Wisdom Teeth Removal

Wisdom teeth (also called “third molars”) usually do not push through the gums until people are in their late teens, twenties or even older. Wisdom teeth are usually the last teeth to come through the gums.

Most people have for wisdom teeth. Some people have no wisdom teeth.

Often there is little space at the rear of the jaws for wisdom teeth to come easily through the gums. If the jaw does not have enough room for the wisdom tooth to come through, the tooth will become wedged in or “impacted”.

Some impacted wisdom teeth remain buried and cause no trouble. However, other impacted wisdom teeth may cause severe problems.

Often one or more wisdom teeth will cause problems and must be removed. If one or more of your wisdom teeth causes problems, your dentist may recommend that it be removed.

Removal of a wisdom tooth is a very common procedure. Removal of troublesome wisdom teeth should usually be done as soon as possible before the problem get worse. If your wisdom teeth are likely to be difficult or complicated to remove, your dentist may refer you to an oral and maxillofacial surgeon.

Due to the shape and position of some wisdom teeth and the shape of the jaws, it may be preferable in such cases for an oral and maxillofacial surgeon to remove the teeth. An oral and maxillofacial surgeon is specially trained in surgery of the mouth, teeth, gums, and jaws.

Problems cased by impact of wisdom teeth:

Infection: when an impacted wisdom tooth starts to push through the gum, an infection can start around the top of the tooth. Infection and inflammation (swollen, red gums) can cause pain, swelling, and jaw stiffness. Swallowing may be painful. The person may feel generally unwell. The infection can cause bad breath and an unpleasant taste.

Crowding: a wisdom tooth may push nearby teeth out of their correct position and may help cause crowding of front teeth.

Cysts: if a wisdom tooth is not removed, a sac of fluid called a cyst can form around the tooth and may displace the tooth. The cyst can destroy bone and damage other teeth and the gums. Cyst formation around unerupted teeth is uncommon.

Damage to nearby molars: an impacted wisdom tooth may keep pushing against the molar next to it. This can cause an “erosion cavity” where the wisdom tooth hits the other molar, This often leads to serious damage to both teeth. The molars may become infected or “abscessed”. Removal of both molars is often needed.

Pain: pressure from the wisdom tooth may cause pain in the tooth next to it. Pain can also be caused by infection around the wisdom tooth.

Ulcer: An upper wisdom tooth may push sideways out of the gum. It may cause an ulcer where it rubs against the inside of the cheek.

A food trap: Food becomes trapped between the wisdom tooth and the molar next to it. This can cause cavities in both teeth.

Treatment of a wisdom tooth infection

  • Your dentist may gently clean the infected area around the tooth. You may be advised to rinse your mouth often with a warm saltwater mouthwash.
  • Use one teaspoon of salt in a glass of warm water.
  • The water should be as warm as possible, but not too hot.
  • Your dentist may also suggest a disinfectant mouthwash and a pain killer for you to use.
  • Your dentist may prescribe antibiotics. Tell your dentist if you have ever had an allergic reaction to any antibiotics or other drugs.
  • Take the complete course of antibiotics.

The decision to remove teeth

After inspecting your mouth, jaws and X-ray films, your dentist can discuss the diagnosis with you.

Your dentist may recommend removal of the wisdom teeth or other options.

If the area around the tooth has been infected. Your dentist may decide to delay surgery while the infection is being treated.

Even though a wisdom tooth has caused problems, it may “settle down” after it pushes through the gum. Your dentist may delay surgery to see if the tooth stops causing problems.

While impacted wisdom teeth may cause problems, some never cause trouble and may not need to be removed.

The decision to have wisdom teeth removed is always yours.

If you decide to have wisdom teeth removed, your dentist may ask you to sign a consent form. Read it carefully. If you have any questions about the form, the surgery or anything else, ask your dentist.

If you are uncertain about your dentist’s advice or diagnosis, you may wish to seek the opinion another dentist or an oral and maxillofacial surgeon.

Early removal of wisdom teeth

Your dentist may recommend early removal of one or more wisdom teeth due to the following reasons:

There is not enough room for the tooth to push through.

You need orthodontic work, and the remaining teeth must not be crowded by wisdom teeth.

The tooth has started to cause trouble. It should be removed son so that pain, infection or other problems do not get worse.

It is best to have troublesome wisdom teeth removed while the person is young. In young people, a tooth’s roots have not formed totally, and the bone surrounding the tooth is softer. This allows easier removal of the tooth, and there is less risk of damage to nerves, bone or other teeth.

Giving your dental and medical history to your dentist

Your dentist will ask you questions about any problems you may have had with your health and teeth. Some health problems may interfere with surgery, anaesthesia and care after surgery.

That is why your dentist needs to know your ental and medical history. This helps your dentist plan the best possible treatment.

Your dentist may recommend blood tests or other health test.

Medicines

Give your dentist a list of all medicines you are taking now or have been taking recently.

This includes the “pill” and any over-the-counter medicines, such as aspirin or cough medicines.

Tell your dentist if you have ever had any type of allergic or bad reaction to antibiotics or any other medicine.

Pregnancy

Tell your dentist if you are or may be pregnant. This could affect your treatment, including

  • X-ray examination
  • Anaesthesia
  • Pain treatment
  • Antibiotics and other medicines
  • Whether removal of a wisdom tooth should be delayed

Bleeding or blood disorders

Tell your dentist if you:

  • bleed too much when you are injured or have surgery
  • Have any blood disorders, such as haemophilia

X-ray examination

Your dentist needs to take X-ray films of your jaw. The films will help your dentist plan the best way to remove troublesome wisdom teeth.

Where to have surgery

Your dentist will advise you whether your wisdom teeth should be removed in the surgery, hospital or in a day-surgery hospital.

Do not drive after surgery. A family member or friend should take you home after the surgery. Arrange this well in advance. You should not drive after surgery.

Stopping pain during surgery

After discussion with your dentist, a decision will be made whether the wisdom tooth will be removed under a local anaesthetic or a general anaesthetic. Discuss the options with your dentist.

Local anaesthesia: If a wisdom tooth removal is fairly simple, your dentist may give you a local anaesthetic with a needle. The local anaesthetic will numb the gums and lower parts of the face.

The dentist can then remove the tooth. Your dentist may give you a table to help you relax during the surgery.

General anaesthesia: For some people, the dentist may recommend “general anaesthesia”, that is, putting them to sleep with an injection.

General anaesthesia is given by a specialist anaesthetist. General anaesthesia may be used in people who:

  • Have wisdom teeth that may be a little more difficult to remove
  • Do not want to remain awake during the surgery
  • Have other problems with their wisdom teeth, gums or jaws

Note: for six hours before surgery under a general anaesthetic, do not eat or drink anything. If your surgery will be done in the morning, do not eat or drink after midnight the night before. If you smoke, you should stop smoking two weeks before the surgery. Your dentist or anaesthetist will give you full instructions.

Modern anaesthesia is safe with few risks. However, a few people have may have serious reactions to them. If you have ever had a reaction to an anaesthetic drug, tell your dentist.

Modern anaesthesia is safe with few risks. However, a few people have may have serious reactions to them. If you have ever had a reaction to an anaesthetic drug, tell your dentist.

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