Wisdom Teeth Removal

8 things to know about wisdom teeth extractions...

If you think your wisdom teeth are coming through or you've been told they may need to be removed, you will probably have a million questions buzzing around in your mind?

Will it hurt? What's involved? Can my dentist pull them out? How long will it take to recover?

Hopefully, we can answer a few in this post.

1. What are wisdom teeth and how do I know if I have them?

Wisdom teeth are third molars which are the very back teeth on the upper and lower jaw. You normally have 4 in total. They usually erupt during the late teens to early 20's, but they can also be stuck completely under the gum and never come to the surface. Some people are congenitally missing their wisdom teeth.

They don't always cause pain and many people have no idea if they have them or not.

During a dental check up, the dentist will take an OPG which is a large x-ray of the whole mouth. This will show if you have wisdom teeth, their position and if they are growing at the right angle. For a majority of people, they only partially erupt through the gum or are impacted by the surrounding teeth or bone.

Wisdom teeth don't often fully erupt into a useful and functional position and commonly need removal.

2. Why do I need the removed?

If the dentist recommends to have them removed, this could be for a few reasons.

The most common is a lack of space, meaning they become trapped and don't make it to their proper position. This can cause pain and irritation of the jaw and gums as food and bacteria get caught around them.

Wisdom teeth may also require removal during orthodontic treatment to make room for other teeth or to prevent tooth movement.

There can be other reasons such as cyst formation.

Common and often serious symptoms of wisdom tooth pain is: pain at the back of the jaw, ulcerated gum, swelling, fever, difficulty opening the mouth or biting together.

3. Things that can occur with impacted wisdom teeth.

Pericoronitis - is an inflammation of the gum surrounding the tooth. It can be very sore and should be checked by the dentist.

Tooth decay - Partially erupted or impacted wisdom teeth are at high risk of tooth decay due to the positioning of the tooth. This is because it is naturally a hard place to clean and food can easily get trapped between the gum and tooth. This can also affect the neighbouring tooth which may lead into loosing both teeth.

Cysts - Wisdom teeth grow and develop within a sac of tissues within the jaw bone. In some cases the sac can fill with fluid and form a cyst. This can cause damage to the bone, teeth and nerves surrounding and require jaw surgery to remove.

Abscess/Swelling - If a wisdom tooth becomes truly infected it can develop an abscess which can lead to swelling and serious bone infections.

Crowding - Wisdom teeth can potentially cause your teeth to crowd as they erupt trying to fit into the mouth

4. How do I know if I need them removed?

During your regular dental check ups, the dentist will be looking at signs of eruption or development. This usually begins during the early teens and throughout your life. If there are signs of any wisdom teeth, the dentist will usually take an OPG x-ray which allows us to see the jaw bone, nerves, tooth roots and your wisdom teeth to make a proper assessment.

If your wisdom teeth are very low risk of causing problems - plus you are not experiencing any pain or issues, then you may make a mutual decision with the dentist to leave them and keep an eye on them. The dentist will explain the best option for you in terms of removing versus keeping an eye on them. From time to time over the years you may then need to get a new OPG x-ray to look for changes and any signs of progression.

If the dentist recommends that they need to be taken out, they will talk you through the reasoning, your options, risks and costs with you so you can make the decision together.

5. Removal in the dental chair vs general anaesthetic

We can remove most wisdom teeth safely and easily in the practice under local anaesthetic, however there are occasions where we refer to a specialist Oral and Maxillofacial Surgeon if they are more difficult or if you request it. It can depend on the persons medical risks, the positing of the tooth, the proximity of the tooth to nerves and complexity of the extraction. Your budget may also influence which way you decide to go as general anaesthetic will inevitably be more expensive.

Going through the hospital with an Oral Surgeon also carries it's own risks as you are ultimately being put to sleep, but the surgeon will discuss these and address any questions you may have.

Either way, rest assured you will be guided and cared for through the entire process.

6. I am nervous, do you offer sedation or happy gas?

Here at Goodlife Dental Studio, we have a couple of options when it comes to removing teeth, reducing you anxiety and improving your comfort. It is important to note however that these may not work for everyone.

Oral Sedation (e.g. Valium) is one option. This is a tablet that we prescribe to be taken 1 hour before surgery/your appointment. This will take away some of your anxieties and make you feel more relaxed. The effects however are quite lasting and can linger for up to 24 hours which means you cannot work or make critical decisions while on this medication and you will need someone to drive you to and from your appointment and to take care of you.

We also offer nitrous oxide. This is what a lot of children and nervous patients prefer as it is very effective with no lasting effects.

Most patients feel very relaxed in our practice under our care and have wisdom teeth removed with local anaesthetic only. Local anaesthetic is extremely effective by itself and means you will feel no pain while the procedure is being undertaken and for some hours after. We will always use local anaesthetic as standard, and then add either nitrous oxide or oral sedation if required.

7. What does the procedure involve?

Whether you decide general or local anaesthetic, the removal process is pretty much exactly the same and the dentist will talk you through every step of the process so you know what to expect.

On the day, so long as you have not been given any type of sedative (e.g. Valium), you will feel a bit numb in the mouth but otherwise normal and still be able to drive home and care for yourself. The dentist and dental assistants will get you ready and comfortable to begin and you will also be able to watch the tv and relax the entire time.

The dentist will need to numb the gum and teeth surrounding the area. The amount of anesthetic will depend on how many teeth you are getting removed and how complex the procedure is. The dentist will always test the area to make sure you are comfortable.

As with any surgical procedure there are risks involved with wisdom teeth removal. Most complications are rare but possible and can include bleeding, bruising, pain, swelling, infections, damaging nearby teeth, broken jaws, tooth/root fractures and damage to nearby nerves or paraesthesia to the lips, jaw, cheek or tongue.

For surgical procedures the dentist will generally follow the following steps;

• making an incision in the gum to visualise, create more space to work and expose the tooth and surrounding bone
• the dentist may remove surrounding bone to create an access point for the tooth to be removed
• in most circumstances the tooth will be divided into sections and elevated out of the socket. This is a more gentle approach as it requires less force and reduces risks.
• the tooth will be elevated/lifted in sections
• the site will be flushed with saline if required and excess bone and tissue will be cleaned away to ensure the healing process is smooth
• sutures may be used to close up the extraction site and help with the healing.
• you will be given a gauze to soak up any excess blood to bite on during the drive home with instructions and everything you need to ensure a smooth recovery.

It is important during for the rest of the day to rest and keep your heart rate down (no exercise or hard work) so that the site stays stable and you don't get excess bleeding. The extraction process usually takes 25-30 minutes for one tooth to up to an hour or more for all 4. It just depends on bone density, positioning of the tooth, root shape and the position of nearby structures (e.g. nerves)

8. How long is the recovery process? Aftercare? What can I expect?

The recovery process can depend on a few influencing factors including how many teeth were removed, how dense the bone is, the position of the tooth and nerve and if sutures were required. It can also depend on your age, health and lifestyle habits. We highly recommend not to smoke or drink alcohol for as long as you can after the procedure as it can have cause complications during the healing process.

Your dentist will give you an in-depth aftercare brochure and spare gauze to take with you as well as organise a follow up visit if required.

Younger people usually recover a lot faster than those who get them removed later in life however generally the principal is the same.

For easy non-surgical wisdom teeth, in most cases you can return to work the next day with light duties. Ultimately, just listen to your body.

For a more surgical procedure or you went through general anesthesia, you may be out of action for a couple days, up to a week. Some people require heavy pain killers or antibiotics which is determined by the dentist or surgeon. During this time, you should spend the time relaxing, letting your body heal.

What to expect:

• Immediately after surgery there will be a some blood which will be clotting with a gauze ball in place that we have instructed you to bite on. You can take this out very gently after 30-60 minutes and repeat as necessary. If there is still any blood flowing/gushing, please contact the dentist immediately on the practice number. Very light weeping or the taste of some blood is normal in the first day.
• When you get home after the surgery once the numbness has worn off, you may place an ice pack for 10 min on the cheek every 1-2 hours to help reduce any swelling which will develop over the coming few days.
• Jaw pain and tender muscles. This can be helped with a heat pack on the cheek after the first 48 hours.
• When the anaesthetic wares of there will be pain at the site of the procedure and you should have taken some pain killers prior to the anaesthetic wearing off to help you ease into it. Over the counter paracetamol and or ibuprofen are great options for managing pain taken separately or in combination. However the dentist will often prescribe something stronger if they believe you need it. Remember the goal of pain relief is to relieve and make the pain manageable, it may not completely resolve it. Ultimately the healing process does have some pain involved but you can make this process comfortable with medication.
• Flushing the site - 24 hours after the extraction when the clot has formed the dentist will ask you to rinse with salt water several times per day for a few weeks. They may also provide you with surgical syringe to flush the site. This will help flush out any debris to avoid risk of infection.

What to avoid:

• Avoid smoking and drinking for as long as possible for best chances of healing.
• Avoid spitting, sucking through a straw, playing with the site or brushing directly on the site for the first 24-48 hours as the clot is very delicate
• Avoid strenuous activities during the first couple of days of the recovery process

If you avoid these things you will also reduce your chances of getting a dry socket which means the blood clot in the site has dissolved away and some raw bone is exposed. This can be super painful and will resolve in time but it is not nice for a patient to experience. If you suspect any problems, please get in touch. We do have products to help alleviate a dry socket if this occurs.

Although complications and risk of infections are low for this procedure, it is important to call the practice if you are concerned about something or have any question.

If you would like to know more or book in for a wisdom teeth consult please feel free to get in touch with us to organise an appointment for you.

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