AFTER DENTAL IMPLANT SURGERY

WISDOM TEETH REMOVAL
 WISDOM TEETH
 

Third molars are commonly referred to as wisdom teeth. They are usually the last teeth to develop and are located in the back of your mouth, behind your second molars. They usually present themselves in your mouth in your mid teen to early twenties. Their erruption is usually associated with mild discomfort but symptoms vary depending on their orientation in your jaw.

 

 IMPACTED WISDOM TEETH?

 

When there is a discrepancy between tooth size and jaw size, there arises a situation where there is insufficient space for the eruption of the tooth into the jaw.  When this happens the tooth remains either partially or completely buried in the jaw bones and is referred to as an impacted tooth.  Any tooth can be impacted but it is rather common with wisdom teeth and canines. The nature and degree of tooth impaction varies amongst individuals, and can even vary on opposite sides of any given individual's mouth.  Therefore, your symptoms, treatment plan, postoperative course as well as complications may vary from your peers.  Impacted teeth might remain asymptomatic, but often cause symptoms/ pathology which indicate their extraction. Your general dentist  or oral surgeon will advice you on your particular case.

 
TYPES OF IMPACTIONS

 

When you come in for a consultation,  we will determine and explain to you the risks, benefits, nature of impaction, potential complications etc. We will also recommend a panoramic X-ray of your mouth and jaws to evaluate your case thoroughly. Please find below some pictures of the various types of impactions that occur.

 

  • Soft Tissue Impaction: There is not enough room to allow the gum tissue to retract for adequate cleaning of the tooth.

  • Partial Bony Impaction: There is enough space to allow the wisdom tooth to partially erupt. However, the tooth cannot function properly in the chewing process, and creates cleaning problems, among others.

  • Complete Bony Impaction: There is NO space for the tooth to erupt. It remains embedded in the jaw bone or if even partially visible requires complex surgical techniques for removal.The impacted wisdom tooth may also be in an unusual position and difficult to remove. This situation can also arise when the shape or size of the jaw bone and other facial structures make removal of this tooth significantly more complex.

 
Why extract my wisdom teeth?
Below are some potential problems associated with wisdom teeth.
Infection:

The most frequent clinical problem  is pericoronitis, (a localized gum infection). Without enough space for eruption, the gum tissue around the wisdom tooth can become irritated and infected, resulting in recurrent pain, swelling, and problems with chewing and/or swallowing.

Cyst Formation:

Cysts are fluid-filled sacs inside the jaw bone that develop around impacted teeth. They slowly expand destroying adjacent jaw bone and occasionally teeth. Although rare, tumors can be associated with the delayed removal of wisdom teeth.

Possible Crowding:

Impacted wisdom teeth may contribute to crowding of your teeth. Although not a direct cause of crowding, it is mentioned that impacted teeth can contribute to it.

Damage to Adjacent Teeth:

Impacted teeth often make it difficult to clean and maintain teeth that lie adjacent to them. Neighboring teeth therefore end up with decay or gum disease shortening their lifespan inside our mouth.

WHAT IF I DON’T HAVE MY WISDOM TEETH REMOVED AS A TEENAGER OR YOUNG ADULT?

 

As wisdom teeth develop, their roots become longer and with age the jaw bone more dense. Extractions performed in ones thirties and beyond are often technically challenging resulting in a prolonged post operative course and higher complication rates.  Healing may be slower and the chance of infection can be increased. If your impacted wisdom teeth are completely impacted in bone, it may be advisable to wait until a localized problem (such as cyst formation or localized gum disease and bone loss) develops. In general, you will heal faster, and more predictably with fewer complications if treated in your teens or early twenties.  Your general dentist , Oral surgeon or Orthodontist will advice you on your case.

 

Day of Surgery

 

Most people prefer to be under sedation to  have their wisdom teeth removed. You are required to have a responsible adult accompany you to your surgical appointment.  They must remain in the waiting room area while your procedure is performed and must drive you home after.  If you are a minor (Under 18yrs) your legal guardian or parent must be present for your surgical appointment. Please refer to the sections on anesthesia, pre-op instructions etc for all pertinent information. Failure to follow all your pre-operative instructions will result in cancellation of your case and you will need to be rescheduled.  The procedure takes about 1 hour, the recovery for anesthesia is  an additional 30 mins. 

 Anesthesia is administrated using an IV which is put in your arm.  You will also be hydrated with IV fluids.  After the procedure is completed, you have recovered from anesthesia and are on your way home, it is important to remember that you will feel tired the rest of the day and must not drive or operate heavy machinery for 24 hours.

If your surgery requires stitches, these are usually the type that dissolve in 3 to 5 days and do not require removal. You may also notice a sensation of your gums feeling swollen and pulling away from your teeth. This is all part of the normal recovery, and will subside in several days.

 

Once the local anesthesia wears off, you will require prescription pain medication. Please take your medications as prescribed.  We recommend starting your post-operative diet with clear liquids such as chicken broth, gradually advancing to your regular diet as your body permits.

 

We do not recommend using dairy products such as yogurt, ice cream or milkshakes on the day of surgery, as nausea and vomiting may develop in conjunction with the anesthetic and pain medication. If you are given antibiotics and you currently take birth control pills, please be aware that the birth control pills might not be as effective and an alternate form of birth control is strongly recommended.

WISDOM TOOTH REMOVAL COST AND INSURANCE COVERAGE?

 

The fee for your treatment is determined by a number of factors. These may include the difficulty involved in  procedure, type of anesthesia that is best for you, your insurance plan etc. You will be given all cost related information at your initial consultation appointment by our billing coordinator so you are well prepared and well informed.

 

QUESTIONS BEFORE SURGERY?

 

At the time of your consultation, your specific situation will be discussed in greater detail. We encourage you to ask any questions you may have. If new questions arise after your consultation, please call our office to speak to one of our staff members.

 
AFTER EXTRACTION OF WISDOM TEETH

 

In most cases, the removal of wisdom teeth is performed under local anesthesia, laughing gas (nitrous oxide/oxygen analgesia), or general anesthesia. These options, as well as the surgical risks (i.e., sensory nerve damage, sinus complications), will be discussed with you before the procedure is performed. Once the teeth are removed, the gum is sutured. To help control bleeding bite down on the gauze placed in your mouth. You will remain under supervision in the office until you are ready to be discharged from our care.  Please make sure to follow all instructions given to you at discharge.

 

Post operative course: what to expect 

 

On the first day after wisdom teeth removal surgery, you may experience some minor bleeding and pain.  A variable amount of swelling can be expected following the surgery. This swelling usually peaks on the second day and should begin to resolve on the third day. You can limit the amount of swelling you will have by using ice pack in your take home bag for the first day 20 mins on and 20 mins off.  Slight stiffness in your jaw muscles is also normal.  You can apply moist heat to your face on the second and third day allowing your muscles to relax. .

 

Please follow your post-operative instructions closely. Doing so will make you as comfortable as possible during the first few days following your procedure. Please allow time for your body to begin healing before resuming an active social, academic, or athletic schedule. Average recovery time is between 5-7 days.

 

ARE THERE ANY PROBLEMS AFTER THE EXTRACTION OF WISDOM TEETH?

 

Some complications that patients undergoing wisdom teeth extraction may experience include:

 

  • Damage to the sensory nerve that supplies sensation to the lips and tongue

  • Sinus communication

  • Dry sockets

  • Infections

 

After the procedure, our assistants will review your post-operative instructions with your escort. We ask that you follow these instructions closely, as they will make you most comfortable following your procedure. If you were sedated, you will be comfortable and drowsy when you leave the office. Most patients prefer to go home and rest with no other physical or scholastic activities planned for a few days. With any medical procedure, there can be unexpected results. These can include delayed healing, infection and post-operative numbness or tingling in your lip, chin, or tongue. We will review relevant post-operative events with you and answer any questions during your office visit.

Damage to Sensory Nerve: (Numbness)

A primary concern is a nerve within the lower jaw bone that supplies feeling to the lower lip, chin, and tongue. This nerve is frequently very close to the roots of the lower wisdom teeth. Having these teeth out between the ages of 12 and 18 usually provides shorter roots so that the nerve is not so close to the roots of these teeth. Occasionally, when the teeth are removed, and especially in older patients, the nerve can become injured. When local anesthesia wears off, you may experience a tingling or numbing sensation in the lower lip, chin, or tongue. Should this occur, it is usually temporary and will resolve gradually over a period of weeks or months. On rare occasions it can result in a permanent alteration of sensation similar to having local anesthesia. We feel that you should be well aware of this possibility before consenting to surgery.

Sinus Communication:

The upper wisdom teeth are situated close to your maxillary sinuses, and their removal can result in a communication between your mouth and the sinus. If it does occur, it will usually close spontaneously, but we may give you special instructions to follow, such as avoid blowing your nose for two or three days following the surgery.  If you have to sneeze, you should sneeze with an open mouth into a tissue. Pressure should not be created in the sinus area, which may dislodge the healing blood clot. If you have any questions about this, kindly contact our office.

Dry Sockets:

Dry sockets continue to be the most common problem people experience following dental surgery. They arise due to premature loss of a blood clot in the empty tooth socket. This seems to occur with greater frequency in people who smoke or are taking birth control pills. While both jaws can be affected, they usually occur in the lower jaw on the third to fifth day. They cause a deep, dull, continuous aching on the affected side(s). Patients may first notice the pain starting in the ear radiating down towards the chin.

 

It is helpful to place a medicated dressing in the empty tooth socket. This will help decrease the pain and protect the socket from food particles. The effectiveness in alleviating the pain lasts for 24-48 hours and may require dressing changes every day or two, for five to seven days. Dressings usually are removed when you have been pain free for 2 to 3 days.

 

Do return for a follow up visit to our office should you develop a dry socket.

Infection:

Occasionally, post-operative infections occur. This usually requires an office visit and clinical examination. Many times, just placing you on an antibiotic for one week will take care of the infection. If it persists, the area will have to be drained and cleaned. Other temporary problems you may experience in the post-operative period include stiffness of the jaws, chafing around the corners of your lips, facial bruising, and blood oozing from the extraction sites. The post-operative instruction sheet we will provide should answer many of the questions related to these more common concerns.

In conclusion, wisdom teeth removal can be considered one of those uncomfortable necessary procedures that most of us have to endure in life.  At ROMS we will try and make this experience as comfortable, safe and enjoyable for you as we can.  Your safety is or number one priority and we are very diligent with our protocol.  If you follow all our pre and post op instructions, you will have an uneventful treatment course.  We look forward to seeing you at your next appointment.