WISDOM TEETH

“Wisdom teeth” are the four permanent adult molar teeth located at the back corners of your mouth on the top and bottom. These teeth are usually seen to erupt in the late teens or early 20s and may need to be removed based on your dentist’s recommendations. Wisdom teeth are called wisdom teeth because they come through at an age when one is said to get wisdom or become mature. For some it comes and goes without event; for most, as is frequently seen in the dental office the eruption of wisdom teeth can become a problem as they can cause crowding in your mouth, erupt in the wrong position, or become impacted.

How many wisdom teeth does one have?

There are usually four.

Can we extract all four together at the same time?

It is possible to extract all four under general anaesthesia if one does not have any other major health issues.

One can extract upper and lower teeth on the same side on the same day if one is up to it and does not have any major health issues.

Do we need x-rays/other diagnostic tests before tooth extraction?

An X-ray is always recommended before a third molar extraction as your dentist will be able to assess the root morphology, level of the tooth in the mouth, proximity to sinus or nerve and difficulty of the tooth extraction beforehand.

In some cases, a CBCT is advised to get a three-dimensional view of the tooth. Sometimes your dentist finds in the x-ray close proximity of the nerve to the tooth, in such cases that warrants a cbct which helps in giving a clearer picture of the position of the mandibular canal to tooth.

What Are the Risks for a Wisdom Tooth Extraction?

While most wisdom tooth extractions don't result in long-term complications, problems can occur after the procedure:

• Dry socket is when the post-surgical blood clot dislodges from the surgical wound (the socket) and exposes bone below. Dry socket can be painful and delay the healing process.
• Trapped food particles or bacteria cause infection in the socket.
• Sinus issues due to inflammation.
• Nerve damage to the lower lip, tongue or chin.

Why it is necessary to get wisdom teeth removed?

A wisdom tooth is extracted to correct an actual problem or to prevent problems that may come up in the future. Some of the problems that can occur when wisdom teeth come in are:

Your jaw may not be large enough for them, and they may become impacted /jammed in and unable to break through your gums.

Your wisdom teeth may break partway through your gums, causing a flap of gum tissue to grow over them. Food and germs can get trapped under the flap and cause your gums to become red, swollen, and painful. These are signs of infection.

More serious problems can develop from impacted teeth, such as infection, damage to other teeth and bone, or a cyst.

One or more of your wisdom teeth may come in at an awkward angle, with the top of the tooth facing forward, backward, or to either side.

What Happens During Wisdom Teeth Removal?

Before your wisdom teeth are pulled, the teeth and the surrounding tissue will be numbed with a local anaesthetic -- the same type used to numb a tooth prior to having a cavity filled. If you have had any prior instances of local anaesthetic allergic reactions, inform your dentist.

In most situations, as the tooth is impacted, surgical removal of the tooth is likely to be done.

Your dentist will make a cut in the gum tissue to expose the tooth and bone and thereby make access.

In some cases, bone needs to be removed that blocks access to the root.

In some instances, sectioning the tooth in two or three pieces for easy removal is done as the tooth might be excessively angulated or bulky.

Then the tooth is removed.

What are the Post-surgical instructions to be followed?

• Most people have little to no pain after surgery. You'll likely have swelling and mild discomfort for 3 or so days. Your mouth may need a few weeks to completely heal.
• Place an ice pack externally over the surgical site to help reduce swelling.
• Your dentist will prescribe antibiotics and analgesics to help in the speedy recovery and healing of the site.
• Avoid hot foodstuffs and forceful spitting.
• Brushing of the extracted site should be done only after 24 hours and gently.
• Saltwater gargling or rinsing with a mouth wash after 24 hours will help in the healing process.
• Also, an important and overlooked factor to consider is practicing some effective and easy mouth exercises like the opening and closing of the mouth to allow a three-finger mouth opening. This helps to prevent stiffness (trismus) of the jaw muscle.

The amount of discomfort will depend on how easy or difficult it was to take the tooth out. It is best to stay fairly quiet and relaxed for 24 hours afterward to make sure there are no bleeding problems. There may be stitches to help the gum heal over. Your dentist will probably want to see you again about a week later to check on the healing and to remove any stitches.

What are the likely complications?

Contact your dentist if there is

• Pus oozing from the socket.
• Pain or swelling not subsiding even after three days.
• Excessive bleeding after 24 hours. Remember a slight amount of bleeding is likely to be seen on the first day after extraction which is normal.
• Difficulty in swallowing.

Always remember just as none else has your thumbprint, no two mouths are alike. Therefore it is always best to get your dentist’s advice instead of taking well-intended advice from others.

Author: Dr.Justin Jacob