Surgical Extraction Technique

For Dentists (& interested patients)

This information may fly in the face of what most dentists are taught. It is a little different to what most universities teach, and different to what is considered ‘ethical’ by most dental associations. To surgically remove teeth that can be removed with forceps only, is considered unethical. It is certainly considered unnecessary to remove the periodontal ligament and some surrounding bone. What is described here is considered over servicing by most dental boards.  Health and wellbeing is not a necessity for these ‘ethical’ institutions.

This is NOT an instruction manual and should not be treated as such. The following information is an outline of the procedures that I used, which proved very successful in thousands of extractions.

What do I call a successful outcome after tooth removal?

• Little to no trauma to the surrounding bone
• No evidence of compression necrosis of the surrounding bone
• Excellent healing with a dry socket rate of about 1 in a 100 compared to about 1 in 10 for forceps extractions.
• No post operative bleeding.
• Little to No post operative pain.
• Little to NO post operative swelling
• No damage to adjacent teeth or other tissues.
• Resolution of medical issues that were related to the tooth.

This might all sound too good to be true, but this is my experience.

The following is mainly for teeth that are firmly embedded in bone. For teeth that are already flapping in the breeze, and are seriously periodontally involved, it is OK to use forceps and lift the tooth out. This is NOT the end of the procedure. The socket still needs to be carefully cleaned. All information from cleaning the socket till the end is still relevant.

Relax – I’m the Dentist !

I never tell a patient to RELAX.

I stop all dental assistants from using this word.  If you were in the chair with all that stuff happening to you and someone told you to relax, you would possibly want to hit them.  At this stage the patient is in a heightened state of ‘fear of being mutilated’.  This state of fear is contradicted internally because they know that they ‘SHOULD’ trust the dentist.  (By the way, the word ‘should’, comes half way in the dictionary between shit and suicide). Telling the patient to relax is contradicting the unconscious state that they are experiencing.  Unconsciously you are telling the patient that you do not recognize or accept their fear.  This will create a huge chasm in their trust for you.

Teaching the patient HOW to relax is quite a different matter;

• Use whatever techniques you are comfortable with.  Pay close attention to their body language.  They will rarely tell you verbally how they feel.  Work with the body language rather than the conscious mind.
• ALWAYS, ALWAYS, ALWAYS, make the patient the centre and focus of your attention.  Remove ALL interaction which distracts from this critical relationship.  Messages from the receptionist, phone calls about your partner’s dramas, or the upcoming golf game, are for a different time and space.
• Tell the truth – if you are going to hurt someone, tell them that they will feel something, even if it is a ‘mosquito bite’ to explain what they will feel as the needle punctures the mucosa.  The higher the level of reality, the greater the chance they will trust you.  You don’t have to be perfect, just be real.  Let the patient know you are totally there for them.  This means keeping your own problems to yourself. 
• Teach the patient how to breath, – explain how they can sense different parts of their body and let the tension go from these parts, gently and softly.
• let the patient hold the armrest of the chair and ask them to do it softly, 

The Screwed Eyes and Body

When is the moment?

The moment that the needle is about to enter the mucosa, is the moment that the patient is at their most vulnerable, out of control and confused.  This is the VERY WORST time to say the word ‘relax’.  It is also the time that most dentists will do precisely that. It is also the time that many dental assistants will tell the patient to relax. Teach your assistant that if they keep doing this, one of the patients, one day, might just take a swipe at them. Teach them, so they too understand.

It is the very best time to teach the patient a valuable self-help tool. You can use this state of utter despair to yours and their advantage. 

At the precise moment that the needle is about to enter the mucosa, I say to the patient ‘BREATH’ & a moment later I also say ‘now breath out as well.’ As they begin to breath out is when the needle penetrates the mucosa.  ‘Keep your breathing soft.  If you are feeling any pain from this injection, please scream at me as it means that I am injecting too quickly – I need you to tell me.  Please don’t expect pain, but if you do feel any, I can slow down immediately.’  This approach gives the patient the control and immediately removes 90% of the tension.

BE GENTLE – this battle is not won by being dominant.

Some Cosmic Advice

Breathing – it is critical that the patient breaths comfortably.  When people hold their breath, they are holding on to ‘everything’, including the tooth that you are trying to take out.  I teach the patient that every time we breath in, we are using energy to lift our rib cage, which then sucks air into the lungs.  Every time we breath out, it is really a ‘letting go’ process.  In fact, what happens is that every cell in the body ‘let’s go’ – this includes the cells of the ligament which holds the tooth in.  So, if you want that tooth to come out easily, then you can ‘breathe’ it out.  Although this may sound like the raving of a cosmic cookie, it actually does work, and there is I believe a physiologic basis.  It really does make for simple extractions.

Keep your own breathing calm.  If you notice that you are holding your breath, you will send that message to your patient and dental assistant.  Make sure that you keep your own breathing calm.  If you are sweating, then make sure it is because you are too hot rather than too tense.

Slow Down the Bleeding

Some practitioners are adept hypnotherapists and can easily take their patients off to a happy island with bells and whistles and lots of birds etc.  I find this approach time consuming and a little unrealistic.  I prefer the use of conscious hypnosis and metaphor.  I often use the concept of taking a shower.  I tell patients that when they are having a shower, the first thing that they do is turn on the hot water and let it come through.  They will then turn on the cold water, and get the temperature just right, so that they can get in and enjoy it.  Today though, they have the opportunity to have a really long relaxing shower, and to achieve this they need to turn the hot and cold water ‘taps’ down, so that they have plenty of water to keep warm and comfortable but will not waste the water and it will not run out. 

By this stage most patients look at me in horror, confusion and disbelief that I may be making some really inappropriate remarks, and they are really thinking that they should leave now, before I pick up the scalpel.  I know that I have them at a stage of confusion where the next positive statement becomes acceptable.

Perfect.  This is the stage that I make it real and contextual. 

I then say, ‘just as you can see yourself turning down the water taps of your shower, so too can you turn down all of the little taps in the blood vessels in the area we are working, so that there is enough blood to keep everything healthy and you will not waste any’. 

There is usually a grateful acceptance, a bit of a laugh and we are ready to start.  You will find that we all have the ability to limit our bleeding – and it is so much easier to work in a blood free zone than to suffer with a clogged sucker.  When this happens and the patient is relaxed, you will cut a flap in the gum and there will be hardly any bleeding.  If you can tie the metaphor to reality and make it fun, it is that much easier for the patient to understand, accept and then act upon.

Teach the assistant to retract the cheek with a mirror or other instrument.  If the suction is used to retract the cheek, it can never be used to gently do what it is supposed to do – suction.  One hand retracts while the other is using the suction and moving freely around the mouth.

If you are the patient reading this, remember that you are able to do all of these things by yourself. You might even teach the dentist how to breath and not be so uptight. The more you can relax in these scary situations, the better the procedure will be.

Planning

Allow one hour for most surgical extractions.

Thorough Medical History

I and you are not better than the patient. We just have a particular skill set. Every other person also has a particular skill set. We can all learn from each other.

My first appointment with most patients was usually for one hour. Patients were informed of this and were quoted a fee for this when they rang to make the appointment. An information brochure and Medical History Questionnaire, were posted to the patient so that they had time to digest the material and bring all relevant information with them. This allowed time to discuss their medical history and to get to know each other. Have the time to listen to the patient. I found that this is the best way of gaining confidence. Find out when a disease began. Compare their dental history to their disease history. Did the problem begin after a gold crown was added to the mouthful of amalgam? Did it start within a year or less of having a root canal done? Find out what treatments have been tried. Find out what worked for that patient, even though you might consider it a bit cooky. The longer I worked the more I began to respect the cooky.

Answer questions as best you can. There is no harm in saying ‘I don’t know’. You are not god or a specialist, and you don’t know everything. There is always room to learn though.

Most dentists rely on a set of six or seven questions for their medical histories. These are acceptable to cover you legally but are useless for getting to know the person sitting in your chair. One aspect that I always paid close attention to, was the person’s allergies/sensitivities. Latex allergies for example means wearing non-latex gloves. It also precludes implanting Gutta Percha into the tooth that you think you can fill. It may also be a clue to take out any old root filled teeth. I have seen many symptoms of latex allergy disappear after removal of these dead, root filled teeth.

The Medical History Questionnaire that I used for many years, became a gold mine for the patients and me. Such a medical history can be referred back to in six months or a year, after the treatment is completed. I used to make a note of the date and would go through every item again with the patient and see what changes had occurred. You will begin to grasp the importance of removing dead teeth and also such a questionnaire. Symptom improvement was also noted with the new date. You can also ask the patient to fill out a new one and see the differences. It is very common when symptoms disappear, that the patient forgets the pain they used to have. It is a reminder for them as well of the health improvements.

As you use this questionnaire, you will begin to see patterns emerging in relation to onset of symptoms/disease states and other factors such as dental and medical treatments, personal histories etc.

Informed Consent

This is what informed consent could look like.

Ensure that the patient is totally informed about what you plan to do and why. The more the patient understands and accepts, the more pleasant the experience will be for everyone. I believe this is also a large contributing factor to the final outcome. Yes, I know this smacks of ‘Placebo’. Your 100% correct. The placebo affect is very important and not to be understood as some sort of derogatory conspiracy against the treatment.

I always told my patients that I could take out the garbage, but it was up to them to do the healing. Most medical literature puts placebo for any treatment at about 30%. This means that for 70%, it was likely that the treatment helped. The placebo group, tell us a different story. Clearly this group of people are able to heal themselves. Whatever the method, this group of people have an innate ability to create healing. This also tells us that if 30% can do it, then possibly 100% of us are able to, if given the opportunity. The creation of a calm, caring and clear space is certainly a part of this. Being informed and having confidence and no fear in the dentist, will allow the patient to be in a more calm, parasympathetic state, with less adrenalin floating around their body. This allows the body to heal – that simple.

Fully informing the patient, means being 100% honest with them. Inform them of potential problems e.g. involvement of the inferior dental nerve, sinus exposure, root fracture etc.

Discuss options for replacing the tooth/teeth that are coming out. Possibly prepare a temporary immediate denture in advance. See the Implant Page Here before going down this route, if you are looking out for the patient’s health.

Make sure you do a FULL and thorough oral examination. Make sure that you are planning to take out the correct tooth. Too often I have heard of the wrong tooth being treated or extracted. This really is mud on your face!

I include Here an Informed Consent Form that I used in my practice. You are welcome to modify it at will and use it at will.

Electrical Considerations

Very often the tooth/teeth you are about to remove, will have some sort of metal filling in or on them.  There is often metal in the other teeth.  These days there is often an implant or two.  Dr Hal Huggins demonstrated the need for removing amalgams in the correct electrical order.  If you don’t, you might find the patient in hospital with a heart attack that night.  This is the situation that prompted Dr Huggins to explore the relationship to currents in the mouth.  This is also what happened to a colleague of mine who was working in my surgery.  No fault of his at all, as the patient came in with a very painful old root canalled tooth.  It had an abscess and it needed to come out.  It was an upper second premolar and a very simple extraction.  Thankfully the patient lived.  The rest of his amalgam removals were done one at a time, in order of the measurements we took at each appointment.  If you don’t have the equipment, (which most of you reading this won’t), at least be aware of this possibility. 

X-rays

PAs and OPGs  are minimum requirements.  For more complex work like lower third molars, you can’t go past a 3D Image.  This will show immediately where the roots are in relation to other structures.  It will also give you a good idea where the abscess is in the palate in relation to the roots.  Often, I found the abscess invisible on the OPG or PA and penetrating into the palate a good centimeter. Hidden on these radiographs by the shadow of the root.  3D imaging usually shows this. This also applies to teeth that have weird bends in the roots and are in line with a PA that is invisible to the X-ray. Such a root will most likely break if you use forceps on it.

Anaesthesia

I almost never used any anaesthetic that contained adrenalin.  I just did not like the stuff and found the post op healing to improve, when I eliminated it from my practice. 

If there is one thing that freaks everyone out, it is a pointy needle coming at their heads.  “You know it’s going to hurt like hell, as it goes through your skull, your brain and out the other side.”  Sadly, this fantasy is a reality for most patients who have been treated by dentists, who don’t know any better. Most have no respect for this part of the procedure and consider it a waste of time.  WRONG!  Learn to give a painless injection.  After you can do this, your practice will fill with happy patients who will refer every one of their friends.  Yes, it takes a little time, but the payoff is worth every second of it. What’s the rush anyway. Life can be much easier if we slow down a little.

1 Use lots of topical anaesthetic.  Leave the cotton bud in situ. Leave it there for a minute or so. (Too many times I’ve been wiped with a bit of topical, and 2 seconds later the needle is going through my gum and the pain is explosive. Wrong Approach.)  The topical will numb the tissue far below the mucosa if you give it the time to do so. (wet the cotton roll slightly before removing it, so as not to damage the mucosa)

2 When you are about ready to inject, get the patient to breath consciously and gently.  Get into the same breathing cycle with them.  This only takes a handful of breaths.  Just before the needle goes in, when you have it about 3mm from the mucosa, get the patient to take a breath IN.  As they and you begin to breath out, slide the needle in just below the mucosa, and as you do this inject just a drop or two of anaesthetic. 

I ALWAYS used the breath.  This is basic for all procedures and all life.  If this is a new concept for you, you may want to start practicing.  It is so simple to do and so incredibly effective.  Try it on yourself.  Press hard with your finger nail into some sensitive skin as you are reaching the height of your inhalation or been holding your breath for a while as most terrified patients do.  Hurt yourself.  Then do the same as you are exhaling.  I bet you will press much harder before you feel pain.  I use the breath at all stages of the extraction.  If you start by doing it with the anaesthesia, than you are training the patient and yourself for when you will use this technique a little later.

3 Let the anaesthetic work before inserting the needle to the desired depth.  Keep injecting at about the rate of 1 drop per second.  NO Faster.   Once you get to your destination, keep injecting at the rate of about 1 drop/ second for at least half of the cartridge.  You can speed up a little after this.  If the patient flinches even slightly, lighten up on the pressure.  What’s the rush? The hand that is holding the cheek while you are injecting, has another role aside from being a retractor. Train yourself to be sensitive enough to feel the flinch. Almost all people will flinch before screaming. Your retraction hand should also be your radar. You can feel the flinch and respond appropriately, before the patient screams the place down. They will love you for this level of sensitivity. It is unspoken and always perfect.

Dental anaesthesia is painful because the dentist injects too quickly.  If the patient is feeling pain, you are injecting too quickly.  There is NO verbal apology or reassurance that will stop this pain.  Only your technique will do this.  The reason it hurts, is because the liquid has nowhere to go, but to tear the tissue on the inside, where you cannot see it.  High speed means that this tissue is not yet numb.  If you go slowly, the tissue will be numb in advance of more liquid going in.  If you go slowly enough the liquid will have time to diffuse through the tissue layers rather than acting as a blunt dissection.

It would often take me a minute or more to give a local anaesthetic. 

A ten second injection is, in the experience of the patient, a ten hour torture!

No Pain at this point = Happy relaxed patient = Happy relaxed dentist.  Take your time and make it a great experience rather than one of ‘having gone to the dentist’.  All that I ever needed to do to gain the patient’s trust, was give a painless injection.  It really is that simple. 

The Dental Nurse / Assistant

Never underestimate the value of a great dental nurse.   Take the time to teach them and you will be well rewarded.  Dentistry prides itself on a no touch technique.  In this modern world of ours, touching another person is frowned upon as some sort of weird sexual act.  We are human.  We need touch.  We are electrical beings and touch does much more than affect the skin. 

A phrase from one of Leonard Cohen’s songs, “I couldn’t feel, so I learnt to touch.”  It is profound. 

It makes no difference what words you may use, when you touch a person, your intent is transmitted and read instantly. If your intent is anything but healing, then don’t touch the person in your chair. This process is completely unconscious but the response to the touch will be immediate. Our intent is transmitted more profoundly and more instantly than any words could hope to have.

A gentle caring hand on the patient’s shoulder can do more than all of your techniques combined.  Train your nurse or perhaps let your nurse train you.  They are usually more humane than we dentists.

Train the nurse to be very proficient at using the sucker and the water spray.  There is nothing worse than feeling like you’re drowning on your own blood.  Next comes drowning from the water that is floating down the back of the throat.  Take the time to train your assistant.  She/he is part of the whole process.  They are not there just to hand you things.  Make them as important as you in whatever procedure you are doing, including the first consultation.  Teach them.

I repeat: Teach the assistant to retract the cheek with a mirror or other instrument.  If the suction is used to retract the cheek, it can never be used to gently do what it is supposed to do – suction.  One hand retracts, while the other is using the suction and moving freely around the mouth.

Remove the Crown of the tooth

You can now see clearly where the top of the roots are and will be able to section them more easily.  There is now no chance of poisoning the patient with mercury.  If you do this before raising a flap, then there is no chance of amalgam specs getting into the soft tissue and blood.

Exposing the tooth

After the crown is out of the way, it is time to raise the flap.  Make the cut with your scalpel firm and precise and all the way to the bone.  Do NOT tear the tissue.  Raise it very gently.  Make the cut long and deep enough into the sulcus that there is NO pressure or stretching on the soft tissue.  Do not stretch it or tear it.   This is an important preparation for good healing later. Tissue heals across the wound, not along it. Therefore, it will heal as quickly, whether a short or long cut. Stretched and damaged tissue will take a lot longer to heal.

NEVER ever use a high speed bur to cut the bone.  It will burn the bone no matter how much water you think is hitting the bur.  A bur buried in the bone is not the same as one which is wiping away a part of the crown of the tooth.  It will always burn the bone and the damage will be far deeper than the surface that you have cooked.  This will become dead bone and will not heal.

Separating the Roots

Once the furcation of the roots is well exposed, you can then switch to the high speed drill.  I rarely did what I was taught and particularly this part.  Now that you can see where the roots are separating, and there is no bone to be touched, you don’t need to guess by drilling from the occlusal side of the roots.  Note that when you do this old style separation, the tip of that High speed bur will be burning the bone below where it penetrates.

Place the bur horizontally in the exposed furcation area and start to drill up toward the crown of the tooth.  This will then separate in the perfect place.  You can then go lingually when there is only a small amount of tooth left to be drilled.  For upper molars, I would take this cut as deep as the part of the palatal root that I could see.  It is then easy to separate the palatal from the buccal roots by cutting from the top.  Now you know how deep to go without touching the bone.  Use lots of water.

Remind the patient to keep breathing while you are doing this.

Using a luxator to Remove the Roots

Of course, I made use of these tools, but only to aid the removal of the loosened roots.  The way that forceps work when relying only on them, is to compress the bone to loosen the tooth.  This causes Compression Necrosis – dead bone.  Dead bone cannot heal.  It is dead.  This is one of the most common causes of dry sockets.

Elevators work like a crowbar.  They apply a great deal of lateral pressure to try to lift a root vertically. They often are used with great force which either compresses the bone or breaks the root.

Luxators are much finer instruments and when you learn to use them you will never go back.  It is held vertically, parallel to the root, and gently let down into the space between the root and the bone.  It will cut the periodontal ligament on its way to the apex.  Very gently work your way around the circumference of the root and gradually the root will loosen enough for you to go a little deeper.  Keep working around the circumference of the root.  It is not an elevator and should no be used as one. Yes, you will still get some compression of the bone but nowhere near as much.

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Have the patient breathing slowly, gently and consciously. By now they have had about 4 opportunities to practice this. They will know, at least unconsciously, that it has helped them at different stages. Dentists need to learn to work with the patient’s breath and not against it. This is very important. One way to get into this habit, is to synchronize your breath with the patient’s. If the nurse can get into this party as well, then all the better. Everyone consciously breathing! Try to apply pressure only on the outbreath. This is working with the breath. (Pressure on the inbreath is working against the breath.) Make the patient part of the procedure. Have them imagine that every time they breath out, the tooth will loosen and that they can breathe that tooth out. I know that from a dental point of view this might sound a little crazy. All I can say is try it. You may be pleasantly surprised.

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The Broken Root

It is inevitable that some roots will still break.  All this means is that you remove a bit more bone and go digging.  Buy some fine pics for the root tips.  It is not a disaster and it just takes a little more time.  The gentler you are with the luxator the less frequently this will happen. 

With a luxator you can see and feel the direction the root wants to come out. Upper and lower molars will have roots facing different directions. They all want to come out according to their individual orientation. Pulling such a tooth with forceps will most likely break at least one of them, because you are restricted to taking it out buccally only. (or the bone will break). If you do get it out in one piece, then you have compressed a great deal of bone. This bone will die, and you’ll be treating a dry socket in a few days. It is also barbaric for the patient, to have so much pressure applied, only to be in agony for a week later. The idea that the nurse should hold and stabilize the patient’s head for the dentist to yank on the tooth, is a concept born in hell.

It is still ESSENTIAL to remove the broken bits of root.  DON’T leave them in the socket and pretend that it is O.K.

Recently the idea of ‘decoronation’ is becoming popular.  To save the patient from potential harm to the Inferior Dental Nerve or a perforation of the sinus, some oral surgeons are advocating to leave the root in situ after chopping off the crown.  HENCE IT HAS NOW BEEN GIVEN A NAME. They pretend that the root is sterile and that the body will cope well with this.  All I can say is that this is just an excuse for sloppy, lazy work which is an abuse of the patient and all medical/dental principles.  The roots will die.  They will always be infected. They will always remain an area of focal infection and neural interference.  If endodontists are so careful to attempt to fill and seal the canals (which they cannot do), then what gives the oral surgeons the right to think that it is OK to leave the roots to rot in the bone?   This is really slop work. It stems from what the dental associations claim to be unethical about what I am describing here.

Cleaning the Socket

Keep reminding the patient to breath.

I know we are taught to pull the tooth, chuck a bit of gauze onto the socket, and get the patient out of the surgery before the bleeding and the pain begin.  Part of the barbaric thinking.  Even if you take a tooth out with forceps only, you are in reality, performing surgery.  Just a sloppy kind.  Every extraction deserves to be treated as surgery on the body.

All dead teeth, whether root canalled or not, will have infection in the periodontal ligament and the bone.  If the tooth has had a root canal procedure, than the root filling materials will have leached out of the root and infiltrated the periodontal ligament and the bone, before marching through the rest of the body.  Most of these materials are cytotoxic at best and carcinogenic at worst.  They kill cells.  Bone that is poisoned and dead from these materials will not heal.  This is the second greatest cause of dry sockets.  Leaving an abscess in the bone will leave a PERMANENT source of infection to the rest of the body. 

We are taught that the white blood cells will come along and gobble up all the mess that is left in the socket.  Very occasionally this might happen.  Most often, new bone will form around these necrotic infected areas and the result will be a cavitation.  Dentists are trained to NOT look for these areas as they are difficult to find.  Simply ignore the whole concept.  It is unethical after all, to remove the tooth surgically, remove the periodontal ligament, remove the abscess and even to place a suture unless absolutely necessary.  These ethics are set by trade organizations who are only answerable to their shareholders.  These ethics have nothing to do with a healthy outcome for the patients.

Many of the anaerobic toxins from the organisms in the apical abscess, will prevent blood clotting.  Leaving this abscess means that the patient will continue to bleed for hours, sometimes profusely.  You will find lots of bleeding while removing and scraping out the abscess and this is where the dental nurse will come to the fore.  You will also find that when this messy tissue is removed and you have scraped down to health bone, the bleeding will change to a slow oozing.  It usually stops as the socket fills, all by itself.  This socket will no longer cause a bleeding problem.

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Fatty Osteitis

If you take a little more time to clean the socket until the bleeding slows down, and wait and watch for this oozing with just a small surgical sucker nearby, you may start to observe something else.  Many times, there is what is called a ‘Fatty Necrosis’ or ‘Fatty Osteitis’ in the bone below these dead teeth.  When the bleeding slows, you can see shiny fat blobs floating on the surface of the blood.  This is the release of the fats from the necrotic part of the bone.  Scrape a bit more of the bone away and eventually there will be no more fat on the surface of the blood.  This is when you can start completing of the surgery.

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Washing the Socket

There is one more thing to do before suturing and gauzing and farewelling the patient.  Wash the socket.  Not with water.

Use local anaesthetic that does not contain any adrenalin or any other vasoconstrictor.  Sounds bizarre right?  The best anaesthetic to use, if you can get hold of it is Procaine.  This was the first synthetic anaesthetic after the use of cocaine.  It has a long history and safety record and has even been shown in German research, to have health enhancing effects.  Sadly, this is not available in all countries. 

So why do this step?  Residual neural foci may remain in the bone even after the most careful cleaning. These foci can have profound effects on health.  Using a full cartridge of anaesthetic into the socket – slowly – will help to neutralize these neural interferences by repolarizing the nerves.

I know other dentists who also wash the sockets with various homeopathic remedies and have great results.  I personally have only done this a few times.  Dr Huggins also washed the sockets using a form of injectable insulin with magical results.  There is so much more to learn.

The concepts of Neural Medicine and Neural Focal Interference are dealt with here- Neural Medicine page.

Bone Grafts

I have never used a bone graft.  I know this is all the rage now and there is a dedication to maintain the height of the bony ridge, usually with the idea of selling an implant or two to replace the missing tooth.  BUT…

You have no idea where that bony implant came from.  In the 70s and 80s, much injectable tissue came from people who died in psychiatric hospitals. Unfortunately, some of this material was contaminated with a particular prion that cause Creutzfeldt Jacobs Disease.  Otherwise known as mad cow disease.  These prions are not destroyed by autoclaving or any other form of sterilization.  They can survive in a dormant state for years and the disease itself has a 14 year incubation period.  Most dentists will not be seeing the patient 15 years later, and certainly will not relate that bone graft done so long ago, with the madness now presenting in their patient.

Even if a bone graft can be fully sterilized, the process itself will only give you dead bone. A bit of calcium and phosphorous.  This is not a living bone graft. These bone insertions will always act as foreign bodies.  They may look great on an x-ray but they will always be foreign and have a destructive effect on health.

Suturing the Flap

All that now remains is to sew the wound up and send the patient on their way.  Some instructions and a pat on the back for being such a great patient is the last bit.

For patients that find it difficult to return a weak later to have the sutures removed, I would use dissolving sutures.  For those who were willing to come back in a week, I preferred Silk sutures.  They are much more reliable.

The reason I liked to see the patient a week later, was to follow up and check the socket, and also to have a chat and see how their health had changed.  I lost count of the number of women who reported that the breast lumps that had been there for sometimes years, had completely disappeared, within a week of taking out the dead upper molars.  The upper 6 & 7 and the lower 4 & 5 are on the Stomach acupuncture meridian, which passes through the breast. This is a very common neural interference.  There are some incredible stories you will hear, if you take the time.  I Never Charged for this follow up appointment.  It is just a part of the cost of the surgery.  Just the last part of the procedure.

Post Operative Care

This is the Post Operative Instructions, that I used to give to my patients.