Maxillo-Facial Surgeon

Wisdom Teeth Removal

Impacted Wisdom Teeth
The wisdom tooth (or third molar) is usually the last tooth to erupt into the mouth from the age of 16 years and older.
Often there is not enough space inside the mouth for this tooth.

When this happens the following problems normally occur:
•    The impacted wisdom tooth causes a lot of pressure on the surrounding teeth. This can lead to pain and discomfort.
•    The pressure from the impacted tooth can also cause the lower front teeth to become crooked. This is especially important in patients who have undergone orthodontic treatment.
•    Often there is a small flap of tissue which sits above the wisdom tooth. Food and bacteria get trapped under this “Gum Flap”. This can lead to repeated attacks of infection in the  gum  surrounding the tooth. This causes pain and swelling.
•    Food often gets stuck around the erupting wisdom tooth. This is because it is very difficult to clean in this area. This leads to dental decay which affects the wisdom tooth and the healthy tooth in front.
•    A Cyst can form around the impacted wisdom tooth.  A cyst is a fluid filled sack which expands and destroys the surrounding bone.

How do I know if I need my wisdom teeth removed?

The best person to advise you is a specialist maxillofacial and oral surgeon. A clinical examination is performed and a panoramic dental radiograph is taken. The panoramic radiograph shows the position of the wisdom tooth very clearly. It also shows the surrounding bone and anatomical structures. This is very important to the maxillofacial and oral surgeon. The surgeon will then advise you on how the impacted wisdom teeth should be removed.

A Panoramic Radiograph

A Panoramic Radiograph

What does the treatment involve?

Because the wisdom tooth has not fully erupted into the mouth and is stuck under the gum,  it is often necessary to make a small cut in the gum to access the impacted tooth. Sometimes it is also necessary to remove a little bit of bone surrounding the crown of the wisdom tooth.  Rarely 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 one week to disappear.

What type of anaesthetic is used?

A number of options are available and depend on how difficult the wisdom tooth is to remove.

Local anaesthetic – this is an injection into gum surrounding the wisdom tooth, similar to that you may have had at your dentist for a routine filling.  The injection takes a couple of minutes to numb the area and means that you will feel no pain while the wisdom tooth is removed.  This is the best option for wisdom teeth that are simple to remove.

Local anaesthetic and intravenous sedation – in addition to a local anaesthetic injection you can be given an injection into your arm.  This makes you feel relaxed and less aware of the procedure.

General anaesthetic –  this type of anaesthetic means you will be put to sleep by a specialist anaesthetist. Your wisdom teeth will be removed by your maxillofacail and oral surgeon while you are sleeping. You will normally be required to spend a morning or an afternoon in the clinic. You will be able to go home on the same day as surgery.

Is there much pain or swelling after the removal of wisdom teeth?

It is likely that there will be some discomfort and slight swelling both on the inside and outside of your mouth after the surgery. This usually improves after the third day. The discomfort can last up to 10 days but generally improves every day.
You may also find that your jaw is stiff and you may need to eat a soft diet for a week or so.  Your surgeon will prescribe painkillers and a mouthwash for you.

Is there anything else I need to do after the extractions?

It is important to keep the extraction sites as clean as possible for the first few weeks after surgery. The best way to do this is to rinse with a mouthwash and warm salty water (dissolve a tablespoon of normal kitchen salt in a cup of warm water) commencing on the day after surgery.

Do I need to take any time off work?

It may be necessary to take a few days off work after the surgery. It is also a good idea to avoid strenuous exercise and contact sport during this period. You will not be able to drive for 24hours after a general anaesthetic.

What are the possible problems?

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 tissue or a piece of cotton wool. If the bleeding does not stop, please contact your surgeon.

Patients who have increasing pain ie the pain gets worse – four or five days after having their wisdom teeth removed need to contact the surgeon. The most common complication after wisdom tooth removal is a “dry socket”. A dry socket occurs when a small amount of food or debri gets stuck in the socket of the extracted wisdom tooth site and delays the healing process. The oral surgeon will need to clean the socket out and place a sedative dressing into the site. This can be performed very easily under local anaesthetic. The pain disappears almost immediately. A dry socket is not an infection and is very easy to treat.

There are two nerves that lie very close to the roots of the lower wisdom teeth.  One of these nerves supplies feeling to your lower lip, chin and lower teeth.  The other supplies feeling to your tongue and helps with taste.
Sometimes these nerves may be bruised when a wisdom tooth is taken out. This can cause tingling or numbness in your lip, chin or tongue, and more rarely altered taste.  About one in thirty people will have some tingling or numbness that can last several weeks.  These risks may be higher if your tooth is in a difficult position.  The surgeon will tell you if you are considered to be at an increased risk.

Your Maxillofacial and oral surgeon will inform you of all the possible risks and complications before you have the procedure.

Please contact us to arrange for a follow up appointment.

We wish you a speedy recovery !!!

Maxillo-Facial Surgeon