Wisdom Tooth Surgery

Wisdom teeth, or third molars, are located at the back of the mouth. They are the last adult teeth to erupt, or enter the mouth. Most people have four wisdom teeth, two on the top, two on the bottom. Third molars are considered to be “impacted” when they don't have enough room to emerge or grow normally.

When Should You Get Your Impacted Tooth Removed?

  • Infection,
  • Damage to neighboring teeth and tissues,
  • Tooth decay,
  • Periodontal disease,
  • Receding gums,
  • Loosened teeth,
  • Bone loss,
  • Tooth loss,
  • Jaw weakening,
  • Development of associated cysts and tumors, and
  • Interference with needed dental treatments.

“Asymptomatic” does not mean “Disease Free”

Even third molars that have erupted into the mouth in a normal, upright position may not be problem-free. Their location in the back of the mouth makes them extremely difficult to keep clean. Bacteria that cause periodontal disease may exist in and around asymptomatic third molars, leading to damage before symptoms appear.

Pathology is always present before symptoms appear. Once damage has occurred, it is not always.

Additional Risks

Bacteria may contribute to systemic health problems, including: Diabetes,heart disease, kidney disease, and other health problems.

Studies have found that periodontal disease in expectant mothers may be associated with a greater likelihood of preterm and low birth weight babies.

Evaluating third molars for surgery

  • Every patient and every case is unique.
  • Decisions regarding surgery must consider:
  • Careful examination of your mouth;
  • Radiographic examination involving x-rays or a CTscan; and
  • Consultation between patient, dentist and oral and maxillofacial surgeon with a balanced discussion of the benefits and risks of retention versus benefits and risks of operative management.

Available Options

  • Depending on the results of the dental examination, the OMS may:
  • Extract the complete tooth;
  • Partially remove the tooth; or
  • Active Surveillance - Observe the tooth over time for changes in condition.

When should you not get your wisdom tooth removed?

  • Adjacent normal anatomies
  • General health
  • No pathology
  • No communication
  • Fully impacted
  • Age

Are there any risks with removing wisdom teeth?

With any treatment there are risks.

  • Anaesthetic problems. General anaesthetics, while very safe today, are not without risks. If you have ever had an allergic reaction to an anaesthetic or any medication please let us know.
  • Bleeding problems. Again this is rare but a possibility. Normally stopping all activity and siting down (not lying) and applying pressure to the area by gently biting on a gauze pack for 15 minutes will generally stop bleeding. Dont keep removing the pack to see if bleeding has stopped

    If, after 15 minutes, bleeding has not stopped please contact us.

  • Dry Socket. After a tooth is removed exposed bone quickly gets covered with a blood clot. If this clot does not form properly or gets washed away you will experience a constant throbbing pain that will last for days. If you do experience pain like this please contact us. Usually we apply a medicated dressing to the bone socket to help relieve the problem. Remember prevention is better than cure and please:
    • Dont rinse or spit with force for the first 24 hours after surgery as this may loosen the clot.
    • DONT smoke for two weeks after the surgery ( and if you stop for that time you may as well give up altogether!). Smokers are more likely to get dry sockets.
  • Numbness. Nerves near the wisdom teeth may be damaged during the removal of the wisdom teeth. This may lead to tingling or numbness which usually disappears over a few weeks as the nerve recovers. In rare cases the nerve may not heal.
  • Infection. This is rare but if you develop a fever, bleeding or increasing pain this may indicate an infection so please contact us.

While there may be risks in wisdom teeth removal we will endeavour to give you the best advise for your mouth and this may be removal of your wisdom teeth although arent aware of any problems with them.

Post operative instructions following removal of wisdom tooth

Immediately Following Surgery

The gauze pad placed over the surgical area should be kept in place for one hour. After this time, the gauze pad should be removed and discarded.

  • Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
  • Take the prescribed pain medications before the local anesthesia loses its effect. This will help you stay ahead of the discomfort.
  • Avoid strenuous activity for 48 hours.
  • Place ice packs to the sides of your face where surgery was performed. Treat with ice for 48 hours. Refer to the section on swelling for explanation.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for one hour. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.

Swelling

The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the body’s normal reaction to surgery and eventual repair. The swelling will not usually become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Plastic bags filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 48 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Three days following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Pain

For severe pain, take the tablets prescribed as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.

Diet

After general anesthetic or I.V. sedation, foods such as yogurt and applesauce can be eaten. Do not chew or drink thin liquids before the local anesthetic wears off. When drinking liquids. Do not use straws. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away form the surgical sites. High calorie, high protein intake is very important. Refer to the section on suggested diet instructions at the end of the brochure. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 5-6 glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat. Caution: If you suddenly sit up or stand from a lying position you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing.

Keep the mouth clean

No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the night of surgery but rinse gently. The day after surgery you should begin rinsing at least 5-6 times a day with salt water, especially after eating.

Discoloration

In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Call the office if you have any abnormal reactions to medications.

Nausea and Vomiting

In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on coke, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine.

Other Complications

  • If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, this is usually temporary in nature be aware that if your lip or tongue is numb.
  • Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
  • You should be careful going from the lying down position to standing. You were not able to eat or drink prior to surgery. It was also difficult to take fluids. Taking pain medications can make you dizzy. You could get light headed when you stand up suddenly. Before standing up, you should sit for one minute then get up.
  • Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots, they are the bony walls which supported the tooth. These projections usually smooth out spontaneously.
  • If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as vaseline.
  • Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days.
  • Stiffness (Trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event which will resolve in time.