WISDOM TOOTH EXTRACTION/REMOVAL
What are they?
Wisdom
tooth (your third molars) are the last teeth to come in –
and the ones least needed for good oral health. They may not
erupt or emerge from your gums until your late teens or early
twenties – if they erupt at all. Most often, they’re
impacted or trapped in the jawbone and gums, usually because
there’s not enough room for them in your mouth. Our
jaws are smaller than those of early humans who needed large
jaws and more teeth for their tougher diet. We don’t
need that extra chewing power anymore. In fact, wisdom teeth
often do more harm than good.
From
Silent to Serious Problems
If
they’re impacted, you may not even know you have wisdom
teeth – until pain suddenly strikes because of infection
or pressure on an adjacent tooth. Partially erupting wisdom
teeth may cause crowding or shifting of your teeth. You may
not know that your developing wisdom teeth are pushing on
the roots of adjacent teeth until those teeth start to shift.
If your wisdom teeth do erupt, they may be hard to clean,
so the odds of decay or infection of surrounding gum tissue
are high.
Removal
May be Wise
Whether
you have obvious symptoms or not, you can rely on our expertise
to diagnose existing or potential problems cause by your wisdom
teeth. If our recommendation is their removal, it may be the
wisest choice for the health of the rest of your mouth. Your
wisdom teeth may be removed by us or we may recommend that
you be attended to by an oral and maxillofacial surgeon (a
mouth and jaw surgery specialist). You can help make your
treatment a success by understanding why your wisdom teeth
may need to be removed, what the procedure involves and what
you can do to promote a successful recovery.
Understanding
Your Wisdom Teeth
Most
people have four wisdom teeth, one in each corner of the mouth,
but each tooth can be at a different stage of eruption and
position of impaction. Since wisdom teeth develop over a period
of many years, harmful changes in your mouth may be gradual.
But these changes could result in sudden and severe pain.
If you learn the different ways wisdom teeth can develop,
you’ll be better able to understand why you may need
to have them removed.
How
Your Wisdom Teeth Grow
By
your late teens, your jawbone has nearly reached its adult
size. But sometimes it isn’t big enough to hold developing
wisdom teeth. When this happens, your teeth become trapped
in the bone and grow wherever they can. The crown (chewing
surface of the tooth) may only partially break through the
gum. In other cases, it may remain completely in the bone.
The roots, which hold the tooth in place, may become misshaped
or grow dangerously close to a sinus cavity or to the nerve
located in your lower jaw.
Positions
of Impaction
Cramped
for room, impacted wisdom teeth grow in many different directions,
commonly at an angle. A wisdom tooth may grow at an angle
toward your other teeth (mesioangular position) or away from
your other teeth (distoangular position). They also can grow
into a horizontal or vertical position.
The
Advantages of Early Removal
Like
all teeth, wisdom teeth develop inside an opening (socket)
in your jaw, protected by bone and gum tissue until they erupt.
Over time, your wisdom teeth become more firmly anchored in
your jaw as their roots lengthen and the jawbone becomes more
dense. So, the older you are, the more difficult it is to
remove your wisdom teeth.
Wisdom
Teeth Problems
Whether
wisdom teeth cause your mouth harm depends on several factors,
including the size of your jaw and how your wisdom teeth grow
in. Sometimes, problem wisdom teeth cause symptoms like pain
and swelling. Or you may have no symptoms at all but the other
teeth in your mouth could be at risk for damage.
Gum
Disease - When a wisdom tooth partially breaks through
the gum’s surface, bacteria can get under the flap,
causing an infection in the gum.
Crowding - An impacted or erupting wisdom tooth can
push on adjacent teeth, causing them to become crooked or
even damaging them structurally.
Decay - A wisdom tooth that is hard to clean due to
its position or because it is partially covered by gum tissue
may collect cavity-causing bacteria. This could also lead
to decay in the tooth next to it.
Poor Position - A wisdom tooth that grows toward the
cheek can irritate nearby tissue. If an erupted tooth is crooked,
it may be hard to clean and can even make it hard to bite
down.
Cysts - If the sac that holds the crown remains in
the bone, it can fill with fluid, forming a cyst that can
destroy surrounding bone.
Your
Dental and Medical History
Your
dentist may ask whether you have tooth or jaw pain or sensitivity
to cold or hot foods, about prior dental treatment and about
gum or jaw problems. You may be asked about medical problems
that could interfere with treatment. Be sure to tell your
dentist about medications you’re taking because they
could affect treatment.
Your
Dental Examination
An
examination helps us determine the general heath of your mouth
as well as that of your wisdom teeth. We may inspect your
gums and jaws for swelling, tenderness or infection. Your
teeth may be examined for the presence of tooth decay. Your
blood pressure, pulse and respiration may be checked to assess
whether you can undergo anesthesia.
Taking
Dental X-rays
To
help confirm the diagnosis, we will take x-rays. X-rays are
especially useful for identifying potential problems when
you don’t have symptoms. Intraoral x-rays are small
and provide an internal view of the individual teeth and jawbone.
If intraoral x-rays don’t provide enough information,
other types of x-rays may be needed such as panoramic x-rays.
They provide a clear image of the area around all four wisdom
teeth as well as surrounding bone. These x-rays can show hard-to-image
impacted teeth clearly.
Risks
and Complications
If
you decide on removal, we will discuss the risks and possible
complications with you and ask you to sign a consent form.
Removal of wisdom teeth is a common procedure but as with
any surgery, there are risks such as side effects from the
anesthetic, bleeding or infection and possible complications
such as numbness.
Numbness
- Impacted teeth may be close to or in actual contact with
the nerves that supply sensation to the teeth, gums, tongue,
chin, cheeks and lips. Occasionally these nerves are injured
when the tooth is removed, causing numbness and tingling.
If this happens, the nerve usually repairs and regenerates
itself within a short time. In some cases, numbness is permanent.
Dry Socket - Healing can be delayed if the blood clot
covering the socket dissolves or is washed away. This exposes
the bone and may lead to constant, deep, throbbing pain, which
can easily be treated with a dressing.
Infection - Infection is a less common complication.
It can usually be treated by draining the infection or with
antibiotics.
Sinus Problems - Because the upper wisdom teeth are
near a sinus cavity, the removal of these teeth can open the
sinus cavity on rare occasions. The sinus usually heals, but
if a problem persists, further treatment may be needed.
Weakening of the Jaw - In rare cases, removal of an
impacted tooth can weaken the jaw, making it more susceptible
to fracture.
Your
Surgery Experience
You
may need to take some days off work or school to give yourself
enough time to recover. Schedule enough time to recover. Schedule
a follow-up visit with us so we can monitor your progress
after surgery and check that you’re healing properly.
Eating
- If your surgery is going to include anesthesia or intravenous
(IV) medication, don’t eat or drink anything after
midnight the night before. Otherwise, don’t eat or
drink anything for at least six hours before surgery.
Transportation - You’ll probably be tired and
not alert enough to drive home safely after surgery. Arrange
to have a responsible adult come with you on the day of surgery
who can drive you home.
Clothing - Wear loose, comfortable clothes. Choose
a shirt or blouse with short sleeves so if you receive an
IV (intravenous) anesthetic, it can be administered easily.
Before Surgery - To help you relax, you may be given
a sedative (by pill or IV). You may even sleep through your
surgery. Or you may receive nitrous oxide and oxygen gas,
given through a mask placed over your nose. Once you are fully
relaxed or asleep, a local anesthetic is used to numb the
area around each wisdom tooth being removed.
During Surgery - Expect the procedure to take about
an hour. If your tooth is erupted, it may be removed (extracted)
from its socket without an incision in your gum. For impacted
teeth, an incision will be necessary. Stitches may be use
to close the incision.
After
Surgery
You’ll
rest for a while under close observation as you recover from
the anesthetic. When your dentist or oral surgeon is satisfied
with your progress, you’ll be able to go home. You
may get a prescription for pain medication as well as instructions
for your home recovery. Plan to rest at home for the remainder
of the day. During the next few days, don’t plan on
driving, drinking alcohol or operating any kind of machinery;
you may be drowsy from the pain medication, other drugs or
anesthetic.
The
Healing Process
The
healing process begins immediately after surgery. The body
sends blood to nourish the tooth socket. To control excessive
bleeding, you may be instructed to bite down on a piece of
gauze, applying constant, direct pressure to the area. This
helps a blood clot to form in the socket. In a day or two
after surgery, soft tissue begins to fill in the opening.
New bone tissue also begins to grow in the socket, becoming
denser over the next two to three months.
Pain
and Swelling
As
the anesthetic or pain medication that you received at the
facility wears off, you may experience some discomfort. Your
gums and jaw may feel tender and sore. To make yourself more
comfortable, take the pain medication that has been prescribed.
It’s normal for your cheek to swell, but you can keep
swelling to a minimum by placing ice packs on your cheeks
during the first 24 hours after surgery.
Healing
Tips
-
DO apply pressure to stop the bleeding by placing the gauze
directly over the extraction site.
-
DO apply ice packs to your face to reduce swelling the day
of surgery.
-
DO eat soft foods, such as soups and blenderized meals after
the bleeding stops.
-
DO drink lots of fluid after the bleeding stops.
-
DO take antibiotics or pain-reducing medication if prescribed.
-
DO keep your mouth clean.
-
DON’T chew hard or crunchy foods such as carrots
or popcorn for 2 weeks. These foods could become lodged
in the extraction site or fracture the weakened jawbone.
-
DON’T brush the teeth in the area of surgery until
the day after surgery. Brush carefully.
-
DON’T rinse your mouth or spit forcefully the day
of surgery; it could loosen the blood clot.
-
DON’T smoke after surgery. Inhaling creates suction
and it could loosen the blood clot.
-
DON’T over exert yourself.
-
DON’T use alcohol the day of surgery or while taking
pain medications.
|
Soft Tissue Impaction |
THB 2,500-4,500 |
|
Partially Bony Impaction |
THB 5,000-7,500 |
|
Totally Bony Impaction |
THB 8,000-10,000 |
