What are the risks of wisdom tooth extraction? How can wisdom tooth extraction lead to a broken jaw? What is dental malpractice related to wisdom tooth extraction?

The Risks of Wisdom Tooth Extraction

Wisdom teeth, also known as third molars, are the last teeth to develop in the mouth. They often emerge in the late teens or early twenties. Due to the limited space in the mouth, wisdom teeth can become impacted or grow in at an angle, causing a variety of problems. While wisdom tooth extraction is a common procedure, it is not without risks.

One of the rarest but most serious complications of wisdom tooth extraction is a broken jaw, or mandibular fracture. According to the dental and medical literature, a mandibular fracture following a wisdom tooth extraction occurs in only 0.0033% to 0.0075% of cases. Most oral surgeons may never see a fractured jaw during their entire careers.

The Case of Sydney Kaye: A Broken Jaw from Wisdom Tooth Extraction

Our client, Sydney Kaye, a woman in her 30s from Houston, was referred to a general dentist to have her wisdom tooth removed. During the procedure, the dentist was reportedly in a hurry and Sydney could still feel everything that was happening, despite receiving multiple anesthesia injections. After the anesthesia wore off, Sydney was in excruciating pain and went back to the dentist’s office the same day.

An x-ray revealed a shocking diagnosis – Sydney’s lower jaw, or mandible, was broken. Mandibular fractures following wisdom tooth extraction are exceptionally rare, yet this is exactly what happened to Sydney Kaye. After the initial diagnosis, Sydney was rushed to an oral surgeon who performed a temporary fix to stabilize her fractured jaw. She then faced additional surgeries that required wiring her jaw shut and placing plates and screws.

The Difference Between General Dentists and Oral Surgeons

General dentists and oral surgeons have different levels of training and expertise. While all oral surgeons are dentists, not all dentists are oral surgeons. Oral surgeons (also called oral and maxillofacial surgeons) have additional specialized training in complex surgeries of the face, mouth, and jaw.

Wisdom teeth, with their deep roots, are usually more complex and difficult to extract than other teeth. Many dental experts believe that wisdom tooth extractions should be performed by oral surgeons, rather than general dentists. General dentists who choose to extract wisdom teeth should inform patients that they are not oral surgeons and obtain proper informed consent.

Nerve Injuries from Wisdom Tooth Extraction

In addition to the broken jaw, Sydney Kaye also experienced a permanent nerve injury after her wisdom tooth extraction. After the anesthesia wore off, she never regained feeling in her tongue and mouth, leaving her with an uncomfortable sensation for the rest of her life.

The oral surgery expert who reviewed Sydney’s case noted that the pre-operative imaging showed her wisdom tooth roots were in close proximity to the inferior alveolar sensory nerve, which provides sensation to the mouth and tongue. The standard of care in such cases would have been to refer Sydney to an oral surgeon who could have performed a specialized procedure called a coronectomy, which requires less force on the jaw and would have spared the nerve from damage.

Pursuing a Dental Malpractice Claim

Sydney Kaye hired our firm, Painter Law Firm, to pursue a dental malpractice case against the general dentist who extracted her wisdom tooth. Our expert review of the records and imaging found that the general dentist’s excessive use of force in extracting the wisdom tooth was the cause of Sydney’s broken jaw and permanent nerve injury.

If you or a loved one have suffered serious injuries due to poor dental or wisdom tooth care in Texas, it’s important to contact an experienced Texas dental and medical malpractice lawyer for a free consultation about your potential case.

Preventing Wisdom Tooth Extraction Complications

Seek Treatment from an Oral Surgeon

When facing wisdom tooth extraction, it’s best to have the procedure performed by an oral surgeon, rather than a general dentist. Oral surgeons have the specialized training and expertise to handle the complexities of wisdom tooth removal, reducing the risk of complications like a broken jaw or nerve damage.

Understand the Risks

Before undergoing wisdom tooth extraction, patients should have a thorough discussion with their dental provider about the potential risks and complications of the procedure. This should include an explanation of the provider’s qualifications and experience in performing wisdom tooth extractions.

Follow Post-Operative Instructions

Patients must carefully follow all post-operative instructions provided by their dental provider to ensure proper healing and avoid complications. This may include taking pain medication, applying ice packs, and limiting physical activity.

Conclusion

While wisdom tooth extraction is a common procedure, it is not without risks. Complications like a broken jaw or permanent nerve damage, though rare, can have a significant impact on a patient’s health and quality of life. By understanding the risks, seeking treatment from a qualified oral surgeon, and following post-operative instructions, patients can help minimize the chances of experiencing serious complications from wisdom tooth extraction.

Dentist breaks patient’s jaw while pulling wisdom tooth

Our client—we’ll call her Sydney Kaye—is a Houston woman in her 30s who was referred to a general dentist to have a wisdom tooth pulled. 

Sydney Kaye remembers the dentist being in a hurry. She remembers getting two or three injections of anesthesia and then the dentist starting pulling the tooth while she could still feel everything going on. She remembers going home and being in excruciating pain once the anesthesia wore off.

She went back to the office the same day, and they did a panorex x-ray and discovered the shocking diagnosis–her lower jaw (mandible) was broken. According to the peer-reviewed dental and medical literature, a mandibular fracture following a wisdom tooth extraction is exceedingly rare, happening in only 0.0033% to 0.0075% of cases. Most oral surgeons would never see a fractured jaw during their whole career.

After diagnosing Sydney Kaye’s broken jaw, the orthodontic staff rushed her off to see an oral surgeon, who did a temporary fix to stabilize her fractured jaw. She faced more surgeries that required wiring her jaw shut and placing plates and screws.

General dentists and wisdom teeth

General dentists aren’t the same as oral surgeons. One way to look at it is that all oral surgeons are dentists, but not all dentists are oral surgeons.

Like other areas of healthcare, dentistry is specialized. Most general dentists have training to handle preventative care, cleaning, oral cancer screening, simple tooth extractions, filling cavities, and placing caps. Oral surgeons (also called oral and maxillofacial surgeons) are dentists with additional dental and medical surgical training in complex surgeries of the face, mouth, and jaw.

Wisdom teeth have deep roots and are usually more complex and difficult to pull than other teeth. That’s why many dental experts feel that they should be handled by oral surgeons, rather than general dentists.

When general dentists choose to handle wisdom tooth extractions as part of their regular practice, they should inform patients that they are not oral surgeons as part of the informed consent process. Additionally, even though they are only general dentists, when performing oral surgeries, they are held to the same standard of care as oral surgeons.

Nerve injuries with wisdom tooth extraction

Unfortunately, Sydney Kaye’s broken jaw wasn’t the only problem she had because of the general dentist pulling her wisdom tooth. After the anesthesia wore off, she never regained feeling in her tongue and mouth. Imagine being left with that uncomfortable sensation for the rest of your life!

Sydney Kaye hired Painter Law Firm to pursue a dental malpractice case against the general dentist who pulled her wisdom tooth. We hired an oral surgery expert who reviewed the records and radiology images. The expert noted that the pre-operative imaging showed that Sydney Kaye had two long wisdom tooth roots in close proximity to the inferior alveolar sensory nerve. That’s the nerve that gives sensation to the mouth and tongue.

Because those roots were so close to the nerve, the expert explained that the standard of care required referral to an oral surgeon to handle the wisdom tooth extraction. An oral surgeon would have performed a specialized procedure called a coronectomy, rather than pulling the whole tooth. A coronectomy requires a lot less force on the jaw and would also have spared the nerve from damage.

The oral surgery expert wrote a report critical of the general dentist’s excessive use of force in extracting the wisdom tooth which broke Sydney Kaye’s jaw and left her with a dreaded permanent nerve injury.

We filed the dental malpractice case last week, which is pending in a Harris County district court.

We are here to help

If you’ve been seriously injured because of poor dental or wisdom tooth care in Texas, contact a top rated, experienced Texas dental and medical malpractice lawyer for a free consultation about your potential case.

Removal of Impacted Wisdom Teeth

Issues with lower wisdom teeth

Wisdom teeth are the last teeth to develop in your jaws, often there is not enough space for them to erupt into the correct position like the other teeth in your mouth. They can vary in their position. Please see the image below for their different positions. Some may not erupt fully because they be impacted against another tooth or may be part covered by the gums (oral mucosa) A combination of this varied position, impaction, being partially erupted and other causes may create issues. You may not be aware that these are occurring.

One of the most common reasons you have been referred is that you’ve been having problems with your wisdom teeth. This may be due to pain, swelling or infection to the gum covering the wisdom tooth, also known pericoronitis. The wisdom tooth may also be decayed. You may also be getting food stuck around your wisdom teeth.

Some wisdom teeth may have no symptoms but there may be a problem developing or there is high risk of a problem developing that you may be unaware of. There is strong evidence to show that wisdom teeth that are mesially or horizontally positioned that have not erupted fully have a high risk of decay occurring within the wisdom tooth and also to the tooth in front. If left alone the decay may get to the extent that you may develop pain from both teeth. If the tooth in front is decayed it will need to be repaired by the Dentist after the wisdom tooth has been extracted.

The decay may get to the extent that the tooth in front has to be removed as well. The same may occur to the bone support around these teeth (periodontal disease). Sometimes cysts can form around the wisdom tooth. A cyst occurs when fluid fills the sack that normally surrounds a developing wisdom tooth and can slowly increase in size.

A horizontal wisdom impacted tooth.

There is early decay in the tooth in front.

Your dentist may be able to repair this tooth

A horizontal impacted wisdom tooth.

There is extensive decay in the tooth in front.

Both teeth will need to be removed.

If you have a medical issue that requires you to start medicines such as immunosuppressants or medicines that affect the bone it is advisable to have an assessment of your teeth including your wisdom teeth before you start these medicines. If you were to have a tooth extracted while on these medicines this may slow down healing of a tooth socket. In rare cases the tooth socket may not heal at all. The assessment may recommend the need to remove teeth that are of a poor prognosis including your wisdom teeth.

If you are intending to travel abroad for a long length of time and access to a dentist or a specialist is difficult the consideration may be given about having treatment for your wisdom teeth and other teeth before you leave.

Do I need to be referred?

Some wisdom teeth can be straightforward to remove. Your Dentist might be able to remove them or may refer you to see a clinician who removes them routinely. You may need to go another Dental practice or a clinic in the community. They may be able to remove them on the same day as your first appointment.

For wisdom teeth that are difficult to remove or there are medical issues or if you wish to see a specialist, you may need to be referred to the hospital. The specialist will often be a Consultant in Oral and Maxillofacial Surgery or an Oral Surgeon. They will have the experience and qualifications to provide you with the information for you to decide about you would like to do about your wisdom teeth. Often the first appointment will be a consultation only and if necessary another appointment will be needed to have your treatment.

What options may be discussed?

There are several options about the management of your wisdom teeth.

No treatment but kept under review

If the wisdom tooth is in a position where it has not been causing problems and there is a low risk of a problem developing then an option can be for the wisdom tooth to be left where it is. Your Dentist can continue to review your wisdom teeth along with the rest of your teeth when you attend for your routine check up. When necessary your Dentist may need to take an X- ray of the wisdom teeth. However, over time circumstances may change and the risk of a problem with your wisdom teeth may increase, which treatment will then be needed. The time of when treatment is needed is a decision that can be made with you and the Dentist or the Specialist. It is important to keep your wisdom teeth under review as problems may develop with out you knowing about them until severe symptoms develop.

Treatment

In most cases where a problem has developed or a high risk of developing the wisdom tooth could be removed completely or part removed. During your consultation these options will be discussed with you in detail along with what is involved and the risks of the procedure. Your upper wisdom teeth may need to be removed as well.

What does the complete removal of lower wisdom teeth involve?

If the wisdom tooth has not fully erupted into the mouth it is often necessary to make a cut in the gum over the tooth. Sometimes it is also necessary to remove some bone surrounding the wisdom tooth. The tooth may need to be cut into 2 or 3 pieces to remove it. Once the wisdom tooth has been removed the gum is put back into place with stitches. In the majority of cases these stitches are dissolvable and take around two weeks to disappear.

What are the main possible risks of removing a wisdom tooth?

Most patients will recover fully with no problems.

• Bleeding
  
  • There may be a little bleeding at the time of the extraction this usually stops very quickly and is unlikely to be a problem. If you are at home and the area bleeds again this can usually be stopped by applying pressure over the area for at least 10 minutes with a rolled up handkerchief or swab. If the bleeding does not stop, please contact the department where you had your operation.

• Altered Sensation to the chin, lower lip or tongue
  • Two nerves lie quite close to the lower wisdom teeth. The nerves can vary in their proximity to wisdom teeth. See the image below. The lingual nerve provides sensation in your tongue whilst the inferior dental nerve gives sensation to the lower lip and skin overlying the chin. Occasionally these nerves may be bruised during tooth removal. If this happens then you may have either numbness or pins and needles in either the tongue, lower lip, skin over the chin or any combination of these. If the wisdom tooth is away from the nerve the risk to the inferior dental nerve is less than 1%, however if the nerve is in very close contact the risk may be as high as 9%. The risk to the lingual nerve is less than 0.5%. It may take up to 18 months for this to recover. Rarely the nerve may not recover fully and you may be left with small patches of numbness to your lip or chin. Taste is rarely affected.

• Infection
  
  • An infection in the in the socket can occur or the blood clot from extraction socket has dissolved away which may result in a dry socket. The incidence of this happening is low being in the order of 2%. It can be minimised by keeping the area clean with rinsing with water or a mouthwash starting this the day after your procedure. It is advisable not to smoke for a few days after having the wisdom tooth removed. Smoking can increase the risk of an infection or a dry socket. It may also be necessary for you to have a course of antibiotics after the extraction.

• Weakening of the Jaw
  • In exceptional cases wisdom tooth removal can cause significant weakening of the jaw with the resultant possibility of jaw fracture. The incidence of this happening is extremely low and is less than 1% (less than 1 in 100).

A coronectomy

A coronectomy may be a treatment option. It may be offered if the inferior dental nerve in close contact to the wisdom tooth. In this technique only the upper portion of the wisdom tooth is removed leaving some of the tooth roots behind. This to minimise the risk of to the nerve. However, there is less than a 3% risk that you may need to have the remaining roots out at a later date or there may be delayed healing. At the consultation an assessment will be made to see to if this option is appropriate for you.

How long does it take to remove a wisdom tooth?

This is a variable. Some wisdom teeth may take only a few minutes to remove. More difficult wisdom teeth that need to be cut into pieces to remove can take around 20 minutes to extract.

Is there much pain or swelling after the removal of wisdom teeth?

It is likely that there will be some discomfort and swelling both on the inside and outside of your mouth after surgery. This is usually worse for the first three days but it may take up to two weeks before all the soreness goes. You may also find that your jaw is stiff and may not be able to open fully. You will need to eat a soft diet for a week or so. There may be some bruising of the skin of your face that can take up to a fortnight to fade away. The application of an ice pack during the first 24 hours post-operatively may help. Do not apply the ice pack directly to your skin – wrap the ice pack in a towel first. The older you are having a wisdom tooth removed the longer it will take to recover.

What type of anaesthetic is used?

A number of options are available and depend on how difficult the wisdom tooth is to remove

Local anaesthetic – this is an injection into gum surrounding the wisdom tooth, rather similar to that you may have had at your dentist for a filling. The injection takes a couple of minutes to numb the area and means that you will feel no pain while the wisdom tooth is removed.

Local anaesthetic and intravenous sedation – in addition to a local anaesthetic injection you can be given an injection into your arm. This makes you feel relaxed and less aware of the procedure. You are awake but patients frequently have little or no memory of the operation.

General anaesthetic – it is usually possible to remove wisdom teeth under a “day case” general anaesthetic, ie although you are put to sleep completely you will be able to go home on the same day as surgery.

Is there anything else I need to do after the extractions?

It is important to keep the extraction sites as clean as possible for the first few weeks after surgery. It may be difficult to clean your teeth around the sites of the extraction because it is sore and if this is the case it is best to keep the area free from food debris by gently rinsing with a mouthwash or warm salt water (dissolve a flat teaspoon of kitchen salt in a cup of warm water) commencing on the day after surgery.

Do I need to take any time off work?

Usually it will be necessary to take a few days off work and avoid strenuous exercise for this time. Depending on the type of anaesthetic used you may well not be able to drive (24 hours after intravenous sedation and for 48 hours after a general anaesthetic).

Further information

If you do want to know more about your operation please speak to your Dentist or the Specialist.

Here is a list of trusted websites that offer safe, sensible, useful information:

Royal College of Surgeons of England

British Association of Oral and Maxillofacial Surgeons

British Association of Oral Surgeons

NHS Stop Smoking Service.

NHS Choices

GOV.UK 

DVLA – Driver and Vehicle Licensing Agency

Call 111 for non-emergency medical advice

Wisdom tooth – complex extraction, impacted dystopic tooth

Impacted is a tooth that has not erupted and is located in the bone tissue, covered by the gum. Dystopic are teeth that have an abnormal position – that is, they are displaced towards the cheek or tongue, rotated around their axis or tilted to the side. At the same time, some teeth can be both impacted and dystopic – that is, they are in the bone, while they are turned to the side relative to the correct vertical position. This mainly concerns the “wisdom teeth” or root eights, which are located at the very end of the dentition.

Why do wisdom teeth grow incorrectly?

Wisdom teeth, or the outermost teeth in a row, usually erupt between the ages of 18 and 25. And they grow, as a rule, with serious violations. Only the lucky ones can boast of even and straight grown “eights”. Retention and dystopia become frequent problems of wisdom teeth, in most cases even both ailments at once.

Incorrect growth of wisdom teeth is explained by the fact that, firstly, they grow in adulthood, when the bone tissue is fully formed, it is very dense and hard – naturally, it is incredibly difficult to “break through” it. Secondly, modern man does not need eighth teeth – our ancestors used them to chew raw meat. Wisdom teeth do not even have guides – milk teeth, so they have to make their own path in hard bone.

Wisdom teeth in most cases are subject to removal, especially if they do not appear above the gum and interfere with neighboring teeth (put pressure on the roots of their neighbors from the side). It is also very important to check the condition of impacted wisdom teeth if there is discomfort when opening and closing the jaw, pain in the ear, or when the body temperature rises.

Extraction of an impacted and dystopic tooth

An impacted wisdom tooth can be in a straight or rotated position (dystopia) – in this case, it will put pressure on the roots of its neighbor. In order to avoid complications, such ungrown teeth must be removed. How is the operation carried out? In several stages:

• obligatory administration of anesthesia: tooth extraction is a painful operation that requires severe tissue anesthesia,
• the gum is cut – access to the impacted tooth is created,
• a hole is created in the bone using a burr,
• tooth extraction: the tooth is removed immediately upon
• bone is restored: in some cases, the cavity freed from the tooth is filled with artificial bone material, or with the patient’s own blood plasma – this measure is necessary in order to the bone has not formed an empty space that can be occupied by adjacent teeth. If they begin to shift, then the entire dentition will gradually “crawl” – gaps will appear between the teeth. In order to understand whether the filling of the hole with any material is required, a doctor’s consultation is necessary,
• gingiva is sutured: after all manipulations are completed, the gingiva is returned to its place, stitches are applied from above.

The operation to remove an impacted / dystopic tooth takes about 30 minutes – an hour. This is a fairly ordinary operation, which, when performing professional actions, will not lead to any complications. In some cases, with a large number of uneven roots, more time may be required. The doctor can determine the approximate time of the operation based on the results of the examination of the picture.

Complications after the removal of “wisdom teeth”

Unerupted teeth are sometimes deep enough in the bone, so their extraction can be quite a difficult procedure – this can lead to certain complications. For example, a nerve injury in the lower jaw, resulting in numbness of the lips, tongue and part of the cheek (passes on its own after a few weeks or months), rupture of the nasal sinus (a runny nose or sinusitis is formed). With the complex removal of wisdom teeth, there is a high probability of a fracture of the jaw, adjacent teeth or prostheses. In order to avoid such complications, it is best to remove wisdom teeth from an maxillofacial surgeon who has extensive practical experience in this field.

Care after the removal of “wisdom teeth”

After the removal of impacted wisdom teeth, there may be slight pain, bleeding from the wound, rarely – divergence of the sutures. There are also swelling of the tissues, pain when chewing food and opening the jaw. If the pain does not go away for 2-3 days (at this time it is necessary to take painkillers – these can be Ketarol, Ketanov, Nise, etc., depending on the prescriptions after the operation), you should consult a doctor. In general, rehabilitation takes from 1 to 5 days. After a few days, you should definitely visit a doctor for a follow-up examination of the results of treatment and removal of sutures.

Expert opinion

Emir Ramizovich Omerelli

Oral and maxillofacial surgeon, implantologist

Experience: more than 17 years

Impacted wisdom teeth are a “popular” reason for patients to visit dental clinics. In about half of all cases, the eighth teeth erupt with problems, and retention is the most common. Interestingly, the age of patients can be different – from 18 years to deep retirement age. It all depends on how impacted the tooth worries the patient. However, the sooner the problem is solved, the less problems the impacted tooth will cause.

After the operation, it is very important to follow the precautionary measures recommended by your doctor: you must refrain from eating for two hours after the extraction of the tooth. For a couple of days, the foods consumed should be warm – not too hot and in no case cold. It is necessary to chew on the side opposite from the place of operation. You should also exclude physical activity for a while. You can brush your teeth, but as carefully as possible so as not to damage the stitches. Do not forget about the need to take antibiotics and drugs that restore the state of the body’s immune system – they will be prescribed by your doctor.

Other works

Examples of before and after work

Simultaneous implantation in the lateral sections of the upper and lower jaws

Case: tooth decay under crowns in the lateral sections of the upper and lower jaws.

Simultaneous extraction and basal implantation (September 2012)

Case: destruction of the masticatory group of teeth in the lower jaw.

ROOTT Combined Implant – Maxilla (April 2013)

Case: tooth decay, periodontitis, gum atrophy.

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Your feedback

Victoria

06/24/2022

I removed a wisdom tooth at the RUTT clinic. After six years of torment, during which he constantly made itself felt at the most inopportune moment, she nevertheless decided to part with him. The removal was difficult (well, they said so), with sawing and pulling out in parts. In terms of time – the doctor worked at least 20-30 minutes. But it doesn’t feel like it hurts at all. In addition to picking in the jaw and pressure, I actually felt nothing. Unpleasant, yes, but not painful at all.

Other reviews

Wisdom teeth removal

Wisdom teeth are the conventional name for permanent third molars or eighth teeth in each of the jaw segments.

The eruption of these teeth occurs at a relatively late age and is often associated with various problems.

If the tooth has erupted, stands in the dentition and has an antagonist tooth (a pair on the upper or lower jaw), there are no problems with it, except for the widespread ones (caries, pulpitis, periodontitis).

When is surgery required?

1. Wisdom teeth often do not erupt due to lack of space in the dentition – they are not detected in the oral cavity, or are partially visible.
2. Can be located in the jaw with an arbitrary inclination in relation to the adjacent teeth.

Indications for surgery:

– pain in the area of ​​an abnormally located tooth
– pathological destruction of the root of the adjacent tooth
– chronic inflammatory process in this area
– orthodontic indications for removal
– any cystic formations in the region of the eighth teeth

Main difficulties in removal:

Lower jaw:

– proximity of the lower alveolar nerve. Its damage leads to numbness of part of the lower lip;
– the risk of a jaw fracture when the tooth is in the angle of the lower jaw.

Upper jaw:

– proximity of the maxillary sinus – risk of part or whole tooth falling into the sinus, development of oro-antral communication after extraction.

Anesthesia during removal:

– outpatient (local – infiltration, conduction) – the introduction of a local anesthetic blocks all types of sensitivity, incl. pain, but due to anatomical features, it may not be completely blocked.

– stationary: in addition to local – intravenous or endotracheal anesthesia eliminates any sensations, emotional reactions, the state is close to controlled deep sleep.

Anesthesia is the only option for patients with severe dental phobia (uncontrollable fear of any dental intervention), allergic to local anesthetics.

Where wisdom teeth can be removed:

– at the dental surgeon under local anesthesia. After the operation, you will go home.

– at the maxillofacial surgeon in the hospital.

Is it possible to remove all 4 wisdom teeth at once: Yes

Medical treatment after extraction:

Only painkillers (non-steroidal anti-inflammatory drugs)
The use of antibacterial agents is ineffective and does not reduce the risk of infectious complications.

Antibiotics are not needed at all:

In some cases, prophylactic antibiotic therapy is prescribed – once before surgery.

In the event of a surgical site infection (i.e. when that small percentage (5-8%) of this complication occurs).

At the consultation before the operation, be sure to inform the doctor:

– about the constant use of glucocorticoids, chemotherapy drugs, blood thinners
– the presence of diabetes mellitus, allergies to local anesthetics; presence of prosthetic heart valves

Oral and maxillofacial surgeon, neurosurgeon – Mark Mikhailovich Bucher. You can make an appointment for a consultation by phone. (343) 228-28-28.

THERE ARE CONTRAINDICATIONS, A SPECIALIST’S CONSULTATION IS NECESSARY

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