Wisdom teeth are the last teeth to grow in. These third molars usually start showing in the teens to approximately 20 years of age.
Over the years, our jaws have become smaller. Most patients do not have sufficient space for them. Our diets have changed to include softer foods so we really don’t need them anymore. As our jaws are now smaller, the wisdom teeth may be impacted, this can cause crowding. It also contributes to gum disease and decay, as the teeth are more difficult to clean. Very few patients have wisdom teeth that erupt properly and remain healthy.
Ideally, it is best to consider removal of wisdom teeth between the ages of 17-21 where indicated. Removal of the teeth and healing is much quicker as the roots aren’t fully developed. The dentist or oral surgeon will review your medical and dental history and do a panoramic x-ray to evaluate these teeth. This provides a view of the teeth, bone, and the root structure.
The extraction procedure is usually done in a dentist’s or oral surgeon’s office, with or without sedations. Sometimes it may have be done in the hospital under general anesthesia. Location will be determined based on medical conditions and/or the type of surgery required to remove the teeth.
You are usually asked not to eat or drink for 6 hours before the procedure if you are being given a medication to help you relax. You will also be given anesthetic to numb the area around the tooth. If the teeth are impacted, and incision will be made and stitches will be used to close the area. If the teeth are already through the gums, there will probably be no need for an incision.
After the surgery is done, and the sedation has subsided, you will be allowed to leave the office. You are asked to have a designated driver for you. The anesthetic or numbness will probably remain for a few hours. You should expect to rest and take it easy for a few days and you will be instructed to apply cold compresses to help with pain and swelling. You will be given medication for pain. Avoid brushing and flossing the surgery sites but make sure to brush and floss the rest of the teeth thoroughly. You should be back to normal in 1-2 weeks but it will be approximately six months before the bone will fill-in. The stitches may have to be removed or they may dissolve with healing. A follow-up visit is usually scheduled to make sure the healing is taking place correctly.
REMOVAL OF IMPACTED WISDOM TEETH
- The removal of impacted wisdom teeth is a SURGICAL PROCEDURE involving an incision of the gums and sometimes the removal of a small amount of bone surrounding the tooth. Therefore, it is normal to experience some swelling following the extractions. The swelling usually reaches a maximum two or three days following the surgery and then gradually disappears over another three to five days. Occasionally some bruising will occur in the cheek area, that is temporary.
- Any BLEEDING which occurs will be taken care of at the time of surgery. It is normal for the extraction sites to ooze slightly for up to 48 hours following surgery: gauze pads will be provided to control this.
- DRY SOCKET is a complication of wisdom tooth extraction which occurs in 15-30% of cases; this delayed healing involves loss of the protective blood clot which forms in the socket after the tooth is removed. This area will heal well, but more slowly than usual. The symptoms of a dry socket are slowly than usual. The symptoms of a dry socket are headaches or earaches on the affected side which do not respond to the analgesics prescribed for discomfort. If a dry socket occurs, contact the dentist; he/she will place a medicated dressing which will make the area comfortable within a few minutes.
- The lower wisdom teeth are located near the nerves which supply sensation to the tongue, chin, lower teeth and lower lip. In 1-2% of cases, there may be some NERVE DAMAGE during the removal of the wisdom teeth, resulting in numbness or tingling of the tongue, chin, teeth or lip. In virtually all cases sensation returns to normal over a few months.
- Although we use sterile instruments and clean surgical techniques, we cannot completely sterilize the patient’s mouth before surgery. INFECTION is therefore a possibility. On occasion an antibiotic is indicated following the surgery in order to reduce the risk of infection.
- The roots of the upper wisdom teeth are often separated from the sinus by only a thin membrane. Any vigorous nose-blowing within a few days after surgery can force infected material from the sinus in to the tooth socket and interfere with healing. This may result in formation a SINUS OPENING between the sinus and the tooth socket which may later require surgical closure. The best approach is prevention: if the patient becomes congested following surgery he/she should use a decongestant and avoid nose blowing.
- Sometimes a wisdom tooth is positioned in a way that causes it to press against the adjacent tooth. Damage can occur to the adjacent tooth, usually by dislodging a large filling.
- For patients having NITROUS OXIDE SEDATION, the following requirements are extremely important: Nothing to EAT or DRINK one hour prior to the appointment and please advise before the appointment of any cold or sinus infection.
- The patient must be ACCOMPANIED home by a responsible adult.
- If you have any questions or concerns regarding any aspect of the surgery, please do not hesitate to inquire.
POST SURGICAL INSTUCTIONS
- Bite on gauze for 1/2hr. Keep fingers and tongue away from socket or operative site.
- Do not forcefully rinse mouth for 8 hours, although it is permissible to drink lukewarm or cool liquids.
- Rinsing with warm salt water rinses are advisable, particularly after meals, commencing the following day, provided no bleeding is evident.
- Bleeding: It is normal for the saliva to be lightly streaked with blood for about a day or two. If heavier bleeding is present fold gauze provided into a firm wad and place directly over the site. Maintain steady pressure for 20 minutes or longer. Do not spit vigorously or chew the gauze. A moistened tea bag may be substituted for the gauze pad.
- Swelling: Swelling is to be expected in certain cases, often reaching its maximum after forty-eight hours, then disappearing spontaneously in a further two to three days. An ice bag may be applied.
- Take prescriptions as advise. Do not take ASA (aspirin)
- Diet: Cool or lukewarm liquids may be taken for the first 4-6 hours following return home, after this period of time, soft foods are permissible.
- Discolouration: Bruising of the skin occasionally occurs and slowly disappears spontaneously in approximately a week.
- Emergencies: Do not hesitate to call the Doctor at any time if in doubt regarding instructions or should problems arise.