Questions
The ones we are actually asked.
Grouped by who asks them. The audience switch in the header reorders this page; it does not hide any of it.
Everyone
Asked by both.
Medication, antibiotics, and who does what — the questions where the answer is the same whichever side of the referral you are on.
Not always. Most of our patients arrive by referral from a general dentist or an orthodontist, and that route works best because we start with your records and imaging. You can also contact us directly, particularly for a second opinion or for a lesion you are worried about.
Usually not. Current guidance for simple dental extractions is to continue direct oral anticoagulants and warfarin within the therapeutic range, and manage bleeding locally with packing and sutures. Stopping a blood thinner carries its own risks. We will make that decision with your prescriber where the case is complex, and never by asking you to stop it yourself.
Yes, and please tell us. Bisphosphonates, denosumab and some cancer treatments are associated with medication-related osteonecrosis of the jaw after extractions and implant surgery. The risk is much higher with intravenous cancer dosing than with tablets for osteoporosis, but it is not zero for either. It does not mean you cannot have surgery; it means we plan differently and talk about it properly first.
Place only. Patients go back to their own dentist for the restoration. We are a referral practice and being in competition with the practices that refer to us would be a poor way to run one.
Call the after-hours line. It is answered by one of our surgeons, not a call centre, and it is on the back of every set of written instructions we give out. Bleeding that has not settled with an hour of firm pressure, difficulty breathing or swallowing, or a swelling that is closing your eye or crossing your neck are all reasons to call immediately or go to an emergency department.
We see adolescents for third molars, exposure and bonding of impacted canines, frenectomy and pathology. Very young children and those needing extensive care under general anaesthesia are usually better served by a paediatric dental service, and we will say so and help arrange it.
Referring practices
Asked by referring doctors.
More on the referring doctors page, including imaging requirements by case type and what comes back to you.
Through the secure portal, by encrypted email, or by fax — whichever your practice already uses. The form on the referring doctors page covers everything we need. Anything urgent should be a phone call to the direct line rather than a form.
Prophylaxis by indication, not by habit. We follow current guidance for infective endocarditis prophylaxis and prosthetic joint patients, and we do not prescribe antibiotics routinely after uncomplicated extractions. Over-prescribing has costs, and we would rather explain that than write a script to end an appointment.
Yes. We hold assessment slots every week for suspicious mucosal lesions. Call the direct line rather than sending a form, and we will use one.
That is your decision and we will talk it through. Options are local anaesthetic alone, local with intravenous sedation, or general anaesthesia. Sedation means you will be comfortable and remember very little. General anaesthesia for most cases means a hospital admission.
For a straightforward extraction, one to two days. For difficult impacted lower wisdom teeth, up to a week. For a full-arch case, two weeks of soft diet and tiredness. For jaw surgery, two to four weeks. Book it in front of quiet days, not in front of something important.
We give a written estimate before anything is booked, and we will submit a predetermination to your insurer where the plan allows it. Surgical procedures often cross the boundary between dental and medical benefits, and we will tell you which side we expect yours to fall on rather than leaving you to find out afterwards.
By procedure
Questions attached to a plate.
Plate 01 · Third molar removal
Not routinely. Prophylactic removal of disease-free impacted third molars is not supported by the evidence, and we will say so. Active review with periodic radiographs is a legitimate plan, particularly in older patients where morbidity rises.
The retained roots stay vital in most cases and migrate away from the canal. A proportion later require retrieval — usually because they have migrated to a position where they are easy to remove, and often years later. Infection of the retained root is uncommon. We will tell you the specific published ranges at consultation.
Plate 02 · Dental implants
Place only, by design. The patient comes back to you for the restoration. We are a referral practice and we do not want to be in competition with the practices that refer to us.
We will want the indication, the dose, the interval and the date of the last injection, and usually a conversation with the prescriber. Oncology-dose antiresorptives are a different risk category from osteoporosis dosing. We do not refuse these patients reflexively, and we do not treat them without a documented discussion of MRONJ risk.
Plate 03 · Full-arch restoration
Four can work well in the mandible. In the maxilla, and in a heavy bruxer, more fixtures buy redundancy. The honest answer is that the decision is made on bone quality, opposing dentition and cantilever length, not on a brand name.
No. Bone reduction is permanent. If there is doubt, we will slow the plan down rather than start it.
Plate 04 · Bone & soft-tissue grafting
Often, for contained dehiscence defects and transcrestal lifts with adequate residual height. Not for large vertical augmentation or a lateral window with minimal native bone, where staging is more predictable.
We use platelet-rich fibrin in selected cases, particularly for soft-tissue handling and donor-site comfort. We would describe the evidence for it as promising rather than settled, and we do not charge it as a premium.
Plate 05 · Corrective jaw surgery
In selected cases with minimal dental compensation and a stable occlusal stop, yes — it shortens the overall timeline. It requires a very committed orthodontic partner and it is not the default.
Sometimes, where there is a functional indication and documentation to support it. It is medically billed rather than dentally billed. See the insurance page for how we handle predetermination.
Plate 06 · TMJ & facial pain
We prescribe a flat-plane stabilisation appliance where it is indicated, and we are usually happy for it to be made by the referring practice. We do not use repositioning appliances as a route to permanent occlusal change.
It may help where a skeletal discrepancy is loading the joint, and it may not. We will not present orthognathic surgery as a treatment for joint pain.
Plate 07 · Oral pathology & biopsy
Biopsy in practice is entirely reasonable for a small, clearly benign, well-defined lesion in an accessible site. Refer anything with a red flag, anything in the floor of mouth, ventral tongue or soft palate, and anything you would want a second pair of eyes on.
No. A brush sample cannot exclude dysplasia or invasion, and a negative brush result on a lesion that warranted a scalpel biopsy is a false reassurance we are not willing to give.
Not answered
Ask us directly.
Referring practices: call the referral line on (612) 555-0150. Patients: the office is on (612) 555-0148, or use the contact form.