted in: tooth extraction by

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Common Causes and Symptoms of Toothache

toothache ChicagoAn aching tooth can make you miserable and disrupt your daily routine. You may get temporary toothache relief from aspirin or ibuprofen only to have the discomfort rear its ugly head again just a few hours later.  The severity of pain that can come from a toothache can be evidenced by patients making frequent statements like, “toothaches are worse than childbirth”, or like “toothaches are like passing a kidney stone”.

Whether you have tooth pain that comes and goes or a toothache that lingers for days, you should visit our experienced dentists and oral surgeons at ORA® Oral Surgery & Implant Studio for an examination to learn what is at the root of your discomfort.  Your oral surgeon can also recommend an appropriate treatment.

Any number of factors can cause a toothache in Chicago patients. The most common culprit is tooth decay.  As the cavity-causing bacteria eat away at teeth’s inner and outer structures, patients may have accompanying pain.  If the decay evolves into an abscess, an advanced infection of the tooth’s root or pulp, your toothache will be even more severe.

Other causes of toothaches include dental trauma or injury (such as a fractured tooth), infection, gum disease or bruxism (tooth grinding).

Your Chicago oral surgeon may recommend a number of approaches for treating your toothache depending on its cause. If a small cavity is the problem then it can be easily filled by a dentist, thereby eliminating the toothache.  Antibiotics can help to control an infection causing dental pain, while a mouthguard can be helpful when toothache is caused by grinding of the teeth.

If your toothache fails to respond to more conservative interventions or the decay has progressed too far, you may need to visit an endodontist rather than an oral surgeon to get relief. A toothache that involves the dental pulp likely will necessitate a root canal.

Alternatively, the tooth may not be able to be saved, leaving extraction as the only viable treatment option, which is where an oral surgeon will once again enter the picture.  Through the comforts of sedation, he can remove the non-restorable tooth, clean out the infection, and fill that area in with a bone graft, carrying out a technique called ridge preservation.  This will prevent the socket from collapsing and the surrounding bone from atrophying, thus preserving the bony ridge.  This will ensure a proper site for a dental implant to replace the previously painful extracted tooth.

The pain associated with a toothache can take on many forms. It may be sharp and shooting, dull and throbbing or somewhere in between. It can be localized tooth pain or the toothache pain can radiate into the ear or temple region. You may also even have halitosis, commonly known as bad breath, from the bacteria that are causing a decay-related toothache.  In addition to the discomfort, you may also notice swelling in the vicinity of the tooth, which is a sign of a potentially serious problem.  If a swelling is present, if you develop a fever and chills or nausea and vomiting, then this is a sign that the infection has spread beyond the tooth and can turn into a serious life-threatening emergency.  Do not delay contacting an oral surgeon immediately.

Patients should not wait out a toothache for any longer than 1-2 days. Contact ORA® Oral Surgery & Implant Studio at 312-328-9000 as soon as possible.

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On January 4th, 2012, posted in: toothache by

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How is a wisdom tooth removed?

There may be no better time than now to have a wisdom tooth removed. With the notable advances in modern dentistry and oral surgery, wisdom tooth removal can be a straightforward outpatient procedure with extremely predictable results.

Patients who may be considering wisdom tooth removal in Chicago IL should schedule a consultation with Dr. Steven Koos, an experienced dual-degree oral surgeon, as soon as possible. The consultation is an important part of the procedure since it affords patients the opportunity to meet the oral surgeon and the staff as well as ask specific questions about the treatment.

During the consultation, Dr. Koos will also gather important details about your medical health and dental history. The wisdom teeth will be evaluated in order to determine the appropriate procedure for their removal. According to the position and condition of the wisdom teeth, Dr. Koos may recommend a variety of procedures. 

With the notable advances in modern dentistry and oral surgery, wisdom tooth removal can be a straightforward outpatient procedure with extremely predictable results.

A surgical extraction is often recommended for a wisdom tooth that is fully erupted. When the tooth is completely visible in the mouth, the hard and soft tissue around the tooth is anesthetized and the tooth is sectioned and a rim of bone is removed and the tooth is extracted with surgical forceps.

A more involved surgical extraction is necessary when the wisdom tooth is partially or completely covered by gum tissue or bone. After the appropriate anesthesia is given, a surgical incision is often required to reveal the tooth prior to extraction. For wisdom teeth that are surrounded by bone, a window in the bone may need to be removed in order to gain access and expose the tooth.

It is very common for patients to be especially concerned about their level of comfort during the various procedures. Our Chicago oral surgery team is committed to creating a soothing and relaxing environment designed to reduce your stress and improve your comfort.  Local anesthesia is typically used to numb the teeth, gums, and nerves in the area of the surgery after your are comfortably sedated, this way you will not even feel the injections! Various levels of sedation are also available to promote comfort and relaxation before, during, and after the procedure.

Each wisdom tooth removal procedure is unique. Contact ORA® Oral Surgery & Implant Studio at 312.328.9000 today to learn more about what you can expect during your procedure.

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On December 19th, 2011, posted in: wisdom tooth removal by

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