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 apicectomy.
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 hospital
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
anaesthetic 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
the doctors or nurses.
