Wisdom Tooth Removal – Overview
A surgical procedure to remove one or more wisdom teeth is known as Wisdom Teeth extractions . The wisdom teeth are the four permanent adult teeth located at the back corners of your mouth on the top and bottom.
If the impacted wisdom tooth doesn’t have room to grow which then results in pain, infection or other dental problems, it will likely needed to be removed. A dentist or an oral surgeon may conduct the Wisdom tooth extraction.
Some dentists and oral surgeons recommend wisdom tooth extraction even if impacted teeth aren’t currently causing problems for prevention from potential future problems.
Why is wisdom tooth extraction done?
Wisdom teeth, or also known as third molars, are the final permanent teeth to appear or erupt in the mouth. These wisdom teeth generally appear between the ages of 17 and 25. Wisdom teeth may never be developing for some people. For other people, the eruption is normal same as their other molars and no problems caused.
Impacted wisdom teeth can be developed by many people. Teeth that don’t have enough space to appear into the mouth or are developing normally. Impacted wisdom teeth may only be partially erupted or not at all.
An impacted wisdom tooth may:
- Grow at a point toward the second molar
- Grow at a point toward the back of the mouth
- Grow at a right angle to the other teeth, as if the wisdom tooth is within the jawbone lying down
- Growing straight up or down like the other teeth but stays within the jawbone
Impacted wisdom teeth – Problems
The impacted wisdom teeth may need to be extracted if the following problems occur:
- Trapped food and debris behind the wisdom tooth
- Disease such as gum disease or infection (periodontal disease)
- Partially erupted wisdom tooth is decayed
- Damage to a nearby tooth or surrounding bone
- Around the wisdom tooth there is development of a fluid-filled sac (cyst)
- Complications with treatments to straighten other teeth
Prevention of future dental problems
Asymptomatic is where the Dental specialists do not agree about the value of extracting impacted wisdom teeth that are not causing any problems.
With impacted wisdom teeth, it may be difficult to predict future problems. However, here are some reasons for preventive extraction:
- Wisdom teeth which have no symptoms could still harbor disease.
- It’s often hard to get to the tooth and clean it properly if there is not enough room for eruption.
- Complications which may be severe might happen less often in younger adults.
- Difficulty with surgery and complications after surgery may be experienced by other adults.
Long term complications may not result in most of the wisdom tooth extractions. However, the extraction of impacted wisdom teeth occasionally requires a surgical method where an incision is made in the gum tissue and removing bone. Complications which are rare may include:
- Socket is painful and dry, or exposure of bone when the post-surgical blood clot is lost from the site of the surgical wound (socket)
- Infection in the socket from bacteria or trapped food particles
- There is damage to the nearby teeth, nerves, jawbone or sinuses
The procedure of extraction will be performed in the office of the dentist. The dentist may suggest for an oral surgeon if the tooth has been deeply impacted or it requires surgery. Local anesthesia will be used by the dentist or surgeon and in addition to making the area numb with local anesthesia; the surgeon may also recommend sedation to allow the patient to be more comfortable during the surgery.
Detailed discussion might be done with the dentist or oral surgeon and any questions that arise may be asked. Questions that might be asked may include:
- No of wisdom teeth to be removed
- Type of anesthesia to be received
- The procedure complications to be expected
- Length of the procedure
- Any damage caused by the impacted wisdom teeth to other teeth
- Any risk of nerve damage
- Dental treatments required for a later date
- Length of recovery
Preparing for surgery
An outpatient procedure is mostly performed for a wisdom tooth extraction. This means that the patient may extract the wisdom tooth and leave the same day of the procedure.
Instructions will be received from the hospital or dental clinic staff on what to do prior to the surgery and the day of the scheduled surgery. Following questions may be asked:
- Arrangements to drive home to be made or not after the procedure
- Time of arriving at the dental clinic or hospital
- Any eating or drinking to be avoided before the procedure and from when
- Prior to the surgery any medicines can be consumed or not. If so, how soon before the surgery can a dose be taken
- Any non-prescribed drugs to be avoided prior to surgery
During the procedure
There are three types of anesthesia which may be used by the dentist or oral surgeon which may depend on the complexity of the wisdom tooth extraction and patient’s comfort level. Types of anesthesia which can be given are local. Sedation or general anesthesia
The dentist or oral surgeon may administer local anesthesia with one or more injections near the area of each extraction. Before you receive an injection, a substance will be applied by the dentist or oral surgeon to the gums to numb them. During the extraction the patient is awake and may feel some pressure and movement in the mouth but should not experience pain. If pain is experienced, the dentist or oral surgeon may give another injection to numb the area
The dentist or oral surgeon gives a sedation anesthesia through an intravenous (IV) line in the arm. During the procedure the sedation anesthesia suppresses the consciousness. No pain will be felt and the patient will have a limited memory of the procedure. Local anesthesia will also be given to numb your gums.
In exceptional situations, general anesthesia may be given. Medication may need to be inhaled through the nose or through an IV line in the arm, or both. Then the patient loses consciousness. Medication, breathing, temperature, fluids and blood pressure are closely monitored by the surgical team. No pain and no memory of the procedure will be experienced. To relieve postoperative discomfort, local anesthesia is also given.
The dentist or oral surgeon may do the following during wisdom tooth extraction:
- To expose the tooth and bone an incision in made in the gum tissue
- Removal of the bone that blocks the access to the tooth root
- Dividing the tooth into sections if it’s easier to remove in pieces
- Removes the tooth
- The site of the removed tooth is cleansed of any debris from the tooth or bone
- the wound closed is stitched to promote healing, though this isn’t necessary always
- A gauze is placed over the extraction site to control bleeding and to help a blood clot form
After the procedure
A recovery room may be taken after the surgery if sedation anesthesia or general anesthesia is received. If local anesthesia is given, a brief recovery time is likely in the dental chair.
The dentist’s instructions should be followed in the phase of healing from the surgery:
- On the first day some oozing of blood may occur after removal of wisdom tooth. Excessive spitting should be avoided so that the blood clot from the socket is not dislodged. Gauze should be replaced over the extraction site as directed by the dentist or oral surgeon.
- Pain will be managed with an over-the-counter pain reliever, such as acetaminophen (Tylenol, others), or a prescription pain medication provided by the dentist or oral surgeon. Prescription pain medication may be helpful especially if bone has been removed during the procedure. Holding a cold pack against the jaw may also relieve pain.
- An ice pack should be used as directed by the dentist or surgeon. Any swelling of the cheeks usually gets better in two or three days. Bruising may take little more days to resolve.
- After the surgery, the remainder of the day should be kept for taking rest. Normal activities should be resumed the next day, but for at least a week, strenuous activity should be avoided which may result in losing the blood clot from the socket.
- Drink lots of water after the surgery. Alcoholic, caffeinated, carbonated or hot beverages in the first 24 hours should not be consumed. Drinking with a straw should be avoided for at least a week because the sucking action can dislodge the blood clot from the socket.
- Soft foods, such as yogurt or applesauce, for the first 24 hours should be consumed. Semisoft foods can be started when it can be tolerated. Hard, chewy, hot or spicy foods should be avoided that might get stuck in the socket or may irritate the wound.
- Mouth should be kept clean by not brushing the teeth, rinsing the mouth, spitting or using mouthwash during the first 24 hours after surgery. Typically after the first 24 hours brushing the teeth can be resumed. Near the surgical wound be particularly gentle when brushing and gently rinse the mouth with warm salt water every two hours and after meals for a week.
- Smoking should be avoided for at least 72 hours after surgery and longer than that if possible. For at least a week tobacco should not be chewed. Using tobacco products after oral surgery, healing process would be delayed and it will also increase the risk of complications.
- The patient may have stitches that dissolve within a few weeks or there are no stitches at all. If the stitches need to be removed, an appointment should be scheduled with the dentist or oral surgeon to have them taken out.
The dentist or oral surgeon should be contacted if any of the following signs or symptoms is experienced and which could indicate an infection, nerve damage or other serious complication:
- Difficulty in swallowing or breathing
- Excessive bleeding
- Severe pain not relieving by prescribed pain medications
- Swelling worsening after two or three days
- A bad taste in the mouth not removed with saltwater rinsing
- Pus in or oozing from the socket
- Consistent numbness or loss of feeling
- Blood or pus in nasal discharge
A follow-up appointment may not be needed after a wisdom tooth extraction if:
- Stitches are not needed to be removed
- No complications arising during the procedure
- Persistent problems are not experienced, such as pain, swelling, numbness or bleeding and any complications that might give a sign of infection, nerve damage or other problems
If complications develop, the dentist or oral surgeon should be contacted to discuss treatment options.