Wisdom Teeth
What is an impacted wisdom tooth?
An impacted tooth is one which has been prevented from erupting into the mouth. The tooth may be blocked by another tooth, dense bone, or a pathological condition. Any tooth can be impacted, but more often than not, impacted teeth are "wisdom teeth" or third molars, as dentists call them.
Some people have enough room in the back of their mouth for their third molars to grow out straight and healthy, and they may function well for a lifetime. However, many others do not have enough room, and the wisdom teeth are crowded and tilted.
What harm can impacted wisdom teeth do?
- Impacted wisdom teeth may grow in any direction, however, they often grow forward and push against the adjacent second molar. This can result in pain in the second molar and possible damage to the roots or crown. The second molar may also be pushed out of position.
- All teeth develop in sacs deep in the bone. If the tooth erupts normally, the sac generally disappears. If the tooth is impacted, however, the sac can fill with fluid and enlarge to form a cyst, which can cause destruction of surrounding bone and damage to other teeth in the area.
- Whenever saliva can reach the tooth, decay may occur, and since such cavities cannot be filled, severe pain may result. This may be followed by the formation of an abscess.
- Bacteria in the saliva may cause an infection around the crown of the wisdom tooth and under the flap of gum tissue which may be covering part of the tooth. This infection may spread to the cheek, throat or neck and result in severe pain, jaw stiffness, fever, and illness.
- Pressure from wisdom teeth may cause crowding of the front teeth. This is why some orthodontists do not consider orthodontic treatment complete until impacted third molars have been removed.
When is the best time to have wisdom teeth removed?
The oral and maxillofacial surgeon can study x-rays of the teeth and jaws and can frequently tell by the teen years if your wisdom teeth are going to be impacted. At this stage, the roots are usually not fully formed in most people and the bone is less dense. Therefore, the wisdom teeth are less complicated to remove and healing is generally faster.
What is it like to have an impacted wisdom tooth removed?
Because the impacted tooth is usually completely beneath the surface of the gum and often encased in bone, we consider its removal an operation in every sense of the word.
This is not intended to frighten the prospective patient, but rather to give a better understanding about certain features regarding cost, careful preparations, and the need for good aftercare.
Both local and general anesthesia or sedation may be used. The surgeon chooses the method of treatment based on each individual situation. Having a comfortable patient helps to control bleeding, allows the surgeon to work without haste and causes less physiological disturbance to the patient.
The actual removal of the tooth is done in keeping with recognized surgical principles, with meticulously sterile instruments, good light, a dry operative field, gentle handling of the soft tissue and bone and the advantages of a well-trained team.
Finally, the surgical wound will typically be sutured with a dissolving material.
How long does wisdom teeth surgery last?
Depending on the degree of difficulty, number of wisdom teeth, and any management of any medical predispositions, the procedure may last from 15 minutes to an hour. If sedation or general anesthesia is used, there will also be a recovery period of 30 minutes to an hour and a half.
What should I expect after wisdom teeth surgery?
Discomfort:
After any surgical procedure, a certain amount of discomfort is anticipated. For this reason, you will be provided with pain relieving medication before you leave the office.
Your surgeon will decide if antibiotic medication is necessary and, if this medication has been prescribed, it should be taken until all tablets are gone.
Swelling:
Swelling after surgery is normal. You should expect to be most swollen 36 to 48 hours after surgery. The swelling then begins to resolve.
Bruising:
Certain individuals are more prone to bruising after wisdom teeth surgery. In some cases, the bruising can extend into the neck and chest. This should not alarm you.
Jaw Stiffness:
Jaw stiffness is a normal occurrence following wisdom teeth surgery, and is usually at its worst 2-3 days after surgery. One should start to exercise the jaws on the second or third post-operative day.
Nutrition:
Although it will probably be difficult to eat after wisdom teeth surgery, one should remember that the body heals itself by drawing upon its reserves of protein, vitamins, minerals, calcium and iron. Failure to replenish the body's supplies of the above mentioned nutrients can result in fatigue, infections, and even delayed healing. For the first 24 hours following surgery, your food and beverages should be warm or cold, not hot. Fluid intake should be approximately 2L (or 8 juice glasses) per day for the average adult.
Detailed post-operative instructions will be provided before you leave the office.
Are there any complications or risks?
Any operation carries some degree of risk. This risk is minimized by careful preoperative assessment of your physical condition by thorough examination of all diagnostic materials, by careful preparation of instruments, and by the skill of your oral and maxillofacial surgeon.
Bleeding:
Post-operative bleeding is usually encountered when the patient has not placed the gauze pack directly over the surgical site. Pressure over the site for 48 to 60 minutes will control most post-operative bleeding. If you are still concerned, please call the office and the problem will be dealt with properly.
Dry Socket:
A condition known as a "dry socket" occurs in approximately 5% of patients. It is more common in smokers and in female patients on contraception. It manifests as a dull, throbbing pain that starts 2-3 days after the operation, and is accompanied by a foul odour from the mouth. The treatment for this problem is simple and consists of 1-2 dressing changes, if needed. Healing is slightly slower than normal.
Infection:
Infections after the removal of wisdom teeth are very rare. Redness, increased swelling after an initial decrease, foul tasting discharge into the mouth, fever, or chills are all signs of infection. If these should appear, call the office and you will be attended promptly.
Other Complications:
Occasionally a large filling in the second molar teeth may be loosened or cracked during the removal of the wisdom teeth in spite of immaculate care and skill. If the possibility of this exists prior to surgery, you will be informed.