The wisdom teeth, which are the third and the final set of molars, are the most controversial and most complained about teeth in dental clinics. They usually erupt in the age group of 18-25 years. The dilemma regarding wisdom teeth always remains whether to extract them or not? What can be the possible complications? How is wisdom teeth removal done?
To get a deep insight into such questions, you must first know the reason for such an ambiguous position of the wisdom teeth. It lies in the fact that our mouth is adequately structured to accommodate teeth up to the second molars. When the third molars erupt around the teenage years, they have to push the other teeth to make space for themselves. This competition often leads to pain in the process and eventually, the misalignment of wisdom teeth. They may project at bizarre angles, even horizontally, and give birth to several secondary complications like an injury to the surrounding jaw bone, soft tissues, nerves, vessels, or hampered functions of biting and chewing due to excruciating pain. A common situation that is encountered is that of a wisdom tooth, impacted in surrounding soft tissue or bone, a painful condition that can be very uncomfortable for you.
However, it is not a rule of thumb that wisdom teeth eruption will always be a problematic scenario in every individual. There is a probability that they may erupt just as smoothly as other teeth do, without any adverse symptoms. If it is asymptomatic, there is no particular need to get them removed, but if they cause any complications, it is necessary to get them removed to prevent further damage. You must remember that the removal of wisdom teeth will not have any antagonistic effect on the standard functions that your dentition serves.
Does everyone have wisdom teeth?
Theoretically, there should be four wisdom teeth, one in every four quadrants of our set of dentitions. But usually, this doesn’t happen. Some people may get just a single wisdom tooth or no wisdom tooth at all, and others may get all four. It varies from person to person, and the anatomy of their mouth is the major determinant of the fate of wisdom teeth. A few conditions where wisdom teeth do not erupt at all are – wisdom tooth which is present but couldn’t erupt due to insufficient space in the mouth, or wisdom tooth impacted in adjacent structure not visible on clinical evaluation.
Should everyone get their wisdom teeth removed?
No, it is not compulsory to get your wisdom tooth removed if it has fully erupted and is perfectly aligned. To keep it healthy, you must clean it regularly as a part of your daily oral hygiene routine. If it can be routinely cleaned and is healthy, there is no need to get it removed.
However, the conditions which require wisdom tooth removal are:
- Unerupted: A wisdom tooth that is unable to erupt due to lack of space and gets implanted in any surrounding structure like the jaw bone or gums. It can cause secondary injury and even infection in the area where it caused the injury. This tooth may or may not be visible on inspection, as it stays hidden in the gums, but the patient will complain of intense pain on movement of the jaw such as during biting, chewing or even speaking.
- Partially erupted: A partially erupted wisdom tooth, which somehow paved its way but couldn’t do it adequately. Such a tooth will cause difficulty in maintaining regular oral hygiene and may ultimately develop infection/decay, or may cause injury to surrounding structures. A pus-filled cyst may develop due to bacterial invasion.
- Fully erupted: A fully erupted tooth pushing the nearby teeth and causing crowding in the concerned area. In such a condition, both the teeth will have to suffer damage.
The procedure of wisdom tooth extraction
Wisdom tooth extraction is a fairly common, minor surgical procedure, which can be performed by skilled dentists or oral surgeons. It is a straightforward procedure; hence, it is usually performed in outpatient departments, but can also be performed in minor OT by oral surgeons in some cases where the tooth is deeply impacted.
Oral examination: Your dentist will have to perform a thorough oral examination to know the condition of your tooth. Sometimes the tooth may not be visible at all because it’s completely impacted. Then your dentist will advise radio diagnostic procedures like an X-ray or in some cases, a CT scan to know the extent of the impaction. Such imaging techniques will allow him to decide the fate of your tooth and also which type of procedure will be suitable as per your oral condition.
Physical examination: Apart from your mouth, the dentist will briefly examine other systems of your body because for the procedure anaesthesia is to be administered. There are a few things to be checked to make a person a person eligible for anaesthesia. He will prescribe a few tests to make sure if you are fit for getting anaesthesia.
Medical management: Before the surgery, anti-inflammatory medications are used to treat wisdom teeth swelling. Apart from these, painkillers are given for pain relief. If there are visible signs of infection, antibiotics for wisdom teeth are preferred for making it infection-free, and further surgical treatment is then taken up.
Preoperative workup: Just like any other intervention, wisdom tooth extraction will be performed after administration of adequate anaesthesia. Your dentist will choose the type of anaesthesia depending on the extent to which wisdom tooth is impacted. Most commonly, local anaesthesia serves the purpose quite well. General anaesthesia is used when the dentist speculates it to be a complicated procedure requiring extensive intervention. IV sedation can also be used as an alternative in case the patient is apprehensive about the process.
- Your dentist will commence the procedure by giving an incision on your gum to expose the underlying bone and the impacted tooth.
- The tooth is then sectioned into small pieces which makes it easier to remove.
- Then your dentist will thoroughly clean the area with an antiseptic and remove any residues or debris from the area.
- The last step is to suture the incision and pack it with a gauze piece to maintain hemostasis. If the incision is very small, suturing won’t be necessary, and the wound will heal on its own. Surgical glue is also being popularly used to close the incision.
Things to take care of in the Postoperative period:
- The effect of anaesthesia gradually fades away. Local anaesthesia fades off as soon as the procedure is completed. You may feel some amount of discomfort or pain, but your dentist will prescribe you analgesics before you leave the clinic. Cold compress over the area will also help in resolving the pain.
- There might be some bleeding from the surgical site, which will subside gradually. Keep it packed with a gaze piece. However, if severe bleeding occurs, it may be indicative of injury to the vessel.
- Normal activities can be resumed from the next day after surgery, but strenuous physical activities should be restricted for about a week. This is because it may dislodge the blood clot and lead to complications.
- Solid food items should be avoided for a few days after surgery. You should drink a lot of liquids right from the day of surgery but avoid caffeinated drinks such as tea or coffee. You can eat soft food items like yogurt or applesauce after 24 hours of surgery.
- Brushing is avoided for 24 hours. You can rinse your mouth thoroughly with water or mouthwash to clean it, but brushing should be avoided. Brushing can predispose to injury as the operated area is very delicate. It can also lead to accidental clot dislodgement predisposing to dry socket.
Recovery period: Complete recovery takes about 1 week to 10 days. It varies from person to person depending on the nutrition they take and the care with which they handle their teeth. If you got stitches during the surgery, your dentist would ask you to visit for a follow-up after 5 days to get them removed. However, if your dentist used absorbable sutures, this follow-up won’t be required.
Risks and complications related to the extraction of wisdom tooth:
Although wisdom tooth removal is a simple procedure completed in around 45-60 minutes, there are a few complications that may occur due to the operation
- Injury to surrounding structures such as soft tissue, nerves, vessels, or sometimes the underlying sinuses is a common intraoperative complication.
- Haemorrhage is another dreaded complication.
- Painful dry socket: This is a very common and critical complication of wisdom tooth removal. It occurs 3-4 days after surgery when the blood clot from the socket gets dislodged, and the underlying bone and nerves get exposed.
- The area might get a bacterial infection if adequate hygiene is not maintained after surgery
Follow up is usually not required after a wisdom tooth extraction if you don’t need to get your stitches removed. However, you must pay regular visits to the dentist for routine check-ups and to know any potential problems that may arise in the future. There are a few danger signs which should be kept in mind and if you experience any of these, contact your dentist for assistance.
- New-onset difficulty during respiration
- Painful swallowing or difficulty during swallowing
- Uncontrollable excessive bleeding
- High fever, with or without chills and rigours
- Severe pain not relieved by analgesics
- Bad sense of taste in your mouth or metallic taste
- Numbness in the operated area
- Pus oozing out from the operated tooth’s socket
How can a painful dry socket be prevented?
Painful dry socket is a severe complication, and care must be taken to prevent it. It occurs due to dislodgement of the clot from the socket exposing bare bone and nerves beneath. You should avoid doing any such activity which can displace the clot such as heavy exercise, using a straw for drinking, brushing your teeth too soon after surgery, or eating solid food items.
A dry socket is a harrowing condition because the most sensitive nerves are exposed directly to the outside. Visit your dentist at the earliest possible if you experience any symptoms of a dry socket such as pain or numbness. Your dentist will cover it with a medicated paste that will prevent further exposure and accentuate the healing process.
What is Preventive wisdom tooth extraction?
Preventive wisdom tooth extraction is the procedure of removing an asymptomatic wisdom tooth. However, specialists don’t find any rationale behind removing it as a prophylactic measure. Still, it is performed in some cases which are at higher risk of developing complications due to wisdom teeth in the future.
Your dentist will assess the anatomy of your mouth and jawbones; if a bizarre eruption is predicted, he will prefer to remove it beforehand.
Wisdom tooth extraction is a frequently performed surgical procedure performed when your wisdom tooth becomes problematic. An impacted wisdom tooth is the most common presentation for which surgery is performed with local or general anaesthesia. It takes around 3 days to 1 week for complete recovery. Proper care must be taken to avoid any complications. At Conway House Dental practice, we have Adrian RJ Curtis FDS RCS (Eng) BDS (QUB), who is an Associate Specialist in Oral Surgery at Stoke Mandeville Hospital in Aylesbury. He specialises in the extraction of difficult teeth, including wisdom teeth.
If you have more queries, please do not hesitate to call us on 01494 526 578.