Oral and Maxillofacial Surgery

A tooth that cannot be kept

A tooth may need to come out when it is too broken down to repair, or when gum disease or infection has destroyed its support. If a filling, a crown, root canal treatment or gum treatment could keep it, those are discussed first. An extraction cannot be undone. In a simple extraction, the tooth is loosened with an instrument called an elevator and removed with forceps¹. In a surgical extraction, a small cut in the gum, removing some bone or cutting the tooth into pieces may be needed¹. Whether yours will be simple or surgical is sometimes clear only after the examination and X-rays. See tooth extraction.

A wisdom tooth that hurts or keeps getting inflamed

A wisdom tooth that is not painful and shows no disease is usually left in place and watched at check-ups². For impacted wisdom teeth without disease, a Cochrane review found insufficient evidence³ to decide whether removal or keeping them is better. Removal is discussed when there is disease, such as decay that cannot be repaired, infection, a cyst or gum inflammation that keeps coming back. Removing an impacted tooth is a surgical extraction. Dry socket is a painful condition in which the protective blood clot is lost from the socket. It is more common after the surgical removal of wisdom teeth than after routine extractions⁴. Less often, removing a lower wisdom tooth leaves the lower lip or chin numb⁵, because its roots can lie close to a nerve. This usually gets better but can take a few weeks or months²; rarely, it does not go away⁵. See wisdom tooth removal.

A missing tooth: implant surgery

A dental implant is an artificial root, usually a titanium screw, placed in the jawbone where a tooth is missing. Once it has fused with the bone, a crown or bridge is fixed on top. Placing it is surgery, and there is a healing period before the final tooth. An implant is not the only way to replace a tooth: a bridge, a removable denture or leaving the gap are options too. See dental implants.

Not enough bone for an implant

A bone graft builds up jaw bone where there is too little to hold an implant. A sinus lift raises the floor of the sinus in the back of the upper jaw, to gain bone beneath it. Neither replaces a tooth; both are extra surgical steps that make an implant possible. Not every patient needs one, and a graft is not the only route. For a shrunken (resorbed) lower jaw, a Cochrane review found short implants appear to be a better option⁶ than building the bone up in height. The review rests on few trials with few patients. See bone grafting and sinus lift.

Fear of treatment, or a long procedure

Most oral surgery is done under local anaesthetic. If you are very anxious, have a strong gag reflex or face a long procedure, conscious sedation may be discussed. It lowers anxiety, but it is not being put to sleep: verbal contact with you is kept throughout the procedure⁷. A local anaesthetic is still given to numb the area. A general anaesthetic is a separate decision, with its own team and an approved setting. The conscious sedation page explains who it is not suitable for, its risks and the escort rule.

An extraction, a bone graft and an implant are often steps of one plan. The usual order is below; not every plan has every step.

1. Can the tooth be kept? A filling, a crown, root canal treatment or gum treatment is considered before an extraction.
2. The extraction. Decide before it how the gap will be filled, and where. The options are an implant, a bridge, a removable denture or, for some gaps, nothing.
3. A graft, if the bone is not enough. In a staged graft, the graft comes first, and the implant follows once new bone has formed, which takes months. In some cases a small graft is placed in the same session as the implant instead.
4. The implant, at once or after healing. Sometimes the implant is placed in the same session as the extraction. In a 2017 review, 95.2 per cent of implants placed straight into the extraction socket survived, against 98.4 per cent in healed bone⁸. These figures are counted per implant and come from published studies, not from our own records. The authors ask for caution with same-session placement.
5. The crown or bridge. It is fitted once the implant has fused with the bone.

The order decides how many appointments and trips you need. Ask for the whole sequence in writing before the first step.

Your dentist asks about your health and your medicines before any oral surgery. Tell your dentist if:

• You take a blood thinner, or an antiplatelet medicine such as aspirin. Do not stop or change it for dental treatment⁹ unless your dentist or doctor tells you to.
• You take, or have taken, a medicine for bone thinning (osteoporosis) or for cancer. Some of these medicines, such as bisphosphonates and denosumab, can rarely cause a healing problem of the jaw bone (osteonecrosis). A leaflet for people taking them for osteoporosis says that an extraction or an implant raises this risk, though it stays low¹⁰. It also advises them to keep taking the medicine. People taking them for cancer are at higher risk¹¹. During high-dose cancer treatment with these medicines, implant surgery is usually avoided; taking them for osteoporosis does not on its own rule implants out¹¹. Any change to the medicine is decided by the doctor who prescribes it.
• You have had radiotherapy to the head or neck.
• You have a heart condition, or your heart doctor has said you may need antibiotics before dental procedures.
• You have diabetes.
• You are pregnant, or might be.
• You smoke. Smoking is linked to dry socket after an extraction¹² and to losing implants¹³.

Also mention any other medical condition and any allergies, and bring a list of every medicine you take, with the doses. Implants and grafts are planned with a 3D scan, which shows the bone, the sinus and the nerve canal. For a wisdom tooth, a 3D scan may be requested if needed. A plan made from photographs, or from an X-ray you send from home, is a preliminary assessment, not a final one.

Turkish law authorises every dentist to diagnose and treat the teeth, the gums and the mouth and jaw tissues directly connected to them¹⁴. Turkish rules add further requirements for some procedures and settings¹⁴.

Oral and maxillofacial surgery (in Turkish, ağız, diş ve çene cerrahisi) is one of the dental specialties set by law in Turkey¹⁴. It has its own training. The rules say that only a dentist with a certificate in that specialty, registered by the Ministry of Health¹⁵, may use its title. Turkish law also lists surgery of the mouth, face and jaws (ağız, yüz ve çene cerrahisi) as a separate specialty of medicine¹⁴.

On this page, “your dentist” means the dentist who examines and treats you. Before you agree to surgery, ask who will carry it out, what their title is and how often they do the procedure. Ask for the answers in writing.

When care belongs somewhere else

A Turkish regulation covers private dental practices, polyclinics, centres and hospitals that provide oral and dental care. It says that these facilities may carry out no medical procedure other than oral and dental care¹⁶. If your problem needs care beyond the treatments on this page, your dentist will tell you if you need a referral.

Some of the treatments on this page can also need another setting. If bone for a graft has to be taken from outside the mouth, general anaesthesia and a hospital stay may be needed. You are told in advance if this applies to you. If a general anaesthetic is discussed for you, ask where it would be given and by whom.

Whether you need surgery depends on your mouth, not on a trip. If you have pain, swelling or signs of infection now, get care where you are; do not save it for a trip.

Flying

A 2023 narrative review of flying after dental treatment suggests how long to wait before flying. It suggests 24 to 48 hours after a simple extraction and 72 hours after a surgical extraction¹⁷. After an implant is placed, it suggests at least 72 hours¹⁷, and after a sinus lift at least two, and ideally six, weeks¹⁷. These times assume there is no pain, swelling or bleeding where you were treated. The authors note that the research is limited and comes mainly from military aviation. Treat these times as a starting point for your dentist's advice, not as clearance. For a graft elsewhere in the jaw, ask the dentist who will treat you how long to wait. Sedation adds a wait of its own; the sedation page explains it.

Days and trips

• Extraction or wisdom tooth removal. Plan to stay near the clinic for the first days of healing. The signs of dry socket usually start 24 to 48 hours after the extraction¹⁸. Ask whether any stitches dissolve or will be removed before you fly home.
• Implant. The implant has to heal before the final crown or bridge is made, so the treatment usually needs at least two trips.
• Graft. A small graft placed with the implant often adds no trip. A staged graft adds a waiting period of months and at least one more trip.
• Sedation. A UK national standard covers conscious sedation in dentistry. For adults, it says that every form of sedation other than inhalation sedation requires an escort⁷. It also says that if an escort cannot be assured, treatment under sedation must not be provided. If you travel alone and want sedation, raise this before you book.

Before you book, ask for a written preliminary plan with the appointments, the trips and the days each one needs. It is based on your description, photographs and any X-rays you send. The examination confirms or changes it, and with it the days and the cost. You can say no, or ask to stop, at any stage. Once a tooth has been extracted, that step cannot be undone. Having the treatment with a dentist where you live remains an option.

Your dentist at home

The Dutch dental association advises you to discuss your plan with your own dentist¹⁹ before treatment abroad. If you do not have a dentist where you live, it helps to find one before you travel. If you have implants placed, agree before you travel who will see you for your implant reviews, and take your treatment record to them. Ask for a written record of what was done, with the materials used, and copies of your X-rays and scans. In Turkey, the health tourism regulation entitles international patients to an itemised bill²⁰. On request, they also get copies of the records of the materials used, the tests and the imaging²⁰. Before you travel, ask the health service or your insurer in the country where you live what they cover after treatment abroad.

Questions to ask before you commit

1. Who will carry out my surgery, and what are their qualifications and title?
2. Is my extraction likely to be simple or surgical, and what changes for my trip if it is surgical?
3. Will I need a graft? If so, which material and membrane, and where do they come from?
4. Which anaesthetic or sedation is planned, who gives it and where, and do I need an escort?
5. How many trips and days will I need, and when can I fly?
6. If there are complications, who pays for further treatment, extra flights and the hotel?
7. What aftercare do you provide, and whom can I contact once I am home?

A longer list, with our answer to each question, is on our page about dental treatment abroad.

After any of these treatments, contact a dentist without delay if you have:

• Bleeding that does not stop despite pressure
• Pain or swelling that increases after the third day, or that painkillers do not relieve
• A high temperature, feeling unwell, a bad taste, or pus from the area
• Numbness of the lip, chin or tongue that lasts after the anaesthetic has worn off
• If you take a medicine for bone thinning or cancer: unexpected pain, tingling, numbness or swelling at the treated site. Scottish dental guidance asks for these to be reported to your dentist¹¹
• After surgery in the upper jaw: discharge from the nose, a blocked nose, or liquid coming out of your nose when you drink

This can be the dentist who treated you or a dentist where you are.

Emergencies. Swelling that makes it hard to breathe, speak or swallow, or that spreads to your eye or neck, needs urgent medical help²¹. Do not wait for a dental appointment or for the clinic's reply. Go to the nearest emergency department or call the emergency number where you are.

Before you fly home, have the area checked, and take written aftercare instructions and a record of the treatment. Once you are home, see a dentist where you live if a problem starts. Each treatment page lists its own warning signs; the tooth extraction page also explains how to press on a socket that keeps bleeding.

This page carries no prices. A plan is prepared after an examination and X-rays, with a 3D scan for implants and grafts. The main factors that shape it are:

• Which treatments are needed, and how many teeth or implants
• Whether an extraction is simple or surgical
• Whether a graft or a sinus lift is needed, and the material used
• Imaging, anaesthesia and sedation
• Check-ups and stitch removal
• The number of trips

Ask for your plan in writing, including what it covers. Also ask who pays for further treatment and extra travel if there is a complication. The Dutch dental association advises counting all the costs, travel and accommodation included¹⁹.