Oral surgery in our office is simpler than the word makes it sound.
Most extractions, along with wisdom teeth, bone grafting and implant placement, go to oral surgeons and periodontists who do them every day. Now and then we take out a tooth here, but only one that should come out easily, in a healthy patient. What we do is the part before and after: figuring out whether surgery is actually needed, getting the right images, planning what happens next, and restoring whatever the surgery was for.
The other exception is soft tissue. Tongue-tie releases and other minor soft tissue procedures are done here, with our CO2 laser.
Why the surgery goes to a specialist
Dr. Sandquist used to do more of this himself, including placing implants. He stopped for a reason that applies to all of it: a procedure that looks routine on an X-ray can turn into a much bigger one once it starts. A root wraps around a nerve, a sinus sits lower than expected, or the bone isn’t there. A surgeon who does this every day handles those moments routinely, in an office built for them.
So the line is drawn tight. A tooth that should come out easily, in a healthy patient, we may take out here. Everything else goes to people who are better at it, and that’s most extractions, especially now that so many missing teeth are replaced with implants and the socket is often grafted at the same appointment. What we kept is the diagnosis, our part of the plan, which we work out with the surgeon, and everything that gets built afterward.
The question before anything comes out
If you’ve been told a tooth needs to come out, the first thing to settle is whether it really does.
Sometimes the answer is clearly yes. Sometimes a tooth that’s been written off can be kept for years with the right treatment. Keeping a natural tooth keeps something an implant can’t replace: the ligament that holds it in the bone, and the natural feel of your bite that comes with it. We explain that trade-off in full here.
And if a tooth does have to come out, the next question is what goes in its place, because that can change what the surgeon does that day. A socket that’s going to get an implant is often grafted at the same appointment to preserve the bone. That’s a decision much better made before the extraction than after.
Wisdom teeth
This is the most common reason people look for an oral surgeon, and the evidence is less settled than most people are told.
When a wisdom tooth is causing trouble, like pain, infection, decay, gum disease, damage to the tooth in front of it, or a cyst, taking it out is an easy decision. The harder question is the wisdom tooth that’s impacted but not causing any problems.
The Cochrane review on exactly that question found only two studies that qualified, and concluded that there isn’t enough evidence to say whether symptom-free, disease-free impacted wisdom teeth should be removed or kept. Very low certainty evidence suggested that keeping them may be linked to a higher long-term risk of gum disease around the molar next to them. The one trial on crowding found no evidence that removing them made a meaningful difference to crowding of the front teeth.
Ghaeminia H, Nienhuijs ME, Toedtling V, et al. Surgical removal versus retention for the management of asymptomatic disease-free impacted wisdom teeth. Cochrane Database Syst Rev. 2020;5:CD003879. One randomized trial at high risk of bias and one cohort study at serious risk of bias. Neither measured the complications of keeping or removing the teeth.
So for a wisdom tooth that isn’t causing problems, the answer depends on that tooth: where it sits, how close it is to the nerve and the molar in front of it, your age, and what the X-rays show over time. That’s a conversation to have with the images in front of you, not a rule.
What goes with you to the surgeon
We don’t just hand you a name and a phone number.
- What we found, and why we think surgery is the answer, in writing.
- 3D CBCT imaging when the case calls for it, showing where the tooth sits, how close it is to the nerve and sinus, and the bone around it. More on the imaging we use.
- The plan for afterward. If an implant is going in, where the finished tooth needs to sit, so we can plan the implant together with the surgeon. Why that matters so much.
The surgeon then does their own consultation and makes their own surgical decisions, including anesthesia and sedation. Surgical offices are set up for options we don’t offer here, which is part of why the work belongs there.
After the surgery
For anything about the surgery itself, call the surgeon’s office first. Bleeding, swelling, pain that’s getting worse instead of better, questions about your instructions: they did the procedure, and they know what they found. Their aftercare instructions come before anything general you read, including here.
Once you’ve healed, your care comes back to us. That might be an implant crown, a bridge, a denture, a filling on the tooth next door, or just making sure everything healed the way it should. We stay in touch with the surgeon the whole time, so nobody is working from half the picture.
What we do here: laser soft tissue work
Not everything surgical leaves our office. Tongue-tie releases and minor soft tissue procedures are done here with our LightScalpel CO2 laser, which cuts and seals tissue at the same time. Dr. Lee-Mirzayan does the tongue-tie releases. A tie that restricts the tongue is often part of a bigger picture that includes breathing, swallowing and myofunctional therapy. More on tongue-tie release.
About cost
The surgeon’s office sets and bills its own fees, and they’ll give you their own estimate. What we can give you is the full picture of what the whole case involves, including what happens afterward, so the surgical quote isn’t the only number you’re looking at. How insurance works here.
Been told you need surgery?
Whether a tooth has been recommended for extraction, your wisdom teeth have come up, or you want a second look before you commit, bring it in. Call 702-734-0776 or tell us what’s going on.
Most extractions, including all surgical extractions and wisdom tooth removal, along with bone grafting and implant placement, are referred to oral surgeons and periodontists. Diagnosis, imaging, planning with the surgeon, laser soft tissue procedures, the occasional easy extraction and restorative care are done here. This is general information, not a substitute for an exam.