Gum coagulation is a biophysical process that occurs in living tissues as a result of exposure to ultra-high temperatures that compress them. This procedure is prescribed for the treatment of soft tissues of the oral cavity, correction of attached gums and removal of gum granulations.
Greater efficiency of gum coagulation is observed when used during surgical interventions for the removal of benign and malignant tumors.
Due to the fact that the process occurs at high temperatures, bleeding does not occur directly during the intervention and, accordingly, healing time is reduced.
If the gum tissue turns white, it means that the gums have been coagulated. The current acts on the walls of blood vessels and thereby promotes blood clotting. Further bleeding stops due to the closure of the lumen in the vessels. At the same time, during coagulation the wound is disinfected.
Before performing gum coagulation, you should pay attention to individual intolerance to current or insufficiency of cardio-vascular system patient.
Our specialists dental center"VIDENT" Vidnoye will perform gum coagulation, price: from 700 rubles.
Gum coagulation is one of the most popular gum plastic operations in dentistry. For example, you can cut off the tissue using a heated tool. Cutting using the coagulation method is very effective as it is not accompanied by bleeding. This effect occurs as a result of using a scalpel heated by electric current. Pulses of electric current are sent to a portion of the cells. These cells “explode”, and the second part dries out.
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Damage to the gums is a common problem that can lead not only to a deterioration in the patient’s well-being and quality of life, but also to a further deterioration of the condition of the oral cavity.
Coagulation of gum tissue can be an effective and painless solution to the problem.
General overview
Coagulation of gum tissue is a biophysical process, or procedure, the essence of which is the effect of ultra-high temperatures on the affected area of tissue.
Using this method of exposure, soft tissues of the oral cavity are treated, in particular, benign and malignant neoplasms.
In each specific case, the dentist decides on the use of one or another device. depending on the technical equipment of the clinic, the financial capabilities of the patient, as well as the indications in the current clinical situation.
For example, it is most expensive to carry out coagulation with a laser, but if there is a need for this (for example, a tumor needs to be removed in a patient with a bleeding disorder), then the choice is made on this technique.
Indications and contraindications
Gum coagulation is used to treat both benign and malignant gingival formations.
The operation is performed to eliminate the following pathological conditions:
- granulation neoplasms;
- overgrown mucosal tissue (gingival papillae);
- tumor formations (fibromas, hematomas, papillomas, etc.);
- corrosive cavities below the gum level;
- attachment of gums.
The operation is not performed if the patient has this moment There is an unsatisfactory hygienic situation in the oral cavity. As soon as the dentist performs effective treatment, you can begin the procedure.
Absolute contraindications for performing the operation are:
- pathology immune system, in which there is a high risk of infection during surgery;
- bleeding disorders;
- endocrine diseases to the degree of decompensation (in particular, diabetes mellitus);
- exacerbation of infectious diseases;
- decompensated cardiovascular pathologies.
If there are such contraindications, the operation is performed only under the supervision of a specialized doctor. and only if the expected harm from disease progression exceeds the expected harm in the event of complications developing.
In addition, it is not advisable to perform gum coagulation if there is inflammation of the bone tissue.
Methods
The advantage of coagulation action over traditional mechanical(excision of the gums using a scalpel) is that under the influence of ultra-high temperatures, tissue cells are compressed, and bleeding does not occur in the area of exposure, which significantly reduces the healing time.
Coagulation of gums is carried out using various instruments:
- Electrocoagulator. Now there is a wide range of these devices on the market, and they are stationary, portable, having different modes, voltage and current.
The basic principle of operation of such devices is to expose tissue to high-frequency alternating current.
- Laser. It affects the gums in a targeted and most gentle manner. The most effective and gentle method.
- Heated sharp instrument. Today it is practically not used, as it is a traumatic procedure and requires long recovery.
With the help of these devices, the pathologically changed area of tissue is cut off, and the cells at the site of damage are compressed, preventing the development of bleeding and eliminating infection. This way the tissue heals quickly.
Electrocoagulation techniques
Coagulation can be performed different ways, which have key differences in the way current is applied to affect tissue.
The first method is monopolar coagulation. In the case of such an operation, the current is supplied to the electrode, which is located directly on the scalpel handle.
In this case, electricity passes through the entire body of the patient, closing on the return plate (its presence during the procedure is a mandatory element).
In this case, the current affects deeper layers of tissue, which is necessary for deep-lying tumors.
Biopolar coagulation differs in a more superficial effect, in which the current passes only through the affected area of tissue.
With this method, a return plate is not required, since the electricity is connected directly to the affected area.
Preparatory activities
No special preparation of the patient is required before the gum removal procedure.
Before performing the procedure, it is advisable to show your dentist your medical card or extracts from specialized specialists – if the patient has any chronic diseases or characteristics of the organism.
You should also inform your doctor if the patient is allergic to medications. local anesthesia, because the operation is performed under local anesthesia.
If the dentist has questions about the nature of the neoplasm, he can refer the patient to various specialized specialists - oncologist, periodontist, infectious disease specialist or other specialist.
Immediately before coagulation, the oral cavity is sanitized, hygienic cleaning and (if necessary) removal of hard dental plaque.
If the condition of the patient’s oral cavity is unsatisfactory, there are inflammatory elements or signs of infection, then a course of treatment is carried out first.
Stages of the procedure
After hygiene procedures, an anesthetic gel is applied to the affected area and wait until it begins to act. Then the doctor, using a device (laser or coagulation), performs tissue excision or removal of the pathologically changed area.
The patient must sit in a chair calmly and motionlessly, so it is important to provide high-quality local anesthesia.
On average, the entire operation lasts from 10 to 20 minutes, depending on the location of the tumor and the technique used.
After the procedure, the patient is not required to follow any special regimen or follow any instructions—the patient’s ability to perform the procedure is not lost.
Treatment of papillae with hypertrophic gingivitis
Coagulation of the gingival papilla is one of the most common applications of the technique.
Its frequent need is due to the fact that this type pathological growth tissue very often occurs due to improper use of hygiene devices - dental floss, toothpicks, household damage, ingestion of solid foods, etc.
The gingival papilla itself is a protrusion of the mucous membrane located in the interdental space, which can hurt and bleed, and in general does not look aesthetically pleasing.
In the case of coagulation, this protrusion of the mucous membrane is simply cut off and the patient is recommended to change his approach to oral hygiene.
Prolonged neglect of treatment of such formations leads to the proliferation of bacteria due to the penetration of blood particles into the tooth enamel. In the future, this can lead to the development of caries.
Another reason to think about radical treatment gingival protrusion - the need to install a filling in the teeth closest to the inflamed area.
Even if the gingival papilla itself does not bother the patient, the small but regular discharges of blood produced by it can wash away the filling, leading to the formation of a gap between it and the dental tissue.
The video shows the flow chart laser correction hypertrophied gums.
After coagulation, it is not recommended to eat for several hours. During the period primary healing(1-3 days) it is not recommended to eat hard or hot food so as not to damage the healing tissue. It is mandatory to maintain oral hygiene – brushing and rinsing your teeth.
To make the healing process faster and safer, the dentist may recommend that the patient rinse the mouth with various herbal decoctions– chamomile, oak bark and others. They have a mild bactericidal effect and promote rapid tissue healing.
After the procedure, especially in cases where extensive excision is necessary, the patient may experience pain for 1-2 days as the healing process occurs at the site of treatment.
As a rule, such a measure is necessary only for people with hypersensitivity mucous membrane, because painful sensations after coagulation are minimal.
Price
In Moscow, a coagulation procedure using alternating current in the area of one tooth can be performed for approximately 2,500 rubles.
A similar procedure performed with a laser will cost the patient 5,000 rubles.
Excision using a heated instrument will cost 100-500 rubles, depending on the clinic.
The stated price does not include diagnostic procedures, consultation with a doctor and preliminary preparation to the procedure.
The final cost depends on the area of the lesion, the individual characteristics of the patient, as well as the technical equipment of the clinic where the procedure will be performed.
Some patients have dental problems that need to be addressed only surgical methods. And classical surgery (with a scalpel), as is known, is always accompanied by certain consequences: bleeding, the need for sutures, a difficult rehabilitation period, and the risk of infection of the areas where the intervention was performed. To avoid all these troubles, an improved method was invented called gum coagulation. Read in our material about what it is, in what cases it is used and what features you need to pay attention to here.
General overview of the procedure
Gum coagulation in dentistry is a process during which diseased tissue is treated, cauterized, and also excised under ultra-high temperature. The procedure can be performed using different heating sources: heated instruments, electrocoagulators. Also, such an operation is often carried out with help - it has the most gentle effect.
The description of the procedure sounds a little scary, but in fact this technique completely safe for the health of the patient, as well as his psychological state. Do you agree that the absence of a scalpel (in the classical sense) and the need to carry out extensive intervention immediately puts you in a positive mood? In addition, the procedure takes place under local conditions, which means no painful sensations you will not feel or have to fear extremely high temperatures.
On a note! Thanks to the impact special devices When cutting off damaged areas, the specialist performs the procedure with maximum precision and comfort for the patient. The soft tissues on which the intervention is performed are immediately cauterized using an instrument, so they do not bleed and remain sterile (they are disinfected), and also heal quickly during the rehabilitation period, which avoids complications and significantly reduces treatment time.
Why is the gum most often cauterized?
Most often, patients are recommended to apply electric shock to the affected areas due to hyperplasia or overgrowth of soft gum tissue, also called papillae. They fill the interdental spaces and are very sensitive to any impact. Their excessive enlargement and inflammation are caused by household injuries (occurring when using floss to remove plaque, toothpicks, brushes with hard bristles, or eating hard foods), dental diseases, poor oral hygiene, malocclusions, or hormonal disorders.
In the absence of proper treatment, the area of the interdental papillae increases, soft fabrics begin to become inflamed and bleed, causing pain and discomfort. In addition, the formation of such growths can cause disruption correct pronunciation sounds, circulatory disorders in the gums, lack of good nutrition, the appearance of complexes (the overgrown mucous membrane can completely cover the crown part of the tooth, which looks extremely unaesthetic), so dentists recommend cauterizing them in a timely manner.
Therapy for hypertrophic gingivitis
The disease is one of the most common in dentistry - it occurs with equal frequency in both adults and children. It is characterized by the proliferation of soft interdental tissues, which, if left untreated, can overlap the crowns of the teeth. The appearance of pathology is provoked not only by poor oral hygiene and hormonal imbalance in the body, but also chewing hard pieces of food that injure the interdental spaces, improper use of personal hygiene items (threads for removing plaque, brushes, etc.).
IN complex therapy(taking anti-inflammatory drugs, physiotherapy, gingivectomy) to treat the disease, dentists recommend using a method such as coagulation.
Other situations when the procedure is performed
Such modern method treatments such as coagulation are often used in dentistry for the following purposes:
- removal of formations on the mucous membrane: malignant and benign,
- removal of any granulation tissue,
- correction and to give aesthetics to the smile,
- treatment and (only in complex therapy): in particular, the procedure can be carried out to cauterize and treat inflamed gingival papillae that have grown during the course of the disease. And also for removing granulations and pathological tissues from periodontal pockets - at the end of the procedure, the periodontal pockets remain completely sterile, the tissues fit tightly to the tooth, which prevents plaque, bacteria and food particles from getting inside,
- cauterization of inflamed gingival papillae: pathology can occur not only against the background of periodontal tissue diseases, but also due to trauma to the mucous membrane, malocclusion, hormonal disorders in the body, incorrectly performed dental treatment, chipped fillings and the presence of uncomfortable prosthetic structures,
- removal of papillomas, fibroids: they may look harmless, but sometimes they grow greatly, causing inconvenience, and become dangerous to health.
Who should not undergo the procedure?
Despite the fact that the described technique has a number of advantages (in comparison with traditional ways surgical interventions) there are also some contraindications to the operation. Coagulation is not performed if the following problems have been diagnosed:
- intolerance to low-frequency electric currents: in this case, it is permissible to use only a laser,
- exacerbated infectious diseases,
- disorders of the cardiovascular system: there is a high probability of increased blood pressure,
- disruption of the hemostasis system: the risk of bleeding increases,
- chronic diseases: for example, diabetes.
Also, the use of “hot” instruments is unacceptable during the active change from primary to permanent occlusion in children, which occurs between the ages of 6-8 and 12 years.
Important! If the patient has the above conditions, the operation should be performed only under the supervision of a highly qualified specialist, and also provided that the likely harm from the development of the disease outweighs the risks of complications after coagulation.
Coagulation methods
There are several options for treating the affected mucosa. Depending on which device is used, the following methods are distinguished:
- cauterization with a metal instrument with a hot tip: the instrument is considered obsolete and is rarely used nowadays - the procedure using it is quite traumatic, and the subsequent rehabilitation period is quite long,
- excision with an electrocoagulator: here, with the help of a device, electrical energy is converted into thermal energy. Alternating electrical currents supplied through the tool high frequency“dry” and destroy damaged areas,
- treatment laser device: damaged tissues are “burned out” by a beam of intense light.
Coagulation techniques and its types
Removal of inflamed tissue can be done different techniques. Each of them differs in the way the current is supplied. There are two types of coagulation. Let's look at each of them in more detail.
1. Monopolar method and its features
The doctor uses an instrument that looks like a scalpel. But the effect on tissue is carried out not mechanically, but with the help of an electrode built into the scalpel handle, through which current is passed. In this case, electrical impulses (weak charges of safe AC voltage) pass through the entire human body, and the safety of the process is ensured by a special return plate with which the tool is equipped. The presence of this element is mandatory, because it is responsible for the process of closing the electrical circuit.
The method is effective when performing coagulation to remove large tumors.
On a note! If cutting is performed with a faulty device or by an unqualified specialist, consequences such as injury and burns to the mucous membrane may occur during the procedure. The method is considered quite outdated these days, so doctors rarely resort to it.
2. Bipolar method and its features
The main difference between this method of coagulation is that the current passes only through the affected areas of the tissue (the doctor acts on them pointwise), so a return plate is not needed for its implementation. The operation is performed with an instrument with a forked tip, which grips and clamps the gum so that the electrical circuit is closed directly in the area of the procedure.
How to prepare for the procedure
There is no need for special preparation before coagulation, but you should do the following:
- visit different specialists: before the procedure, if necessary, the doctor may refer you for a consultation with other specialized specialists (infectious disease specialist, oncologist, periodontist),
- Avoid drinking alcohol several days before the procedure, as well as on the day of coagulation: it negatively affects blood clotting and the effect of medications and anesthetics used during the procedure,
- have a snack before the procedure: the snack should not be heavy, but you should not completely refuse food, because After the operation, you will not be able to eat for at least another 1-2 hours.
How is the procedure performed?
The operation is performed only by an experienced dental surgeon. First, the doctor will sanitize the oral cavity and administer anesthesia (in the case of using a laser, it is often possible to confine oneself to local “freezing” in the form of gels and sprays, since the procedure causes virtually no pain to the patient). Next, the specialist works with an instrument designed for coagulation and performs the necessary manipulations.
Important! The patient should relax in the dentist's chair and not make sudden movements. Otherwise, the hand of even the most experienced specialist may tremble, and the instrument will damage healthy areas.
The duration of the operation directly depends on the degree of complexity of the actions performed, but on average coagulation takes no more than 20 minutes.
Advantages of the method
In comparison with the long-familiar, classical methods of surgical interventions, coagulation allows you to gently and painlessly target pathological areas of tissue, as well as destroy pathogenic bacteria. In addition, the gums do not bleed after coagulation, heal faster and look attractive. Therefore, you should not delay your visit to the doctor for fear discomfort. Timely assistance will be the key to the health of your oral cavity and the beauty of your smile.
What complications may arise after surgery?
Many patients note that their gums hurt in the first few days after coagulation. This phenomenon is considered quite natural consequence interventions. To reduce discomfort, you can take painkillers that you usually use and keep in your medicine cabinet.
If the pain does not disappear after some time, and additional alarming symptoms(inflammation and redness of the mucous membrane, the appearance unpleasant odor from the mouth, discharge of pus), then be sure to visit a doctor. The specialist will tell you what to do to make the gums suppurate go away: for these purposes, antibiotics that destroy pathogenic microflora and treatment of the mucous membrane with antiseptics are most often prescribed.
Useful tips to help you recover after surgery
If you want the tissue healing process and rehabilitation period passed as quickly as possible, then be sure to follow these recommendations after the operation:
- refrain from eating in the first few hours,
- As soon as you can have a snack, follow the rules: exclude hot, cold, hard, spicy foods - dishes can be heated to a temperature no higher than 37 degrees. You need to adhere to the restrictions during the first few days,
- chew only on the side that was not coagulated,
- After each snack, rinse your mouth: for this you can use herbal decoctions with a mild bactericidal effect, antiseptic solutions, soda solution, special rinses or at least regular drinking water.
Also, carefully perform oral hygiene, the main thing here is without fanaticism. Do not put strong pressure on the sensitive mucous membrane, so as not to injure it and cause the development of a repeated inflammatory process.
Coagulation is used in dental practice in the treatment of both benign and malignant tumors. Using a coagulation apparatus, the specialist excises the tumor with the highest level accuracy. The patient does not feel pain and does not experience psychological discomfort at the sight of a surgical instrument. Laser gum excision
What is gum coagulation
Gum coagulation is the surgical excision of mucous tissue using a hot instrument. This is plastic surgery of gum tissue performed using electric current.
Despite the frightening description, the procedure is as painless and comfortable as possible for the patient. The operation is performed under local anesthesia. Unlike classical surgery, the patient does not lose a drop of blood during the procedure.
The method is used to remove various types of tumors and to treat diseases such as:
- periodontitis;
- periodontal disease;
- inflammation of gum pockets;
- fibroma;
- hemangioma;
- tissue hyperplasia, etc.
Periodontal diseases Why do you burn your gums when treating teeth?
The most common reason, for which the patient is prescribed a coagulation procedure - this is the growth of gingival growth, also known as the gingival papilla. This is the mucous tissue that fills the spaces between teeth or voids formed as a result of periodontal disease. It can also begin to grow after trauma to the mucous membranes with a hard toothbrush, rough food, or due to insufficient hygiene oral cavity.
Types of coagulation (cauterization) of gums
Monopolar technology
A special return plate is placed on the patient’s body, which is responsible for closing the electrical circuit. Weak electrical impulse passed through the patient's entire body and through surgical instrument. With this procedure, you can get rid of even large neoplasms and tumors located in the deep layers of tissue. Due to its effectiveness, this method is used more often than others.
Bipolar technology
An electrical discharge is passed locally, only through the part of the body in which the tumor or inflammation is located. Therefore, the end plate is not used. This method is effective for therapy dental diseases light form.
The gum cauterization method is widely used in dental practice and shows good results in the treatment of periodontal diseases.
Before performing the operation, the doctor examines the patient’s oral cavity for injuries to the mucous tissues, since their presence can cause complications.
Bipolar gum coagulation technology Upon completion of the operation, the patient is given a list of recommendations and a prescription for medicines. For each patient, recommendations are made individually, depending on the disease and its severity.
Preparing for surgery
Coagulation does not require special training. As before any other dental operation, the patient must undergo professional cleaning oral cavity and get rid of tartar. If the appearance of a neoplasm is accompanied by any diseases of the teeth or gums, the patient must first visit the offices of a periodontist and dentist to receive advice and eliminate the problems.
The day before the procedure, you should avoid drinking alcohol and smoking, as they have a bad effect on blood clotting.
How does the procedure work?
The operation is performed by a dental surgeon. Since the procedure is practically painless, it is performed under local anesthesia, which uses an anesthetic gel.
While sitting in the dental chair, the patient should try to relax as much as possible and do not move. Due to sudden movements, the instrument in the hands of a specialist can shake and damage healthy tissue.
With help laser beam the doctor excises the inflamed areas of tissue or completely removes the tumor. In total, this type of operation takes a quarter of an hour. It may take more or less time depending on the patient's specific problem.
The main thing for the patient is not to move It costs several hours after the operation abstain from eating food so as not to damage tissues that have become particularly sensitive after the procedure and not to cause infection. It is necessary to take special care to keep your mouth clean and rinse after every meal. You can chew outside the house chewing gum or use dental floss.
To speed up regeneration and relieve discomfort, you can rinse your mouth with decoctions medicinal herbs (chamomile, oak bark, calendula etc.).
In order to make sure that the operation will be successful and will not cause any complications, the dental surgeon can refer the patient to an oncologist, infectious disease specialist and periodontist for additional examination and health monitoring.
Coagulation of the gingival papilla
The procedure is quite in demand due to careless attitude most people to own health. Due to limited time or fear of dentists, many simply do not treat diseases of the gums and teeth, such as gingivitis, caries, etc.
As a result, the lesion site becomes overgrown with pathological gum tissue. This disease requires medical intervention, namely coagulation of the gingival papilla.
Inflamed gingival papilla Cauterization is carried out under local anesthesia and during the procedure the patient feels only mild discomfort. Thanks to the use of an electrocoagulator, healthy tissues are not affected by the instrument.
Oral care after the procedure
The postoperative period is quite unpleasant and painful, since, in essence, surgical removal parts of living mucous tissue, albeit pathological nature. Pain syndrome will accompany the patient for two days after the operation, after which it will gradually retreat. To alleviate the condition, the doctor may prescribe analgesics.
Rinsing with herbal decoctions or chewing propolis will help relieve pain.
The recovery period after surgery takes on average from 2 to 10 weeks. This is exactly how much tissue needs to fully regenerate. During this time, the patient must regularly visit the attending physician’s office to monitor the condition.
Your doctor may prescribe rinses antiseptic solution Chlorhexidine or Furacilina and the use of anti-inflammatory ointments. It is very important to prevent infection from entering the treated tissue areas.
Furacilin Depending on the character past illness The doctor may prescribe antibiotic medications to completely destroy the pathogenic microflora and prevent recurrence of complications.
Conclusion
Gum coagulation has a number of undeniable advantages compared to classical surgery, where pathological tissue is excised manually using a cutting instrument. Thanks to high temperatures and electricity, the patient does not experience blood loss during surgery, pathogenic bacteria die, and the wound heals much faster.
Coagulation of gums – surgical intervention, which involves cutting off the soft tissue of the gums using a heated instrument.
In other words, gum coagulation is Plastic surgery using electric current. Moreover, the procedure is completely bloodless and as safe as possible (compared to a scalpel). The coagulation method is widely used for the resection of malignant and benign neoplasms, as well as a number of other diseases.
Kinds
IN modern dentistry There are two types of coagulation:
- Monopolar – electricity During surgery, it passes through the patient's entire body. The safety of the procedure is ensured by the return plate with which the instrument is equipped. The monopolar coagulator is considered a little outdated, but is still widely used in medical practice.
- Bipolar coagulation does not require the use of a return plate - the current passes only through the required area and is immediately closed.
IN Lately The electrocoagulator was replaced by a laser. Using a laser beam, the same manipulations are carried out, but in a more gentle way. Laser therapy allows you to act only on the affected area, without affecting healthy tissue.
Indications
Coagulation of gums – effective method treatment for the following diseases:
- hemangioma;
- fibroma;
- abnormalities of soft tissue development;
- periodontal diseases;
- inflammation of gum pockets;
- tissue hyperplasia.
The most common problem that can be solved with coagulation is gum growth. This pathology known as the gingival papilla. In this case, the mucous tissue extends beyond the gums and fills the interdental space. May be due to improper use hygiene products care oral cavity– dental floss, toothpicks or brushes that are too hard. Too hard food can also injure the delicate membrane of the gums and provoke tissue growth.
Is special training required?
Special training not needed for the procedure. Immediately before the operation, it is necessary to carry out thorough oral hygiene and remove tartar. If the patient has concomitant problems with teeth or gums, it is necessary to first undergo treatment with a periodontist or dentist.
When visiting a doctor, you need to take a medical history and opinions of other specialists (if any). Before the procedure, you need to eat a hearty meal - this will help the patient feel better. It is also worth considering that it is not recommended to eat food in the next few hours after coagulation. Also, you should not drink alcohol the day before - it can negatively affect blood clotting.
How does the procedure work?
Coagulation of the gums is carried out by a dental surgeon under local anesthesia. The coagulation procedure (especially using a laser) is almost painless, so a special anesthetic gel is sufficient for complete pain relief.
During the operation, the patient must sit quietly in a chair - sudden movements can damage healthy tissues of the oral mucosa. Using a laser or coagulator, the doctor excises the required areas of tissue. If we are talking about a neoplasm, then it is carried out complete removal.
The entire operation lasts on average 10-20 minutes - the duration directly depends on the method and complexity. For several hours after coagulation, you should not eat hard or hot food, which can further injure the wound. It is also necessary to maintain oral hygiene. For fast healing It is recommended to rinse your mouth with soothing infusions (oak bark, chamomile, etc.).
List of additional specialists that may be needed
Before performing coagulation, the surgeon may refer the patient to the following specialists:
- periodontist;
- dentist;
- oncologist;
- infectious disease specialist, etc.
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