Wisdom Teeth

Wisdom teeth or third molars are usually the last teeth to develop; they are located in the back of your mouth and generally appear between the ages of 17-24yrs. The jaws of modern humans are normally not large enough for the wisdom teeth to enter into the mouth and become fully functional. When this occurs they are classified as ‘impacted’, meaning that they are blocked by another tooth or bone and are therefore prevented from entering and assuming a normal position in the mouth. A special x-ray of your teeth and jaws called 3D Cone Beam Computed Tomography Scan can determine if your wisdom teeth are impacted or require removal.

What harm can impacted wisdom teeth do?

1. Infection: The gum tissue around the crown of the wisdom tooth becomes irritated, inflamed and infected. This infection may spread to the cheek, throat or neck resulting in pain, swelling and stiffness of the jaws. 

2. Damage: Because they are difficult to clean the wisdom teeth may be harmful to the tooth in front of it (second molar) resulting in bone loss, gum disease or cavities. In addition, the wisdom tooth itself can decay resulting in severe toothache.

3. Disease: Non-infectious diseases may occur around impacted wisdom teeth. A cyst can form around the crown of the impacted wisdom tooth and this can cause destruction of surrounding bone and damage to other teeth and nerves in the area. Although rare, a benign tumor may develop from the walls of the cyst surrounding the impacted wisdom tooth and a more complicated surgical procedure with more potential risks may be necessary.

What is the best age to have impacted wisdom teeth removed?

A young patient will heal faster and have fewer complications (eg. infection and delayed healing) than an older patient. Surgery and healing may be more difficult if you are in your 30s, 40s or beyond. Studies have shown that early treatment results in a superior outcome for the patient. 

What is it like to have wisdom tooth removed?

Depending on the difficulty of the case, the procedure may take from 20-60 minutes (surgical time). State-of-the-art sterilisation and strict infection control techniques are used at all times.

Removal of an erupted wisdom tooth is usually a relatively straight forward procedure. 

The removal of an impacted wisdom tooth is accomplished by making a small incision in the gum tissue to expose the tooth and the surrounding bone. Some of the bone may need to be removed before the tooth is extracted. The area from which the tooth has been removed is cleaned thoroughly and stitches may be placed to join the gum tissue back into place. The stitches assist in control of bleeding; however, there may be some slight oozing which should stop within 24-48 hours. The stitches dissolve in 10-14 days and do not have to be removed.

Following any wisdom tooth surgery, you will be monitored by trained staff until it is safe for you to go home. Prior to leaving we will provide post-operative instructions and a post-operative instruction sheet will be given for you to take home. It is very important that these instructions are followed closely to maximise your comfort post-operatively and to avoid potential problems. 

A prescription for pain medication and antibiotics may be provided. It is normal to have some discomfort, and swelling after the surgery (this is part of the normal healing process). Bruising and jaw stiffness may also occur. By following the post-operative instructions provided and taking the prescribed medications as directed, these symptoms can be significantly minimised.

In most cases you can resume your normal activities within a few days depending on the degree of surgical difficulty and the number of impacted wisdom teeth removed. 

Impacted_wisdom_tooth

Known risks and complications of wisdom tooth surgery

The surgical removal of wisdom teeth is a routine procedure that has few associated serious complications. However, as with any surgical procedure, there are some potential complications, which although occur rarely, you should be aware of:

1. Infection: Infections are rare and any post-operative signs of infection should be taken seriously and reported to your dentist promptly. Signs of infection include fever, abnormal swelling and pain, a bad taste in the mouth, and pus discharge. It may be appropriate to prescribe antibiotics to eliminate the problem or in some rare instances, drainage of the infection may be required.

2. Injury or Damage: to adjacent teeth, fillings and crown and bridgework.

3. Dry Socket (Osteitis): This is where a blood clot does not form properly in the tooth socket for some reason such as smoking, use of oral contraception, or poor oral hygiene. A dry socket heals more slowly than normal, and is a very painful condition because the bone within the socket is exposed. The pain associated with a dry socket is not usually relieved by the prescribed pain medications. However, the condition is easily treated by washing out the socket and placing a sedative dressing into the socket. Dry sockets usually occur 3 days after removal of the tooth/teeth, and once treated, subside within several days.

4. Permanent or Temporary Numbness or Pain: Sensory nerves serving the mouth can be in close proximity to impacted wisdom teeth, especially the lower ones. Occasionally, in spite of all precautions, if one of the nerves becomes irritated during the surgery, patients may experience partial or total loss of feeling or pain in the areas served by the nerve. This numbness or tingling sensation can affect the lip, tongue, cheek, chin, gums, or teeth, depending on the nerve involved. The nerves involved are purely sensory (transmit sensation or feeling), so there is no change in appearance, speech, or eating ability. In the vast majority of cases the numbness is temporary and short lived, but in rare instances can be permanent. The exact duration of the numbness cannot always be predicted. However, young patients have the best chance for full recovery of nerve function. Also, the likelihood of nerve damage is much lower if the wisdom teeth are removed before root development is complete. 

5. Sinus Complications: The roots of upper wisdom teeth sometimes penetrate into the maxillary (upper jaw) sinus cavity. Sometimes an opening into the sinus with drainage or sinus pain (sinusitis) may occur following upper wisdom tooth removal. Usually these complications are temporary. If a significant opening into the sinus cavity does occur, an additional procedure may be necessary to close or repair the opening or communication.

6. Root Fragment Fracture: Roots may be extremely long and fragile, and a piece of root may break off during surgery, most of the time the fragment is removed, however, if it lies close to a nerve or a sinus cavity, or its removal would jeopardise and adjacent tooth, the dentist may elect to leave the fragment in place. This usually presents no long term problems with normal bone growing around the retained root fragment.