Wisdom Teeth Removal 

General information on wisdom teeth:

Wisdom teeth are the very back teeth on either side of the upper and lower jaws, and are more correctly described as the third molar teeth. They are the last teeth to erupt into the gum-line, usually between the ages of 17 and 21.

It is quite common for there to be insufficient space in the jaws to allow wisdom teeth to take their correct position, and consequently they remain partly or completely below the surface of the gum. Sometimes they may be deeply buried inside the jawbone. Wisdom teeth, which have failed to develop into a normal position, are commonly referred to as being “Impacted”.

Possible problems arising from impacted wisdom teeth

1. By far the most common problem associated with lower wisdom teeth is infection of the overlying gum, a condition called “pericoronitis”. This is a painful and occasionally serious infection. Treatment often involves use of antibiotics. Wisdom teeth, which are partially erupted through the gums, are most likely to be affected. It is preferable to remove such teeth before they become infected, as there are fewer complications with healing.
2. There is often a pocket between the wisdom tooth and the tooth in front that is difficult to keep clean. This may lead to food trapping and decay starting in the wisdom tooth, or worse, in the second molar tooth in front. This can cause bad breath and an unpleasant taste.
3. Many orthodontists believe that pressure from the developing wisdom teeth can cause the front teeth to become overcrowded, and removal of wisdom teeth is often recommended before or immediately after orthodontic treatment is completed.
4. Pressure from a wisdom tooth pushing on the second molar tooth in front, will occasionally cause the root of the second molar tooth to be absorbed, with subsequent damage to, or loss of, the second molar tooth.
5. Wisdom teeth buried beneath the surface are sometimes associated with development of a cyst, which may cause considerable damage to the jawbone, or more rarely be associated with development of tumours.
6. Impacted wisdom teeth constitute a weakness in the lower jaw, and this is the most common site for a fracture when a broken jaw occurs.

Early removal of wisdom teeth

Your dentist may recommend early removal of one or more wisdom teeth due to the following reasons

1. There is not enough room for the tooth to push through
2. You need orthodontic work and the remaining teeth must not be crowded by wisdom teeth
3. The tooth has started to cause trouble. It should be removed soon so pain, infection or other problems do not get worse.
4. It is best to have troublesome wisdom teeth removed while the person is young. In young people, a tooth’s roots have not formed totally and the bone surrounding the tooth is softer. This allows easier removal of the tooth, and there is less risk of damage to nerves, bone or other teeth

Removal of wisdom teeth

The removal of impacted wisdom teeth involves a minor surgical operation and, in particularly difficult cases, is usually undertaken within a specialised clinic. Although uncomplicated wisdom tooth surgery may be carried out under local anaesthesia, in many cases it is more appropriate for the patient to have a full general anaesthetic. In the latter case, surgery is undertaken either as “day surgery” in a Day Surgery Unit, or occasionally as an in-patient in hospital.

The anaesthetist, who is a specialist medical practitioner, will carry out a short medical examination of the patient before the anaesthetic is given.

Surgery to remove the impacted wisdom tooth typically involves a minor incision to uncover the tooth’s crown, then removing the tooth in sections. If any bone was needed to be removed, new bone will regenerate over a six to eight week period. Stitches are placed at the time of surgery and will dissolve after about five days.

There are two common after-effects when wisdom teeth are removed; pain and swelling. It is usual for some pain to be present for the first two days, and strong painkillers are provided to enable comfort over this time. There will be some noticeable swelling or puffiness of the cheeks that will normally subside within five days.Occasionally a little bruising, with skin discoloration, may be present below the jaw. Because the jaw muscles become tight following surgery, it may be a week or more before your mouth can be opened widely with comfort.

It is common practice nowadays to administer anti-inflammatory medication at the time of the wisdom tooth surgery. However, it is sensible to allow a minimum of four days off work following surgery, and it is advisable to rest quietly at home during this time. A soft diet is also advised.

Possible complications of wisdom tooth removal

1. In up to 10% of patients, the condition of “dry socket” may occur following wisdom tooth removal. This happens when part of the blood clot lining the tooth socket is lost, usually after about three days, is very painful and associated with a bad taste. Treatment is simple, consisting of gently washing out of the socket and placing a sedative dressing which quickly relieves the pain. Smoking is the most common factor associated with dry socket
2. Unusual post-operative bleeding is rare and most commonly seen in patients taking aspirin or related medication, which ‘thin’ the blood. You should take only the painkillers that have been prescribed or recommended following your surgery
3. Post-operative infection is uncommon and treated with antibiotics when it occurs
4. The roots of lower wisdom teeth sometimes lie in contact with a nerve inside the lower jaw, this being the nerve, which supplies feeling to the lower lip and chin on the same side.
   Occasionally this nerve may be bruised or otherwise damaged when the wisdom tooth roots are removed, resulting in temporary numbness of the lip and chin, which may last for 3 - 9 months.
   It is usually, although not always, possible to determine from the pre-operative x-rays, whether such nerve injury is likely. Permanent nerve damage is also possible but extremely rare.
5. The nerve that supplies feeling to the side of the tongue may be damaged during wisdom tooth surgery, resulting in loss of feeling and loss of taste on that side of the tongue. Recovery may take 6 - 12 months but on rare occasions, loss of feeling and taste may be permanent.
6. Local anaesthetic injections, to numb the wisdom tooth area, are an alternative to general anaesthetics but are also given during general anaesthetics so that pain will not be present for some hours afterwards.
7. Some patients may have side effects associated with having a full general anaesthetic. These may include nausea (feeling sick or vomiting), tiredness, dizziness, blurred vision, aching in muscles and minor nosebleeds. Such side effects are not usually serious. Nausea can be treated with suitable medicine.
8. Although it is sometimes believed by patients that it might be necessary to “break the jaw” to remove difficult wisdom teeth, this is never the case.
9. When removing impacted wisdom teeth from the upper jaw, it is possible for a small hole to result between the mouth and the air sinus in the upper jaw. Normally this heals without event, but occasionally a minor surgical procedure is subsequently necessary to repair this.

General comments

Although wisdom tooth surgery is not something people look forward to, modern surgical and anaesthetic techniques have now combined to make such surgery a far more acceptable experience than in the past.

If you have any further questions that you would like answered about wisdom teeth or their surgical removal, please do not hesitate to contact our dental rooms.