Болит зуб после удаления нерва и чистки каналов при надавливании: почему и что делать

Содержание статьи

Удаление зубного нерва – технически сложная стоматологическая манипуляция, после которой у некоторых пациентов наблюдается такое остаточное явление, как боль на месте прооперированного зуба. Почему может болеть «мертвый» (не имеющий нерва) зуб? Нужно ли терпеть эту боль, в каких ситуациях следует повторно обращаться к врачу?Чистка зубного канала

Что такое зубной нерв

Это сплетение кровеносных сосудов и нервных окончаний. В медицинских справочниках зубные нервы называются пульпой, а процедура их удаления – депульпацией или депульпированием.

Зубной нерв находится под эмалью и слоем дентина. Пульпа способствует притоку минералов и полезных веществ – это делает эмаль прочнее. Также благодаря нерву зуб имеет способность реагировать на внешние раздражители:

• холод;
• тепло;
• сладость;
• горечь.

Почему удаляют зубной нерв: причины и показания

Удаление нервов проводят только в крайних случаях. После удаления пульпы зуб “мертвеет”, ослабевает, меняется цвет эмали. Показания для этой процедуры могут быть следующими.

1. Зуб разрушен из-за кариеса, наблюдается воспаление пульпы (пульпит). В этом случае при тщательном осмотре стоматолог может оставить часть зубного нерва или удалить его полностью. Итоговое решение зависит от степени воспаления.
2. Периодонтит. Зубной нерв спасти невозможно, стоматолог удаляет его полностью.
3. Обширное разрушение коронки.
4. Конкременты – это камни, которые находятся в зубном канале. Они давят на пульпу, вызывают болезненность и воспаление. В этом случае дантист удаляет зубной нерв, даже если внешне зуб выглядит полностью здоровым.

Противопоказаниями к удалению зубного нерва является первый триместр беременности, острые воспаления в ротовой полости, гипертония, гепатит, тромбоз и плохая свертываемость крови.

Процедура удаления нерва

Стоматологическая манипуляция состоит из 3 последовательных этапов.

На первом производится подготовка, на втором – непосредственно удаление, а завершает процедуру пломбирование канала.

После осмотра проблемного зуба врач делает рентген. На основе полученного снимка выявляется точное расположение каналов, ставится диагноз. Далее, чтобы пациенту не было больно, стоматолог делает анестезию. Обезболивание обычно проводится в виде местной анестезии, но по желанию пациента может быть применен наркоз. Чаще всего наркоз используется в детских стоматологических клиниках.

Удаленный зубной нерв.

Следующая составляющая процедуры – гидроизоляция. Рабочая зона обкладывается ватными шариками, турундами или тампонами. В некоторых клиниках применяют коффердам – специальное приспособление в виде полоски из латекса, которое предотвращает попадание слюны в операбельную зону.

Затем происходит ввод воздушно-водяного охлаждения через трубку, при этом расширяются канальные пути. В результате этих манипуляций образуются ровные отверстия, которые в дальнейшем будут запломбированы.

Как проходит удаление

1. В сделанное отверстие вставляют пульпоэкстрактор. Это одноразовое приспособление в виде зубчатой иглы, отдаленно похожей на штопор.
2. На пульпоэкстрактор навинчивают нерв и аккуратно удаляют из зуба.
3. Многие дантисты заменили пульпоэкстрактор на файлы. Файл отличается размерами игл на конце, является многоразовым приспособлением.
4. После удаления нерва доктор проводит обеззараживающие процедуры с помощью ультразвукового наконечника, обрабатывает каналы антисептиками.
5. Наложение временной пломбы.

После удаления временной пломбы ставят постоянную. Для процедуры используют метод латеральной конденсации холодной гуттаперчи – в отверстие вставляют штифты и закрывают твердеющим силером.

Пломбирование зуба и чистка каналов

Почему болит зуб после удаления нерва при надавливании

Для удаления пульпы стоматологи применяют специальное приспособление – бормашину. Происходит полноценное оперативное вмешательство. Поэтому болевые ощущения после удаления, имеют естественный характер: необходимо время для заживления и полного устранения боли. Но есть и ряд патологий, от которых десна может воспалиться и опухнуть. Эти патологии вызывают болезненность при нажатии на зуб или надкусывании пищи.

• Некачественная работа с пломбой. При пломбировке материал заполнил не все пустоты. Из-за этого в оставшиеся пустоты попадает еда, вода, появляются бактерии, начинается воспалительный процесс, который и вызывает болевые ощущения.
• Корневая перфорация или занесение инфекции. Нарушается целостность корня, пропадает его герметичность. Для устранения проблемы требуется промывание отверстия, дезинфекция и реставрация корня.
• Попадание в канал металлического осколка инструмента.
• Выход пломбировочного материала за границы корня.
• Усадка пломбы.

Зафиксированы случаи, когда у пациента возникает аллергическая реакция на пломбировочный материал. Это сопровождается болевыми ощущениями, отечностью. В этом случае нужно повторно обратиться к стоматологу для замены пломбы.

Устранение симптомов и боли

Снизить выраженность болей, устранить дискомфорт можно при помощи медикаментов или домашних отваров. Любые лечебные средства рекомендуется применять после согласования с дантистом.

Лекарства в таблетках

Найз

Перед приемом обезболивающих нужно внимательно ознакомиться с инструкцией, не превышать суточную дозу. Устранить боль поможет:

• Найз;
• Некст;
• Нурофен;
• Темпалгин;
• Кетанов.

В крайне сложных ситуациях стоматолог назначает ультразвуковую или лазерную терапию, электрофорез, сверхчастотные волны для воздействия.

Народные средства

Компоненты	Приготовление	Использование
Раствор йода, соли и воды.	По 1 ч.л. соли и соды, 5 капель йода растворить в теплой воде.	Полоскать ротовую полость.
Настой валерьяны	Смочить в настое ватный диск.	Приложить к больному месту в ротовой полости.
Пихтовое масло	Смочить ватный диск.	Наложить диск на зуб так, чтобы он не касался эмали. Держать 10-15 минут.
Ромашка, календула, тысячелистник.	Взять в равной пропорции, заварить, настоять, заморозить.	Замороженные кубики прикладывать к больному месту.

Когда нужно обращаться к специалисту

Обратиться к специалисту повторно нужно в ряде случаев. Это может быть:

• боли сильные и продолжительные, их длительность превышает 2 недели;
• боль усиливается, обезболивающие препараты не помогают;
• острый воспалительный процесс в полости рта, рост отечности;
• наблюдается повышение температуры тела.

Как предотвратить осложнения

Чтобы не допустить развития осложнений после вмешательства, важно соблюдать все предписания стоматолога. Также в восстановительный период нужно не забывать про несложные общие правила ухода и гигиены:

• не употреблять горячую, холодную, сладкую пищу и напитки в день проведения процедуры;
• не переохлаждаться и не перегреваться;
• не употреблять в пищу твердые продукты;
• стараться жевать на здоровую сторону полости рта;
• по возможности отказаться от курения;
• аккуратно чистить зубы, полоскать, делать ротовые ванночки;
• стараться не нажимать сильно на зуб.

Заключение

Красивые и здоровые зубы – одна из основных составляющих уверенности в себе. При первых проявлениях болевых ощущений, повышенной чувствительности или дискомфорта в ротовой полости нужно обращаться к дантисту. Не занимайтесь самолечением и не откладывайте визит к специалисту. Помните, что лечения и операций можно избежать, если регулярно посещать стоматолога, правильно и качественно ухаживать за зубами.

90000 Nerve removal in the tooth 90001 90002 The process of removing the nerve from the tooth 90003 90004 The process of removing the nerve from the tooth can not be started without prior anesthesia. Earlier, arsenic was used for this purpose, the procedure was long and painful. In modern medicine, the approach to anesthesia is much more sparing — with the help of anesthetics, the patient is painlessly removed the nerve for about thirty minutes. After the introduction of anesthetic with the help of the right tools, access to the pulp opens, then the root canals are thoroughly cleaned, all microorganisms are destroyed, mechanical and dental treatment takes place.To determine the length of the canal, the patient is X-rayed or an apex locator is used (a special tool that allows to determine the length of the root canal). If necessary, the patient may be given a temporary filling, in such a situation the treatment will need to be continued a little later. Then, after all the necessary procedures are performed, a permanent seal is installed. The effectiveness of the filling directly depends on the quality of cleaning channels. 90005 90006 Nerve removal in the milk tooth 90007 90004 Removal of the nerve in the milk tooth may be required when the tooth is destroyed by caries and, as a consequence, the development of pulpitis.From the age of six months, the first teeth of the baby’s teeth erupt, and although they are not permanent, they can also be affected by caries. The result of such a lesion can be pulpitis, which shows the removal of the nerve. Since the roots of the milk teeth are able to form, then dissolve, in the treatment of canals, it is possible to injure the forming permanent tooth. It is for this reason that when the nerve is removed from the milk tooth, the processing and sealing of the canals is not carried out along the entire length of the root, but only at its outlet.Special preparations are used for this purpose. They destroy all microorganisms and preserve the existence of the milk tooth until the time of its replacement by a permanent one. 90005 90006 Nerve removal from the front tooth 90007 90004 Removing the nerve from the front tooth is quite a complicated procedure, requiring preliminary preparation and examination. Before removing the nerve from the tooth, the doctor should perform channel cleansing and antiseptic treatment. After this, under local anesthesia, the nerve is removed directly, after which a seal is placed on the depulpated tooth.90005 90006 Removal of the nerve of the tooth during pregnancy 90007 90004 Removal of the nerve of the tooth during pregnancy is recommended to be carried out, starting from the second trimester of pregnancy, because in the early stages, the fetal organs and systems are laid and during this period it is better to refuse tooth treatment if the situation is not critical and does not require immediate removal of the nerve. Before the beginning of treatment, the doctor should be informed about what medicines were taken.Modern anesthetics used for anesthesia before nerve removal, have a local effect and do not penetrate the placental barrier, which allows to ensure safety for the fetus. Since pre-treatment of canals pre-X-rays, for safety, pregnant women wear a special lead apron, which protects from harmful radiation. 90005 90006 Tooth Teeth: Nerve Removal 90007 90004 Tooth wisdom: removal of the nerve in the wisdom tooth is performed with preliminary anesthesia in the development of inflammation of the pulp.After the introduction of the anesthetic, the channels are cleaned and the bacteria destroyed. In total, the procedure for removing the nerve in the wisdom tooth takes about half an hour. In order to determine the length of the channel, pre-radiological examination or determine the length of a special device. If in the process of treatment there is a need to establish a temporary filling, a permanent can be established even after a repeated visit to the dentist. 90005 90002 Treatment of a tooth with removal of a nerve 90003 90004 Before the treatment of the tooth, it is necessary to carry out a thorough examination and make an X-ray examination.When the nerve is removed, the channels are cleaned first, and then they are sealed. Treatment of the tooth with removal of the nerve is strictly according to the indications, which include the following: 90005 90026 90027 development of the inflammatory process of the pulp. The main symptoms are often recurring pains that occur spontaneously; 90028 90027 tooth decay with caries and infection of pulp; 90028 90031 90004 Necrosis of pulp. Such pathology can develop due to traumatization or infection.This process, as a rule, is not accompanied by any symptoms, which in turn can provoke the risk of complications. The diagnostic study is performed using X-ray. 90005.90000 Wisdom tooth removal — Complications 90001 90002 90003 As with any type of surgery, wisdom tooth removal carries some risks. However, these risks are usually small. 90004 90005 90002 Risks can include: 90005 90008 90009 90003 dry socket 90004 — where a blood clot fails to develop in the tooth socket, or if the blood clot becomes dislodged 90012 90009 90003 nerve injury 90004 — this can cause temporary or permanent problems, such as tingling or numbness 90012 90009 90003 infection 90004 — signs include a high temperature, yellow or white discharge from the extraction site, and persistent pain and swelling 90012 90009 90003 bleeding 90004 90012 90025 90002 See your dentist if you have signs of infection after having your wisdom teeth removed, or if you’re bleeding heavily from the extraction site.90005 90028 Dry socket 90029 90002 Dry socket (alveolar osteitis) is one of the most common complications of wisdom tooth removal. It’s where a blood clot fails to develop in the tooth socket, or if the blood clot becomes dislodged or disappears. This can happen 3 to 5 days after surgery. 90005 90002 The empty socket causes an ache or throbbing pain in your gum or jaw, which can be intense like a toothache. There may also be an unpleasant smell or taste from the empty tooth socket.If you look into the socket, you might be able to see exposed bone rather than a blood clot. 90005 90002 You’re more at risk of developing dry socket if: 90005 90008 90009 you do not follow your dentist’s instructions after the extraction 90012 90009 you smoke 90012 90009 you’ve had the condition before 90012 90009 you’re over 25 years old 90012 90009 the extraction was difficult or complicated 90012 90025 90002 See your dentist or surgeon if you think you have dry socket. They can flush any debris out of the socket or cover it with a medicated dressing, which may be removed and replaced frequently until it heals.90005 90028 Nerve injury 90029 90002 Although far less common than dry socket, injury to sections of a nerve called the trigeminal nerve is another possible complication of wisdom tooth removal. It can cause pain, a tingling sensation and numbness in your tongue, lower lip, chin, teeth and gums. 90005 90002 The damage is usually temporary, lasting for a few weeks or months. However, it can be permanent if the nerve has been severely damaged.90005 90002 A nerve injury can interfere with your daily activities, making things such as eating and drinking difficult. However, a nerve injury will only cause sensation problems — it will not cause any weakness to your lip or tongue. 90005 90002 Your dentist or surgeon will try to minimise the possibility of nerve damage when removing your wisdom tooth, and they should tell you about the risk of complications before the procedure. 90005 90028 General anaesthetic 90029 90002 General anaesthetic is occasionally needed for the removal of wisdom teeth.90005 90002 It carries some additional risks, but complications are very rare, occurring in less than 1 in every 10,000 cases. 90005 90002 Page last reviewed: 4 April 2018 90067 Next review due: 4 April 2021 90005 .90000 how to kill at home 90001 90002 Today, dental diseases are one of the most urgent problems, so many people interested in methods of treatment of various dental ailments, in particular, how to kill nerve in tooth. As you know, a toothache, which most often occurs due to the development in the oral cavity of certain inflammatory processes or as a result of injury to the nerve has a distinct intensity, that is, pain in such cases can be quite sharp and sometimes unbearable.These dental problems include dental disease such as caries, pulpitis, tooth thinning cervix and many others. 90003 90002 90003 90006 To go to the dentist or not 90007 90002 For the most part, when people are faced with similar problems, their primary goal is to understand how to kill tooth nerve at home, in fact it becomes the primary source of pain. Will definitely cope with this disease is possible without qualified specialists, but first we need to understand what are the dental nerves, and then to figure out how to destroy them.90003 90002 First and foremost, if a person had dental problems, but rather with severe pain of the inner layers of the teeth, you should visit the dentist who will provide the necessary guidance for correct elimination and treatment of the nerves in the teeth. 90003 90002 As a rule, most people are not thinking about the consequences begin to look for various ways and means which in their opinion should help them to get rid of the tooth nerve. But in fact it is a typical error that can lead to quite serious complications to the extent that after some home techniques people will be forced to seek help not only to the dentist and other doctors, because there is a huge risk of burning the mucous membrane of the mouth, cause allergic reaction or lead to total destruction of tooth enamel.90003 90006 What is the nerve of the tooth 90007 90002 As mentioned above, to eliminate pain in the tooth, you can use various recipes of traditional medicine, but first you need to know it now the pain intensity and the cause of this pain. 90003 90002 90003 90002 It is worth noting that the nerve is an integral part of the tooth. Teeth have a hard surface, as for their domestic content, from the inside it consists of soft tissue, called pulp. Pulp also has lymph nodes, blood vessels circulation and nerves.These nerves are so that have the appearance of some semblance of branches that are all the dental roots and their canals. 90003 90002 Usually when a tooth loses his nerve, he abruptly begins to die, that is ceases to be one of the living components of the human body. If you want to remove dental nerve, but not touching the tooth with proper care and in compliance with all relevant recommendations of the dentist to ensure that he can not be bothered for quite a long time. But after a while, he’ll start to shrink and then completely crumble.The nerves of the teeth act as sensory functions, and any sensation of pain may begin to signal that in in the oral cavity occur destructive processes. 90003 90006 How to kill tooth nerve 90007 90002 If you have problems with the pain of the dental nerve, but you have no idea how to implement it, you will first need to visit the dentist’s office which will give appropriate recommendations, how to kill tooth nerve. In cases if the nerve has undergone partial or full exposure, then a visit to the doctor should be implemented immediately, because the fun can only worsen the condition, triggering the development of serious complications.90003 90002 Every person ever in his life faced with the problem of how to kill a tooth nerve. At such moments, he feels unbearable pain because of which other options but to remove the nerve just is not there. Most people dare to kill nerve only when nothing helps, including modern techniques and medicines aimed at reducing the pain of the teeth. 90003 90002 To efficiently perform the removal of the nerve in the teeth only if the destructive processes do not have time to cover the largest part of the pulp.Otherwise, the patient is prescribed surgery, which is accompanied by a prolonged rehabilitation, that is, a person will have sufficiently long time to perform a lot of recommendations for the return teeth and gums healthy. 90003 90002 The nerve is subjected to elimination just before pulling the tooth. This is done to ensure that the patient has not felt a severe pain. Most often this procedure is carried out if the patient has the disease, such as periodontitis, or pulpitis. 90003 90002 In addition, the removal of the nerve is possible with prolonged aching pain, which is twice as worse at night, with sudden movements and rotation of the head.Such pain often occur after eating sweet, spicy or sour food, and cold or hot beverages. 90003 90006 Medical treatment of the patient’s dental nerve 90007 90002 90039 Currently in medical treatment dental problems there is a huge variety of drugs to address those or other problems with teeth or a full mouth in General. 90003 90002 For toothache are assigned certain drugs that vary in effectiveness and impact. If you suffer severe pain and do not know what to kill diseased nerve in a tooth, you should pay attention to the following drugs: 90003 90043 90044 DeWitt-ARS; 90045 90044 DeWitt-C; 90045 90044 Casticin; 90045 90044 Septodont; 90045 90044 DeWitt-P; 90045 90044 Kaustinen Rapid; 90045 90044 Pullparser, and others.90045 90058 90002 All the above drugs are used only in dental clinics, that is, in the home, the use of them is prohibited, for mismatched dosage in humans can occur the appearance of adverse effects full. It is also worth noting that the means facilitating pain during dental ailments can only help in those cases if the problem is only superficial, that is not a serious illness, or when you know exactly what caused the onset of pain dental nerve. As a rule, by means of painkillers a doctor can only provide devitalization process.All used the specialist drugs have detoksicirutuyu and do not have any particular side effects. 90003 90002 90003 90006 How to kill a nerve in the home 90007 90002 If you have no idea how and what can kill the nerve and how in General to kill him at home, you should pay attention to the recipes of traditional medicine, which are most common and have high reviews. If you can not timely access to a doctor, and the heart-rending tooth hurts, you can help of different solutions and infusions on the basis of various herbs and substances that have medicinal properties.90003 90002 The simplest, but at the same time, an effective folk remedy for opponents of the tooth nerve is a pure medical alcohol, which may require up to three times a day to wet the cotton wool and apply it to the affected teeth. 90003 90002 The competitor of this tool is iodine, which is used the same way as alcohol. To kill tooth nerve, you can use traditional medicines such as: 90003 90071 90044 Gunpowder. They need to sprinkle the cotton wool, which was later to impose on the aching tooth or the remainder.This method is radical, as it can cause poisoning from powder gases 90045 90044 Vinegar. Also is a rather dangerous tool to remove nerve. Though he is more effective, but improper use can burn the mucous membranes of the mouth 90045 90044 Zinc. To get this substance, you just need to burn the paper, and ashes to wet cotton wool and apply to the sore place. Before to apply this method it is necessary to take some pain medicine 90045 90044 Arsenic. This substance is the most dangerous in the case of incorrect use can cause serious poisoning or death.So at home this tool is not recommended. 90045 90080 90002 loading … 90003 90002 In addition to these traditional medicine for the elimination of the dental nerve and used other recipes, but each one has not only positive results but more are negative. Based on all above described we can conclude that the best and safest option for removing the nerve will appeal to the doctor conducting the necessary surveys will prescribe the correct treatment without serious complications and risk of tooth decay.90003 .90000 Wisdom tooth removal — Your.MD 90001 90002 90003 The removal of wisdom teeth, or third molars, is one of the most common procedures carried out in the UK. 90004 90005 90002 The wisdom teeth grow at the back of your gums and are the last teeth to come through. Most people have four wisdom teeth — one in each corner. 90005 90002 Wisdom teeth usually grow through the gums during the late teens or early twenties. By this time, the other 28 adult teeth are usually in place, so there is not always enough room in the mouth for the wisdom teeth to grow properly.90005 90002 Because of the lack of space, the wisdom teeth can sometimes emerge at an angle or get stuck and only partially emerge. Wisdom teeth that grow through like this are known as impacted. 90005 90012 When to see a dentist 90013 90002 You should make an appointment to see your dentist if you’re experiencing severe pain or discomfort from your wisdom teeth. Your dentist will check your teeth and advise you on whether they need to be removed. 90005 90002 If your dentist thinks you may need your wisdom teeth removed, they’ll usually carry out an X-ray of your mouth.This gives them a clearer view of the position of your teeth. 90005 90002 As with any teeth problems, it’s important to see your dentist as soon as possible, rather than waiting for your regular dental check-up. 90005 90012 Why are wisdom teeth removed? 90013 90002 Your wisdom teeth do not usually need to be removed if they’re impacted but are not causing any problems. This is because there’s no proven benefit of doing this and it carries the risk of complications. 90005 90002 Sometimes, wisdom teeth that have become impacted or have not fully broken through the surface of the gum can cause dental problems.Food and bacteria can get trapped around the edge of the wisdom teeth, causing a build-up of plaque, which can lead to: 90005 90026 90027 90003 tooth decay 90004 (dental caries) — this develops when plaque begins to break down the surface of your tooth. When tooth decay becomes more advanced, it leaves holes (cavities) in the tooth, which can affect the surrounding teeth. 90030 90027 90003 gum disease 90004 (also called gingivitis or periodontal disease) — this occurs when plaque releases toxins that irritate your gums, making them red, swollen and painful.Gum disease can also affect the surrounding teeth and the bone around the wisdom teeth. 90030 90027 90003 pericoronitis 90004 — when plaque causes an infection of the soft tissue that surrounds the tooth. 90030 90027 90003 cellulitis 90004 — a bacterial infection in the cheek, tongue or throat. 90030 90027 90003 abscess 90004 — when pus collects in your wisdom teeth or the surrounding tissue due to a bacterial infection. 90030 90027 90003 cysts and benign growths 90004 — very rarely, a wisdom tooth that has not cut through the gum develops a cyst (a fluid-filled swelling).90030 90051 90002 Many of these problems can be treated with treatment such as antibiotics and antiseptic mouthwash, so removing your wisdom teeth is only recommended when other treatment has not worked. 90005 90012 How wisdom teeth are removed 90013 90002 Your dentist may remove your wisdom teeth or they may refer you to a specialist surgeon for hospital treatment. 90005 90002 Before the procedure, you’ll usually be given a local anaesthetic injection to numb the area around the tooth.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. 90005 90002 In some cases a cut may be needed in your gum, and the tooth may need to be cut into smaller pieces before it’s removed. 90005 90002 The time it takes to remove the tooth will vary. Some procedures only take a few minutes, whereas others can take 20 minutes or longer. 90005 90002 After your wisdom teeth have been removed, you may experience swelling and discomfort, both on the inside and outside of your mouth.This is usually worse for the first three days, but it can last for up to two weeks. 90005 90002 Read more about how a wisdom tooth is removed and recovering from wisdom tooth removal. 90005 90012 Possible complications 90013 90002 As with all surgery, there are risks associated with removing a wisdom tooth. These include infection or delayed healing, both of which are more likely if you smoke during your recovery. 90005 90002 Another possible complication is «dry socket», which is a dull, aching sensation in your gum or jaw, and sometimes a bad smell or taste coming from the empty tooth socket.Dry socket is more likely if you do not follow the after-care instructions given by your dentist. 90005 90002 There’s also a small risk of nerve damage, which can cause pain or a tingling sensation and numbness in the tongue, lower lip, chin, teeth and gums. This is usually temporary, but can be permanent in some cases. 90005 90002 Read more about the possible complications of wisdom tooth removal. 90005 90012 Dental costs 90013 90002 Dentists charge depending on the treatment required, unless you’re under 18 or otherwise exempt from NHS charges.90005 90002 If hospital treatment is required, it will be provided through the NHS free of charge. 90005 90002 Read more about dental costs and find your local dental surgery. 90005.