Wisdom Teeth Extraction

The wisdom tooth (or third molar) is usually the last tooth to erupt into the mouth anytime after about 16 years of age. Frequently there is not enough room to accommodate wisdom teeth and as such they do not come into the mouth normally. When this happens, the wisdom teeth are said to be “impacted”. Wisdom teeth are usually either impacted forwards into the tooth in front or backwards into the jaw bone.

Wisdom Teeth Extraction is usually required for:

Infection or gum disease (periodontal disease) involving the wisdom teeth.
Tooth decay in partially erupted wisdom teeth.
Cysts or tumors involving the wisdom teeth.
Wisdom teeth that are causing damage to neighboring teeth.

Why do I need treatment?

An impacted wisdom tooth can cause a number of problems that mean the tooth is best removed.

Most commonly these are:

Repeated attacks of infection in the gum surrounding the tooth. This leads to pain and swelling.
Food packing which causes decay in either the wisdom tooth or the tooth in front.
Cysts can form around the wisdom tooth if it does not come into the mouth properly. A cyst occurs when fluid fills the sack that normally surrounds a developing wisdom tooth.

What does the treatment involve?

Because the wisdom tooth has not fully erupted into the mouth it is often necessary to make a cut in the gum over the tooth.

Sometimes it is also necessary to remove some bone surrounding the crown (upper portion) of the wisdom tooth. Not infrequently the tooth needs to be cut into 2 or 3 pieces to remove it. Once the wisdom tooth has been removed the gum is put back into place with stitches. In the majority of cases these stitches are dissolvable and take around two weeks to disappear.

The technique of coronectomy is also practiced by some surgeons. In this technique the upper portion of the wisdom tooth is removed (decoronation) leaving some of the tooth roots behind in an attempt to minimise the risk of nerve damage.

Early studies suggest that there may be a reduced risk of inferior dental nerve injury (the nerve giving sensation to the lower lip and skin over the chin) using this technique.

However, there can be up to a 15% complication rate due to migration of the retained root or delayed healing, resulting in a need for further surgery.

For more information on Wisdom Teeth Extraction please contact us here.

The possible side effects / problems of Wisdom Teeth Extraction

Swelling

This is the most common side effect and usually lasts for up to 14 days. The amount of swelling varies from patient to patient. In addition to this the application of an ice pack during the first 24 hours post-operatively may help. Do not apply the ice pack directly to your skin – wrap the ice pack in a towel first.

Restricted Mouth Opening

This is a consequence of the swelling and often settles once the swelling disappears. During this time when your mouth opening is restricted you may have to modify your diet, eating soft foods. There are however no hard and fast rules about what you should eat. You must however keep your mouth as clean as possible to reduce the risks of infection using regular mouthwashes.

Bleeding

Although there may be a little bleeding at the time of the extraction this usually stops very quickly and is unlikely to be a problem if the wound is stitched. Should the area bleed again when you get home this can usually be stopped by applying pressure over the area for at least 10 minutes with a rolled up damp handkerchief or swab. If the bleeding does not stop, please contact the department.

Weakening of the Jaw

In exceptional cases wisdom tooth removal can cause significant weakening of the jaw with the resultant possibility of jaw fracture. The incidence of this happening is extremely low and is significantly less than 1% (less than 1 in 100).

Infection

An infection in the space left following wisdom tooth removal is often referred to as a dry socket. The incidence of this happening is low being in the order of 2%. It can be minimised by adopting scrupulous oral hygiene during the recovery phase. This usually encompasses normal tooth brushing with additional mouthwashes as advised plus the avoidance of smoking.

Nerve Injury

Two nerves lie in close proximity to impacted wisdom teeth. The lingual nerve provides sensation in your tongue whilst the inferior alveolar nerve gives sensation to the lower lip and skin overlying the chin. Occasionally these nerves may be bruised during tooth removal. If this happens then you may have either numbness or pins and needles in either the tongue, lower lip, skin over the chin or any combination of these.
Rarely taste can be affected. This however is uncommon. Rarely the nerve damage can be permanent. Most of the time it is temporary although it can take up to 18 months to recover. On occasions it may not fully recover and on occasional patients may be left with patches of numbness.

Wisdom Teeth Extraction