Wisdom Teeth Extractions
Wisdom teeth are the third and final set of molars that most people get in their late teens or early twenties. Sometimes these teeth can be a valuable asset to the mouth when healthy and properly aligned, but more often, they are misaligned and require removal.
Wisdom teeth present potential problems when they are misaligned - they can position themselves horizontally, be angled toward or away from the second molars or be angled inward or outward. Poor alignment of wisdom teeth can crowd or damage adjacent teeth, the jawbone, or nerves. Wisdom teeth that lean toward the second molars make those teeth more vulnerable to decay by entrapping plaque and debris. In addition, wisdom teeth can be entrapped completely within the soft tissue and/or the jawbone or only partially break through or erupt through the gum. Teeth that remain partially or completely entrapped within the soft tissue and /or the jawbone are termed "impacted."
Wisdom teeth that only partially erupt allows for an opening for bacteria to enter around the tooth and cause an infection, which results in pain, swelling, jaw stiffness, and general illness. Partially erupted teeth are also more prone to tooth decay and gum disease because of their hard-to-reach location and awkward positioning that makes brushing and flossing difficult.
An impacted wisdom tooth may:
- Grow at an angle toward the next tooth (second molar)
- Grow at an angle toward the back of the mouth
- Grow perpendicular to the other teeth, as if the wisdom tooth is "lying down" within the jawbone
- Grow straight up or down like other teeth but stay trapped within the jawbone
Extraction is performed if an impacted wisdom tooth results in such problems as:
- Infection of the wisdom tooth
- Damage to an adjacent tooth
- Development of a fluid-filled sac (cyst) around the wisdom tooth
- Damage to surrounding bone
- Complications with orthodontic treatments to straighten other teeth
Preventing future dental problems
The rationale for preventive treatment is that:
- It's difficult to predict future problems with impacted wisdom teeth
- An asymptomatic impacted wisdom tooth may not be free of disease and may be a particularly vulnerable site for gum disease and tooth cavities
- Removing impacted teeth lowers the risk of potential problems
- The procedure rarely results in serious complications in younger adults
- The procedure is more difficult and more likely to cause complications later in life, particularly among older adults
Most wisdom tooth extractions don't result in long-term complications. Problems that can occur include:
- Dry socket, or exposure of bone when the post-surgical blood clot is dislodged from the site of the surgical wound (socket) — a complication that delays healing and causes pain
- Infection in the socket from bacteria or trapped food particles
- Damage to sinuses near the upper wisdom teeth
- Weakening of the lower jawbone
- Damage to nerves that results in altered sensation in the lower lip, tongue or chin
With well over 2000 wisdom tooth extractions performed thus far, Dr Laaly has not encountered any of the above mentioned complications with any of his patients, but still continues to inform his patients of the rare and very real potential risks involved.
How you prepare
Questions to ask:
Dr. Laaly may perform the procedure in his office. However, if the tooth is deeply impacted or if the extraction is expected to be difficult, he may suggest you to see an oral surgeon. Questions you may want to ask include:
- How many wisdom teeth need to be removed?
- Will I need local anesthesia (which numbs your mouth and jaw) or sedation anesthesia (which makes you unaware of the procedure)?
- How complicated do you expect the procedure to be?
- How long is the procedure likely to last?
- Have the impacted wisdom teeth caused damage to other teeth?
- What other dental treatments might I need at a later date?
- How long does it take to completely heal and return to normal activity?
Preparing for the surgery
A wisdom tooth extraction is almost always performed as an outpatient procedure. This means that you go home the same day.
You'll receive instructions from Dr. Laaly or his clinic staff regarding what to do before the surgery and the day of your scheduled surgery. Plan to get answers to the following questions:
- Will I need to make arrangements for someone to drive me home after the procedure?
- When do I need to arrive at the dental clinic or hospital?
- Do I need to avoid eating food, drinking fluids or both (fast)? If so, when do I begin?
- Can I take my prescription medications before the surgery? If so, how soon before the surgery can I take a dose?
- Should I avoid any nonprescription drugs before the surgery?
What you can expect
During the procedure
There are generally two types of anesthesia that can be used. The appropriate anesthesia for you depends on the expected complexity of the wisdom tooth extraction and your own comfort level. Your options include the following:
- Local anesthesia is administered with one or more injections near the site of each extraction. Before you receive an injection, your dentist or surgeon applies a substance to the gums that numbs the site and makes the injection virtually painless. You're awake during the tooth extraction. Although you feel some pressure and movement, you will not experience pain.
- Oral Sedation is a medication that's usually taken in the form of a pill or it may be inhaled through your nose. Sedation anesthesia makes you Hypo-Conscious during the procedure, and you don't feel any pain nor remember the procedure. The surgical team closely monitors your medication, breathing, temperature, fluids and blood pressure.
During a wisdom tooth extraction, your dentist or oral surgeon:
- Makes an incision in the gum, creating flaps to expose the tooth and bone
- Removes any bone that blocks access to the tooth
- Divides the tooth into sections if it's easier to remove in pieces
- Removes the tooth
- Cleans the site of the removed tooth of any debris from the tooth or bone
- Stitches the wound closed to promote healing, though this isn't always necessary
- Packs the empty socket with gauze to control bleeding and to help a blood clot form
After the procedure
If you receive sedation anesthesia, you're taken to a recovery room after the procedure. If you have local anesthesia, your brief recovery time is likely in the dental chair.
You'll receive instructions about what to expect during the healing process and how to care for your surgical wound. These instructions will likely address the following issues:
- Activity. After your surgery, plan to rest for the remainder of the day. Resume normal activities the next day, but for at least a week, avoid strenuous activity that might result in dislodging the blood clot from the socket.
- Beverages. Drink lots of water after the surgery. Don't drink alcoholic, caffeinated, carbonated or hot beverages in the first 24 hours. Don't drink with a straw for at least a week because the sucking action can dislodge the blood clot from the socket.
- Food. Eat only soft foods, such as yogurt or applesauce, for the first 24 hours. Start eating semisoft foods when you can tolerate them. Avoid hard, chewy, hot or spicy foods that might get stuck in the socket or irritate the wound.
- Pain management. Your surgeon or dentist may prescribe a pain medication, or you may be able to manage pain with an over-the-counter pain reliever, such as acetaminophen (Tylenol, others). Holding a cold pack against your jaw also may relieve pain.
- Bleeding. Some oozing of blood is normal the first day after removal of your impacted wisdom tooth. Swallowing small amounts of blood-tinged saliva is preferred to excessive spitting to avoid dislodging the socket blood clot. Replace the gauze packing as directed by your dentist or oral surgeon.
- Swelling and bruising. You'll likely have swelling and bruising of your cheeks that should start to improve in two or three days. Use an ice pack as directed by your dentist or surgeon.
- Cleaning your mouth. Don't brush your teeth, rinse your mouth, spit or use a mouthwash during the first 24 hours after the surgery. After that time, gently rinse your mouth with warm salt water every two hours and after meals for a week after your surgery. Mix 1/2 teaspoon (2.5 milliliters) of table salt in 8 ounces (237 milliliters) of water. After the first 24 hours, resume brushing your teeth, being particularly gentle near the surgical wound.
- Tobacco use. If you smoke, don't do so for at least 24 hours after surgery. If you chew tobacco, don't use it for at least a week. Any use of tobacco products after oral surgery can delay healing and increase the risk of complications. Also, consider talking to your doctor or dentist about a program to help you quit permanently.
- Stitches. If you received stitches that need to be removed, schedule an appointment to have them taken out. Alternatively, you may have received stitches that dissolve within a couple of weeks or no stitches at all.
When to call your dentist or surgeon
Call your dentist or oral surgeon if you experience any of the following signs or symptoms that could indicate an infection, nerve damage or other serious complication:
- Swelling that worsens after two or three days
- Severe pain not alleviated with prescribed pain medications
- A bad taste in your mouth
- Pus in or oozing from the socket
- Blood in nasal discharge
- Persistent numbness or loss of feeling
You probably won't need a follow-up appointment after a wisdom tooth extraction if:
- You don't need stitches to be removed
- No complications arose during the procedure
- You don't experience persistent problems, such as pain, swelling, numbness or bleeding — complications that might indicate infection, nerve damage or other problems
If complications develop, Dr. Laaly will discuss appropriate treatment options with you.