Wisdom Teeth Removal

Wisdom teeth have absolutely nothing to do with your actual wisdom. Instead, they are so named as they generally erupt later than all your other teeth, usually at a time when you are apparently 'wiser'. Sometimes, a person's wisdom teeth will come through without any pain and relatively uneventful. For others, wisdom teeth can cause lots of pain and swelling and even be the cause of other dental issues such as misaligning other teeth. Everyone is different, which is why we always monitor your children's oral health for any indication that wisdom teeth may become an issue before they actually do.

What are wisdom teeth?

Your wisdom teeth are large molar teeth that are located at the very back of your mouth. Generally a person will have 4 wisdom teeth, two on the top jaw line and two on the bottom. Wisdom teeth are sometimes also known as 'third molar' teeth, as they come through in effectively a 'third' way of new teeth. By this we mean that during a person's lifetime they will first get their 'baby teeth', then their 'permanent teeth' and sometime after this the last 4 wisdom teeth will come through. This can be even as late as 25 years old.

Why and when should wisdom teeth be removed?

Generally speaking we always try to maintain and keep your original teeth, whether this be through restorations or root canals or any other dental procedure that may be required. Maintaining the original tooth by enlarge is always preferable to replacing it with an implant or other alternative. That being said, wisdom teeth are not necessary for having a healthy and beautiful smile and are one of the main exceptions to that rule. In fact, wisdom teeth can cause more harm than good by keeping them in.

Some of the reasons why wisdom teeth may need to be removed include:

• Wisdom teeth coming through at an angle and not straight thus making future cleaning difficult and may cause infections down the track. Tooth decay can also become a serious issue in some of these cases.
• A wisdom tooth may grow out too far, causing the surround area to be affected and damaged, including the cheek and gums.
• A wisdom tooth does not grow out far enough causing a dental issued called pericoronitis. This can if left untreated become a more serious dental health concern.
• The arrival of the wisdom tooth pushes other teeth out of line as there is not enough room for an additional tooth.
• The space may be required to allow the front teeth to be moved back via orthodontic treatment and the arrival of the wisdom teeth will not allow enough space for this to be done.
• A cyst may develop around the tooth or the jaw in the area of the newly arrived wisdom tooth.
• There may be repeated or even more serious infections of the gum near the site of the new tooth which may require the tooth to be removed. In some cases the infections may even spread to the lymph glands which are beneath the jaw.

There are of course other scenarios as well which may require your wisdom teeth to be removed which you can discuss with our team. Remember, wisdom teeth removal does not necessarily mean all of your wisdom teeth are removed. It is fairly common to, for example, only remove the top wisdom teeth, as generally speaking they are usually the ones at causes more issues. Everyone's case will be different, however, so if you start to feel or even see your wisdom teeth come through, or that of your child's, come in and see us for a routine comprehensive exam so that we can best advise you.

My wisdom tooth is painful, do we really need to extract it?

As pointed out above, everyone is different. If you or your children have been coming in for your routine dental exam with us we will have noticed the teeth long before they erupt on an x-ray. That is really the best way to determine the direction the tooth will come out at and let us decide early if extraction is required.

In some cases, extraction may indeed not be required. For example, if you have some pain or discomfort when opening your mouth it maybe a simple case of the wisdom tooth being trapped underneath your gums. In some of these cases a simple cut along the gum line to allow the tooth to come out (operculectomy) is all that will be required. After this simple procedure, the wisdom tooth can come through and settle in happily with the rest of your pearly whites.

Whilst not as common, a partial removal of the wisdom tooth may also be an option. If the root of the tooth is very close to the nerve endings in your jaw, it may not be possible to completely remove a wisdom tooth. In these cases a partial removal, or coronectomy, may be more suited. This procedure involves simply removing the crown of the tooth, however, leaving the root of the tooth in place.

The best way to determine the whether these options are suitable for your particular case is to come in and see us and have an x-ray taken of the tooth in question. It may turn out that some painkillers, antibiotics, mouthwash and some time may be all that is needed.

How is a wisdom tooth extracted?

Wisdom teeth will be removed either via a local anaesthetic or a general anaesthetic depending on the difficulty of the removal. If the case is a simpler one, then extraction will take place in the dental chair using a local anaesthetic in much the same way as any other tooth. A small set of forceps will be used and the tooth will be gently rocked from side to side until it becomes loose enough so that it can be completely removed. Generally some stiches will be inserted to the area after the procedure, which in most cases fall out without explicit removal after several days. The whole procedure usually takes between 10 minutes to an hour.

For more complex cases, such as where the root of the tooth is impacting on nerve endings, a general anaesthetic may be required. In some cases we will refer this out to a hospital or a specialist oral surgeon if the shape or position of the roots of the tooth are particularly problematic requiring a more complex operation.

What happens after the extraction?

Immediately post the operation we usually recommend that you have a family member or friend drive you home. This is because you will generally still be affected by the anaesthetic used during the procedures. As the anaesthetic wears off, some discomfort will be experienced, however, over the counter painkillers are usually sufficient to combat any pain. During the first day or two, we strongly recommend that pressure is not applied to the area, including when rinsing your mouth. Gently does it is the order of the day.

In terms of eating and drinking, a staple diet of mashed foods and soup is advised, usually for around 4 days. After this harder foods can be slowly reintroduced, however, cutting them smaller and trying to avoid chewing close to the area is still recommended. For at least a week we also remove avoid alcohol, smoking and caffeine, as these can cause complications after the surgery such dry socket. Avoiding using a straw is also recommended to avoid unnecessary suction pressure in your mouth. Generally speaking, it may take a week or slightly more before you can return to normal eating habits.

We should point out that some bleeding, i.e. the taste of blood, will be normal post the operation. Swelling of the area will also be experienced, however, an ice pack gently on the side of the jaw can help with this.

Are there any complications with wisdom teeth removal?

As with any surgery, complications can occur after a wisdom tooth removal. These include:

• Swelling of the area and side of the jaw.
• Bleeding from the extraction point.
• A risk of infection post the removal of the tooth.
• A condition known as dry socket developing, which can be extremely painful. You can decrease your risk of this by avoiding alcohol and smoking post the operation.
• A low risk of damage to a nearby tooth if the extraction does not go as smoothly as planned.
• Sinus issues, possibly due to swelling or other triggers from the removal of the wisdom tooth.
• A general level of jaw stiffness or not being able to fully open your mouth.
• Damage to nerves that were not visible on an x-ray pre operation. This may affect some taste or feeling in the area.
• An extreme rare condition where the tissue on the jawbone starts to die off post the operation. This is known as osteonecrosis.

Naturally, our team will go through with you before the operation and after the operation what you can expect in the days following the procedure. If for whatever reason you feel that the healing process is not going as discussed then come in and see us and let our team do a post-op check-up. Generally speaking, however, after the initial swelling and bloody taste has decreased, there are very few complications that arise, making wisdom tooth removal a safe and effective treatment option.