WISDOM
TOOTH EXTRACTION
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 their hard-to-reach location and
awkward
positioning makes brushing and flossing difficult.
How
Do I Know if I Have Wisdom Teeth?
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.
Ask your dentist about the positioning of your wisdom teeth.
He or she may take an X-ray periodically to evaluate for the
presence and alignment of your wisdom teeth. Your dentist may
also decide to send you to an oral surgeon for further evaluation.
Your
dentist or oral surgeon may recommend that your wisdom teeth
be extracted even before problems develop. This is done to avoid
a more painful or more complicated extraction that might have
to be done a few years later. Removal is easier in young people,
when the wisdom teeth roots are not yet fully developed and
the bone is less dense. In older people, recovery and healing
time tend to be longer
How Is a Wisdom Tooth Removed?
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. The relative ease at which your dentist
or oral surgeon can extract your wisdom teeth depends on the
position of the impacted teeth. Your oral health care provider
will be able to give you an idea of what to expect during your
pre-extraction examination. A wisdom tooth that is fully erupted
through the gum can be extracted as easily as any other tooth.
However, a wisdom tooth that is underneath the gums and embedded
in the jawbone will require an incision into the gums and then
removal of the portion of bone that lies over the tooth. Oftentimes
for a tooth in this situation, the tooth will be extracted in
small sections rather than removed in one piece to minimize
the amount of bone that needs to be removed to get the tooth
out.
What
Happens During the Procedure?
Before
your wisdom tooth is extracted, the tooth and the surrounding
tissue will be numbed with a local anesthetic – the same injection
with the same medication you would receive to numb a tooth prior
to having a cavity filled. In addition to the local anesthetic
to numb the pain, you and your dentist or oral surgeon may decide
that a sedative is desired to control your anxiety.
Sedating medications that could be selected include: nitrous
oxide (otherwise known as "laughing gas"), an oral
sedative (for example, Valium), or an intravenous sedative (administered
via an injection into your veins). If nitrous oxide is given,
you will be able to drive yourself home. If any of the other
medications is selected, you will need someone to drive you
both to and from the appointment in which your tooth will be
extracted.
What
Does Recovery Involve?
How
quickly you heal depends on the degree of difficulty of the
extraction (a simple extraction of a fully erupted tooth versus
a tooth impacted into the jawbone). In general, here's what
to expect.
During
the first 24 hours
Bleeding
may occur for several hours after tooth extraction.
To control it, position a piece of clean moist gauze over the
empty tooth socket and bite down firmly. Apply constant pressure
for about 45 minutes. A moistened tea bag is an effective alternative.
The tannic acid in tea helps healing blood clots to form (blood
clots function similarly to a scab on an open wound). Repeat
this process if a small degree of bleeding continues; if heavy
bleeding continues to occur, contact your dentist or oral surgeon.
Avoid rinsing or spitting for 24 hours after tooth extraction,
avoid "sucking" actions (for example, don't drink
beverages through straws or smoke) and avoid hot liquids (such
as coffee or soup).
These activities can dislodge the clot, causing dry socket to
develop.
Facial swelling in the area where the tooth
was extracted typically occurs. To minimize swelling, place
a piece of ice, wrapped in a cloth, on that area of your face,
on a schedule of 10-minutes on, followed by 20-minutes off.
Repeat as necessary during this first 24-hour period.
Pain medications, such as acetaminophen (Tylenol)
or ibuprofen (Neorufen or Advil) can be taken for minor pain.
Your dentist or oral surgeon may prescribe more potent pain
relievers, such as narcotics, if necessary.
Antibiotics
that may have been prescribed prior to tooth extraction (to
treat any active infection around the wisdom tooth to be extracted)
should continue to be taken until the full prescription is gone.
Foods
should be chewed on the side of the mouth opposite the extraction.
Avoid hot liquids and alcoholic beverages for at least 24 hours.
In the case of difficult extractions, consume a soft or liquid
diet for the first 24 hours.
Continue to brush your teeth, but avoid the
teeth directly neighboring the extracted tooth during the first
24 hours. On day two, resume the gentle brushing of your teeth.
Do not use commercial mouth rinses - these can irritate the
extraction site.
AFTER
24 HOURS
Facial
swelling in the area of the tooth extraction should
be treated with heat after the first 24 hours of ice. Apply
a moist warm towel to the area on a 20-minute on, 20-minute
off schedule. Repeat as necessary.
Rinse your mouth with warm salt water (1/2
teaspoon of salt in a cup of warm water) after meals and before
bed. Do not use commercial mouth rinses.
Stitches, if used and if not of the self-dissolving
type, need to be removed by your oral health care provider in
about 1 week. If you do require stitches, ask what type you
have been given.
Watch for signs of dry socket. This condition
requires treatment by your oral health care provider.
Complete
healing doesn't occur for a few weeks to a few months
following the extraction. However, usually within the first
week or two, enough healing has taken place for use of your
mouth to be reasonably comfortable in the area of the extraction.
Our dentist will explain what to expect in your specific case.
What
Are Potential Complications?
Two
of the more important complications include:
Dry
Socket, Dry socket is a common complication that occurs
when either a blood clot has failed to form in the extracted
tooth socket or else the blood clot that did form has been dislodged.
Without clot formation, healing will be delayed. When it happens,
dry socket typically occurs 3 or 4 days following the extraction
and is accompanied by pain (ranging from "dull" to
moderate to severe) and a foul mouth odor. Your dentist or oral
surgeon will treat the dry socket by placing a medicated dressing
in the socket. Dressing will need to be removed and replaced
every 24 hours until symptoms subside.
Paresthesia, Paresthesia is a less frequently
occurring complication. Wisdom teeth entrapped in the jawbone
are often close to nerves. Sometimes these nerves can be bruised
or damaged during the tooth removal process. The result is a
numbness (called a paresthesia) of the tongue, lip or chin that
can last a few days, weeks, months or may even be permanent.
