Wisdom Tooth Extraction

 

Wisdom teeth, or third molars, usually do not push through the gums until people are in their teens or twenties; they are usually the last teeth to come.

 

Most people have four wisdom teeth, some have none.

 

Often there is little space at the rear of the jaws for wisdom teeth to easily erupt through the gums. If the jaw does not have enough room, the tooth will become wedged or impacted.

 

Some impacted wisdom teeth remain buried and cause no trouble. However, other impacted wisdom teeth may cause severe problems.

 

Often one or more wisdom teeth will cause problems and must be removed.

Removal of a wisdom tooth is a very common procedure. Removal should usually be done ASAP before the problems get worse. If your wisdom teeth are likely to be difficult or complicated to remove, your dentist may refer you to an oral and maxillofacial surgeon.

 

Due to the shape and position of some wisdom teeth and the shape of the jaws, it may be necessary or preferable in such cases for an oral and maxillofacial surgeon to remove the teeth..

 

Problems Caused by Impacted Wisdom Teeth

  • Infection – when an impacted wisdom tooth starts to push through the gum, an infection can start around the top of the tooth. Infection can cause pain, swelling and jaw stiffness. Swallowing may be painful and it may cause a bad taste and bad breath.

  • Pain – pressure from the wisdom tooth may cause pain in the tooth next to it.

  • Crowding – a wisdom tooth may push nearby teeth out of their correct position and cause crowding in the front teeth

  • Cysts – if a wisdom tooth is not removed, a sac of fluid, called a cyst can form around the tooth and may displace the tooth. The cyst can destroy bone and damage other teeth and the gums.

  • Damage to nearby molars – an impacted wisdom tooth may keep pushing against the molar next to it. This can cause an ‘erosion cavity’ where the wisdom tooth hits the other molar and seriously damages it and the molars may become infected.

  • Ulcer – an upper wisdom tooth may push sideways out of the gum and rub on the inside of the cheek.

  • A food trap – food becomes trapped between the wisdom tooth and the molar ext to it possibly causing cavities.

 

Treatment of a Wisdom Tooth Infection

our dentist may gently clean the area around the infection. You may be advised to rinse your mouth of with warm salt water or a disinfectant mouthwash. You may be prescribed antibiotics also.

After inspecting the tooth with an x-ray, our dentist will discuss the diagnosis. They may delay surgery until infection clears up or wait to see if any pain stops. It is always your choice to decide if you want them removed or not.

 

our dentist may suggest early removal because:

  • There is not enough room for the tooth to push through

  • You need orthodontic work and the remaining teeth will become crowded

  • The tooth has started to cause trouble

It’s best to have them removed when you are young as the roots will not have formed completely and the surrounding bone and gum is softer.

 

Treatment

  • Where to have surgery – your dentist will advise you whether your teeth should be removed in the dental surgery or hospital

  • You may be given a sedative to relax

  • Stopping pain – the tooth may be removed under a local or general aneasthetic

  • Local aneasthesia:  if a wisdom tooth removal is fairly simple, you will be given a local aneasthetic with a needle; this will numb your gums and lower parts of the face.

  • General aneasthesia: this involves putting the patient to sleep with an injection. This is given by a specialist anesthetist. This may be used in patients that have teeth that are more difficult to remove.

  • Removal – an incision will be made in your gums to remove the tooth. A small portion of bone may have to be removed. The tooth may have to be divided into segments so it can be removed safely. The incision is closed with stitches that may be dissolvable or have to removed later.

  • After the surgery – after removal, you will be asked to rest for a while. If you have had general anesthetic, you will be able to leave once it has worn off. Do not engage in any strenuous activity, take several days off work or school, do not drink alcohol, eat soft foods, drinks lots of fluid and use ice packs to reduce swelling.

  • Pain relief – you may prescribed a pain reliever to deal with pain after the surgery.  The pain will usually start to decrease after the second day but may last up to a week. If your pain doesn’t reduce, tell your dentist.

  • Control of bleeding – you can apply pressure over the area of bleeding by gently biting on a piece of cotton gauze. This pressure helps stop bleeding and allows a blood clot to form. Do not disturb the area or it may bleed again. Bleeding should stop by the second day, if it doesn’t, contact your dentist.

  • Swelling – swelling is likely to occur and usually takes 4-5 days to come down. It can be reduced by applying ice packs.

  • Follow up – a follow up is important so the dentist can check on healing and remove any stitches.

 

Possible Side Effects of the Surgery

  • Numbness or altered sensation – an impacted wisdom tooth may be close to the nerves or may be touching a major nerve. When the tooth is removed, the nerve may become bruised. This can cause numbness, tingling and loss of feeling in the gums, cheek, tongue, lips, chin and around the jaw. An injured nerve will usually heal in less than 4 weeks and rarely, it make take up to 18 months. Extremely rarely, it may not heal.

  • Dry Socket – after the wisdom tooth is removed, a blood clot will form over the bone. This clot is important for proper healing and relief of pain. If this clot is washed away, the bone is exposed. This is called ‘dry socket’. This results in a throbbing pain. To help prevent a dry socket:

  • For the first day after surgery, do not rinse your mouth or spit with force.

  • After the first day, very gently rinse every four hours with warm salt water

  • Do not smoke

  • Do not brush around the area for the first day, afterwards, be very gentle

  • Infection – an infection in the gum or bone is usually treated with antibiotics.

  • Difficulty in opening the mouth – pain or discomfort when opening the mouth after surgery is common. This usually goes away after a few days.

  • Fever – the body temperature may be slightly higher after surgery but should return to normal within 12-24 hours. A fever that lasts longer may an indication of infection or other complication, contact your dentist if this occurs.

  • Excessive bleeding (haemorrhage) – although rare, haemorrhage may occur. It may be caused by too much exertion or by vomiting. It can be stopped by placing a piece of gauze over the wound and applying pressure for 15 minutes.

  • Lip sores – surgical instruements may cause bruises or small sores

  • Damage to nearby teeth – when a wisdom tooth is removed, the tooth or filling next to it may become chipped.

  • Vomiting – some people vomit when they are recovering from aneasthetic

  • Sinus problems – the roots of the upper wisdom teeth are close to the sinuses. In some cases, a sinus may be opened when the tooth is removed. The opening usually heals quickly without infection. However, if infection occurs, further treatment may be necessary.

  • Weak jaw – removal of the tooth may cause the jaw bone to temporarily become weaker. This is rare and usually only occurs in the elderly.

 

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