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Wisdom tooth removal - How It Is Performed

How it's performed-Wisdom tooth removal

Wisdom tooth removal can be carried out by a dentist or a specialist surgeon working in a hospital.

If your dentist recommends removing your wisdom teeth, they'll take an X-ray of your mouth to help them determine who should carry out the procedure.

Any charges and payment methods should be discussed before the procedure begins. Read more about NHS dental charges.

Anaesthesia

Before having your wisdom teeth removed, you'll be given an injection of local anaesthetic to numb the tooth and surrounding area.

If you're particularly anxious about the procedure, your dentist or surgeon may give you a sedative to help you relax. This will usually be an injection into your arm.

General anaesthetic is rarely needed for wisdom tooth removal. It's only occasionally used when the procedure is carried out in hospital. However, in this case, you should still be able to go home on the same day as the procedure.

Removing the wisdom tooth

If the tooth hasn't come through the gum, a small cut (incision) will be made in the gum to access it. A small piece of the bone covering the tooth may also need to be removed.

The tooth may be cut into smaller parts to make it easier to remove through the opening. There's less need to make an incision if the tooth has broken through the gum.

You'll feel some pressure just before the tooth is removed, as your dentist or oral surgeon needs to widen the tooth socket by rocking the tooth back and forth before taking it out.

You shouldn't feel any pain as your wisdom teeth are removed because the area will be numb. However, if you do feel pain during the procedure, tell your dentist or oral surgeon so they can give you more anaesthetic.

How long it takes to remove the tooth will vary. Simple procedures can take a few minutes, but it can take longer than 20 minutes if it's more complicated.

After surgery

If an incision has been made, dissolving stitches are used to seal the gum. Your dentist will tell you how long the stitches take to dissolve (usually 7 to 10 days).

Your dentist may place gauze over the site of the extraction and ask you to keep pressure on it by biting your jaws together for up to an hour. This is to allow a blood clot to form in the empty tooth socket. Blood clots are part of the healing process, so try not to dislodge them.

In some cases, antibiotics may be prescribed if you have an ongoing infection.

For the 24 hours after removing your wisdom tooth, you should avoid:

rinsing your mouth out with liquid
drinking alcohol and smoking
drinking hot liquids such as tea or soup
strenuous physical activity

Transurethral resection of the prostate (TURP) - How It Is Performed

How it's performed-Transurethral resection of the prostate (TURP)

A transurethral resection of the prostate (TURP) is carried out in hospital under anaesthetic. You'll usually need to stay in hospital for 1 to 3 days.

Preparing for surgery

You'll usually be asked to attend a pre-admission appointment a few weeks before your operation so a doctor or nurse can make sure the operation is suitable for you and that you're well enough to have an anaesthetic.

This may involve tests such as blood tests and an electrocardiogram (ECG) to check your general health. An ECG is a simple test to check the electrical activity of your heart.

You can also use this appointment as an opportunity to ask any questions about the procedure and discuss any concerns you have.

Make sure you tell your doctor or nurse if you're currently taking medication to prevent blood clots, such as aspirin, warfarin or clopidogrel. These medications could cause heavy bleeding during surgery, so you may be advised to stop taking them in the lead-up to your operation.

If you smoke, you should try to cut down or give up completely before your operation, as this can help reduce your risk of potentially serious complications such as chest infections and blood clots.

Read more advice about stopping smoking.

Before the procedure

You'll usually be asked to come into hospital on the day of the operation or the day before.

You'll be asked to stop eating and drinking around 6 hours before surgery. Depending on the results of your pre-admission assessment, you may be given compression stockings to help prevent blood clots.

Just before the operation is carried out, you'll be given an anaesthetic to stop you feeling any pain during the procedure. The type of anaesthetic used may be either:

a general anaesthetic – this means you'll be unconscious throughout the procedure
a spinal or epidural anaesthetic – this means you'll be awake during the procedure but won't be able to feel anything below your waist

The operation

A TURP is usually carried out using a device called a resectoscope. This is a thin metal tube containing a light, camera and loop of wire.

The surgeon will insert the resectoscope into your urethra (the tube that carries urine out of the body) before guiding it to the site of your prostate with the help of the light and the camera.

An electric current is used to heat the loop of wire, and this is used to cut away a section of your prostate. After the procedure, a catheter (a thin, flexible tube) is used to pump fluid into the bladder and flush away pieces of prostate that have been removed.

A TURP can take up to 1 hour, depending on how much of your prostate needs to be removed.

Once the procedure has been completed, you'll be moved back to your hospital ward so you can recover. The catheter will be left in place for a few days until you're able to urinate normally.

Waiting times

TURP isn't normally regarded as an urgent operation, which means you may have to wait several months for it to be carried out.

Ask your surgeon or GP about estimated waiting times when the procedure is discussed with you.

Read more about waiting times in the NHS.

Root canal treatment - How It Is Performed

How it is performed-Root canal treatment

Root canal treatment is carried out by your dentist over 2 or more appointments.

Unless you're entitled to free NHS dental treatment, you'll have to pay for root canal treatment.

Read about NHS dental charges and getting help with dental charges.

If the work is particularly complex, your dentist may refer you to a specialist in root canal treatment, known as an endodontist.

All registered dental specialists in the UK are listed on the General Dental Council (GDC) website.

Preparing for root canal treatment

Before having root canal treatment, your dentist may take a series of X-rays of the affected tooth.

This allows them to build up a clear picture of the root canal and assess the extent of any damage.

Root canal treatment is usually carried out under local anaesthetic, a painkilling medicine that numbs your infected tooth and the gum around it.

In some cases where the tooth has died and is no longer sensitive, it may not be necessary to use a local anaesthetic.

Removing the pulp

Your dentist will place a rubber sheet (dam) around the tooth to ensure it's dry during treatment.

The dam also prevents you swallowing or breathing in any chemicals the dentist uses.

Your dentist will open your tooth through the crown, the flat part at the top, to access the soft tissue at the centre of the tooth (pulp). They'll then remove any infected pulp that remains.

If you have a dental abscess, which is a pus-filled swelling, your dentist will be able to drain it at the same time.

Cleaning and filling the root canal

After the pulp has been removed, your dentist will clean and enlarge the root canal.

The root canal is usually very narrow, which makes it difficult to fill.

Your dentist will use a series of small files to enlarge the canals and make them a regular shape so they can be filled.

This part of the treatment may take several hours, and may need to be carried out over a number of visits.

Your front incisor and canine teeth (biting teeth) usually have a single root containing 1 root canal.

The premolars and back molar teeth (chewing teeth) have 2 or 3 roots, each containing either 1 or 2 root canals.

The more roots a tooth has, the longer the treatment will take to complete.

If the treatment needs to be carried out over several sessions, your dentist may put a small amount of medicine in the cleaned canal in between visits to kill any remaining bacteria.

The tooth will then be sealed using a temporary filling.

If you have symptoms from the infection, such as a raised temperature or large swelling, you may be given antibiotics to help manage and prevent further infection.

Sealing and fixing the tooth

At your next visit, the temporary filling and medicine within the tooth is removed and the root canal filling will be inserted.

This, along with a filling, seals the tooth and prevents reinfection.

Root-filled teeth are more likely to break than healthy unrestored teeth, so your dentist may suggest placing a crown on the tooth to protect it.

In some cases a root-filled tooth may darken, particularly if it's died as a result of injury like a knock to the tooth.

There are several ways your dentist can treat discolouration, such as whitening the tooth using chemicals.

Adding a crown

A crown is a cap that completely covers a real tooth. It might be necessary to use a crown after root canal treatment to prevent the tooth fracturing.

Crowns can be made from:

metal or porcelain (or both)
a ceramic material
powdered glass

The dentist will reduce the size of your tooth and use the crown to replace what's removed.

A mould of your tooth will be taken to ensure the crown is the right shape and size, and fits your tooth accurately.

When fitting the crown, cement will be used to glue the crown to the trimmed-down tooth.

If there's only a small amount of tooth left after the root canal treatment, a post can be cemented in the root canal and used to help keep the crown in place.

Find out more about what NHS dental fillings and crowns are made of

How successful is root canal treatment?

Root canal treatment is usually successful at saving the tooth and clearing the infection.

Around 9 out of 10 root-treated teeth survive for 8 to 10 years.

Having a crown fitted to the tooth after root canal treatment is important for improving tooth survival rates.

If you keep your teeth clean, your treated tooth should survive for a long time.

The survival of your tooth depends on a number of factors, including:

how much of the natural tooth remains
how well you keep your teeth clean
the biting forces on the tooth

But if an infection does return, the root canal treatment can be repeated.

Or if treatment has already been carried out to a high standard and the infection remains, a small operation to remove the root tip (an apicoectomy) may be carried out to treat the infection.

Plastic surgery - How it's performed

How it's performed-Plastic surgery

Plastic surgery can involve a number of different techniques to move and manipulate body tissue.

Before having plastic surgery, you should have a consultation with a plastic surgeon.

They'll explain in detail what will happen before, during and after surgery. You may also be given a psychological assessment.

Skin grafts used to be the main type of plastic surgery, but newer techniques, such as tissue expansion and flap surgery, are now often used.

Skin grafts

A skin graft is where healthy skin is removed from an unaffected area of the body and used to cover lost or damaged skin.

They can be used for bone fractures that break the skin (open fractures), large wounds, or where an area of the skin is surgically removed – for example, due to cancer or burns.

There are 2 main types of skin graft.

Partial or split thickness skin graft

This is where a thin layer of skin (as thin as tissue paper) is shaved from an area that usually heals well, such as the thigh, buttocks or calf.

The donor area usually take 2 to 3 weeks to heal and is pink for a few months before fading to leave a faint (hardly noticeable) scar.

Full thickness skin graft

This is where the full thickness of skin (the top layer and layers underneath) are removed and the area is directly closed.

Sites often used include the neck, behind the ear, the upper arm and groin.

Because this type of skin graft is thicker, picking up a new blood supply can be more difficult, so any dressing will be left in place for 5 to 7 days before being removed by the surgical team.

What happens

Before the procedure, you'll be given a general anaesthetic or a local anaesthetic, depending on the size and location of the affected area.

The skin graft will usually be held in place using stitches, staples, clips or special glue.

The area will be covered with a sterile dressing until it has connected with the surrounding blood supply, which usually takes around 5 to 7 days.

A dressing will also be placed over the area where the skin has been taken from (the donor site) to help protect it from infection.

The donor area of partial thickness skin grafts usually takes about 2 weeks to heal.

For full thickness skin grafts, the donor area only takes about 5 to 10 days to heal, because it's normally quite small and closed with stitches.

At first, the grafted area will appear reddish-purple, but it should fade over time. It can take a year or two for the appearance of the skin to settle down completely.

The final colour may be slightly different from the surrounding skin, and the area may be slightly indented.

Tissue expansion

Tissue expansion is a procedure that encourages the body to "grow" extra skin by stretching surrounding tissue. This extra skin can then be used to help reconstruct the nearby area.

Examples of when tissue expansion may be used include breast reconstruction and repairing large wounds.

Under general anaesthetic, a balloon-like device called an expander is inserted under the skin near the area to be repaired.

This is gradually filled with salt water, causing the skin to stretch and grow.

The time it takes for the tissue to be expanded can vary, depending on the size of the area to be repaired.

If a large area of skin is affected, it can take as long as 3 or 4 months for the skin to grow enough. During this time, the expander will create a bulge in the skin.

Once the skin has expanded sufficiently, a second operation is needed to remove the expander and reposition the new tissue.

This technique ensures that the repaired area of skin has a similar colour and texture to the surrounding area.

There's also a lower chance of the repair failing because the blood supply to the skin remains connected.

Flap surgery

Flap surgery involves the transfer of a living piece of tissue from one part of the body to another, along with the blood vessels that keep it alive.

It may be used for a variety of reasons, including breast reconstruction, open fractures, large wounds, and, in rare cases, for improving a cleft lip and palate.

In most cases, the skin remains partially attached to the body, creating a "flap". The flap is then repositioned and stitched over the damaged area.

For more complex reconstruction, a technique called a free flap is used.

This is where a piece of skin, and the blood vessels supplying it, are entirely disconnected from the original blood supply and then reconnected at a new site.

A technique called microsurgery (surgery using a microscope) is used to connect the tiny blood vessels at the new site.

A free flap is often used when large areas of specific tissue types are needed for reconstruction.

Depending on the location and size of the flap, the operation can be carried out under general or local anaesthetic.

As flap surgery allows the blood supply to the repaired area to be maintained, there's a lower risk of the repair failing compared with a skin graft.

Specific conditions

For information about specific treatments for conditions where plastic surgery is commonly used, see:

Pacemaker implantation - How It Is Performed

How it's performed-Pacemaker implantation

Before having a pacemaker fitted, you'll have a preoperative assessment.

The team looking after you will check you're fit for surgery. You can discuss the operation and ask any questions at the assessment.

Some tests may be performed, including blood tests and an electrocardiogram (ECG).

You'll be asked about your general health and heart problems, and how they affect you.

You'll also be asked about any additional medical problems and previous operations you have had, as well as any problems or reactions you or your family have had with anaesthetics.

Taking steps to improve your health and fitness, such as stopping smoking if you smoke, eating a healthy diet and exercising regularly, should help speed up your recovery time and reduce the risk of complications.

You'll usually be told when you have to stop eating or drinking before surgery during the preoperative assessment.

Your specialist

The pacemaker implantation will be carried out by a heart specialist, known as a cardiologist, who will probably have a special interest in pacemakers.

If you're being treated in a large heart hospital, the operation will often be carried out by an electrophysiologist. This is a cardiologist who specialises in heart rhythm disorders.

Fitting the pacemaker

Transvenous implantation is the most common method of fitting a pacemaker or an implantable cardioverter defibrillator (ICD).

Transvenous implantation

During transvenous implantation, the cardiologist will make a 5 to 6cm (about 2 inch) cut just below your collarbone, usually on the left side of the chest, and insert the wires of the pacemaker (pacing leads) into a vein.

The pacing leads are guided along the vein into the correct chamber of your heart using X-ray scans. They then become lodged in the tissue of your heart.

The other ends of the leads are connected to the pacemaker, which is fitted into a small pocket created by the cardiologist between the skin of your upper chest and your chest muscle.

Transvenous implantation is carried out under local anaesthetic, which is given as an injection.

This means the area where the cuts are made is numbed, but you remain awake during the procedure.

You'll feel an initial burning or pricking sensation when the cardiologist injects the local anaesthetic.

The area will soon become numb, but you may feel a pulling sensation during the operation.

Before the procedure, a thin tube called an intravenous (IV) line will be attached to one of your veins.

Medication to make you drowsy will be given through the IV line to keep you relaxed during the procedure.

The procedure usually takes about an hour, but it may take longer if you're having a biventricular pacemaker with 3 leads fitted or other heart surgery at the same time.

You'll usually need to stay in hospital overnight and have a day's rest after the procedure.

Read more about recovering from a pacemaker implantation.

Epicardial implantation

Epicardial implantation is an alternative and less widely used method of fitting a pacemaker.

In this method, the pacing lead or leads are attached to the outer surface of your heart (epicardium) through a cut in your abdomen, below the chest.

Epicardial implantation is often used in children and people who have heart surgery at the same time as a pacemaker implantation.

It's carried out under general anaesthetic, which means you'll be asleep throughout the procedure.

The surgeon will attach the tip of the pacing lead to your heart and the other end of the lead is attached to the pacemaker box. This is usually placed in a pocket created under the skin in your abdomen.

The procedure usually takes between 1 and 2 hours, but it can take longer if you're having other heart surgery at the same time.

Recovery after epicardial implantation usually takes longer than after transvenous implantation.

Implantable cardioverter defibrillators (ICDs)

In most cases, implantable cardioverter defibrillators (ICDs) are fitted transvenously, along a vein. But they can also be fitted under the skin (subcutaneously).

Subcutaneous implantation is either carried out using general anaesthesia, or with local anaesthesia and sedation.

During the procedure, a pocket will be created in the left side of the chest where the ICD will be positioned.

The pacing lead and electrodes are also placed under the skin along the breast bone and are connected to the device.

After the cuts have been closed, the sensing, pacing and recording functions of the ICD will be tested and adjusted.

Fitting an ICD can take 1 to 3 hours depending on the type of device you're having fitted.

An overnight stay in hospital is often, although not always, required.

Testing and setting the pacemaker

Once the leads are in place, but before they're connected to the pacemaker or ICD, the cardiologist will test them to make sure they work properly and can increase your heart rate. This is called pacing.

Small amounts of energy are delivered through the leads into the heart, which cause it to contract and pull inwards.

When the leads are being tested, you may feel your heart beat faster. Tell the medical team about any symptoms you feel.

Your doctor will adjust the settings of your pacemaker after deciding how much electrical energy is needed to stimulate your heartbeat.

Waiting times

How long you'll have to wait to have a pacemaker fitted will depend on why surgery is required.

If it's needed to treat a potentially serious condition, such as severe heart block or cardiac arrest, surgery is often performed as an emergency.

If the reason for surgery isn't thought to be life threatening, you may have to wait up to 18 weeks.

In most cases, surgery is carried out as soon as possible once it's been decided that you would benefit from a pacemaker.

Osteopathy - How It Is Performed

How it's performed-Osteopathy

During your first osteopathy session, the osteopath will ask about your symptoms, general health and any other medical care you're receiving before carrying out a physical examination.

The osteopath will use their hands to find areas of weakness, tenderness, restriction or strain within your body, particularly the spine.

With your consent, you'll probably need to remove some clothing from the area being examined, and you may be asked to perform simple movements.

You should then be able to discuss whether osteopathy can help treat the problem and, if so, what the treatment programme should involve.

Osteopaths are trained to identify when a patient needs to be referred to a GP or needs further tests, such as MRI scans or blood tests, to help diagnose the problem.

Osteopathic techniques

An osteopath aims to restore the normal function and stability of the joints to help the body heal itself.

They use their hands to treat your body in a variety of ways, using a mixture of gentle and forceful techniques.

Techniques are chosen based on the individual patient and the symptoms they have reported.

These include:

massage – to release and relax muscles
stretching stiff joints
articulation – where your joints are moved through their natural range of motion
high-velocity thrusts – short, sharp movements to the spine, which normally produce a clicking noise similar to cracking your knuckles

These techniques aim to reduce pain, improve movement and encourage blood flow.

Osteopathy isn't usually painful, although it's not unusual to feel sore or stiff in the first few days after treatment, particularly if you're having treatment for a painful or inflamed injury.

Your osteopath will explain whether you're likely to have any reactions. If you feel any pain during or after treatment, tell your osteopath.

You may be given advice on self-help and exercise to aid your recovery and prevent symptoms returning or getting worse.

In general, the first appointment will last about 45 minutes to an hour. Further treatments last around 30 minutes. Your course of treatment will depend on your symptoms.

MRI scan - How It Is Performed

How it's performed-MRI scan

A magnetic resonance imaging (MRI) scan is a painless procedure that lasts 15 to 90 minutes, depending on the size of the area being scanned and the number of images being taken.

Before the scan

On the day of your MRI scan, you should be able to eat, drink and take any medication as usual, unless you're advised otherwise.

In some cases, you may be asked not to eat or drink anything for up to 4 hours before the scan, and sometimes you may be asked to drink a fairly large amount of water beforehand. This depends on the area being scanned.

When you arrive at the hospital, you'll usually be asked to fill in a questionnaire about your health and medical history. This helps the medical staff to ensure you have the scan safely.

Read more about who can and can't have an MRI scan.

Once you have completed the questionnaire, you'll usually be asked to give your signed consent for the scan to go ahead.

As the MRI scanner produces strong magnetic fields, it's important to remove any metal objects from your body.

These include:

watches
jewellery, such as earrings and necklaces
piercings, such as ear, nipple and nose rings
dentures (false teeth)
hearing aids
wigs (some wigs contain traces of metal)

Any valuables can usually be stored in a secure locker.

Depending on which part of your body is being scanned, you may need to wear a hospital gown during the procedure.

If you don't need to wear a gown, you should wear clothes without metal zips, fasteners, buttons, underwire (bras), belts or buckles.

Contrast dye

Some MRI scans involve having an injection of contrast dye. This makes certain tissues and blood vessels show up more clearly and in greater detail.

Sometimes the contrast dye can cause side effects, such as:

feeling or being sick
a skin rash
a headache
dizziness

These side effects are usually mild and don't last very long.

It's also possible for contrast dye to cause tissue and organ damage in people with severe kidney disease.

If you have a history of kidney disease, you may be given a blood testto determine how well your kidneys are functioning and whether it's safe to proceed with the scan.

You should let the staff know if you have a history of allergic reactions or any blood clotting problems before having the injection.

Anaesthesia and sedatives

An MRI scan is a painless procedure, so anaesthesia (painkilling medication) isn't usually needed.

If you're claustrophobic, you can ask for a mild sedative to help you relax. You should ask your GP or consultant well in advance of having the scan.

If you decide to have a sedative during the scan, you'll need to arrange for a friend or family member to drive you home afterwards, as you won't be able to drive for 24 hours.

Babies and young children may be given a general anaesthetic before having an MRI scan.

This is because it's very important to stay still during the scan, which babies and young children are often unable to do when they're awake.

During the scan

An MRI scanner is a short cylinder that's open at both ends. You'll lie on a motorised bed that's moved inside the scanner.

You'll enter the scanner either head first or feet first, depending on the part of your body being scanned.

In some cases, a frame may be placed over the body part being scanned, such as the head or chest.

This frame contains receivers that pick up the signals sent out by your body during the scan and it can help to create a better-quality image.

A computer is used to operate the MRI scanner, which is located in a different room to keep it away from the magnetic field generated by the scanner.

The radiographer operates the computer, so they'll also be in a separate room to you.

But you'll be able to talk to them, usually through an intercom, and they'll be able to see you at all times on a television monitor.

A friend or family member may be allowed to stay with you while you're having your scan. Children can usually have a parent with them.

Anyone who stays with you will be asked if they have a pacemaker or any other metal objects in their body.

They'll also have to follow the same guidelines regarding clothing and the removal of metallic objects.

To avoid the images being blurred, it's very important to keep the part of your body being scanned still throughout the whole of the scan until the radiographer tells you to relax.

A single scan may take from a few seconds to 3 or 4 minutes. You may be asked to hold your breath during short scans.

Depending on the size of the area being scanned and how many images are taken, the whole procedure will take 15 to 90 minutes.

The MRI scanner will make loud tapping noises at certain times during the procedure. This is the electric current in the scanner coils being turned on and off. You'll be given earplugs or headphones to wear.

You're usually able to listen to music through headphones during the scan if you want to, and in some cases you can bring your own CD.

You'll be moved out of the scanner when your scan is over.

After the scan

An MRI scan is usually carried out as an outpatient procedure. This means you won't need to stay in hospital overnight.

After the scan, you can resume normal activities immediately. But if you have had a sedative, a friend or relative will need to take you home and stay with you for the first 24 hours.

It's not safe to drive, operate heavy machinery or drink alcohol for 24 hours after having a sedative.

Your MRI scan needs to be studied by a radiologist (a doctor trained in interpreting scans and X-rays) and possibly discussed with other specialists.

This means it's unlikely you'll get the results of your scan immediately.

The radiologist will send a report to the doctor who arranged the scan, who will discuss the results with you.

It usually takes a week or two for the results of an MRI scan to come through, unless they're needed urgently.