What harm do impacted wisdom teeth do?
What is the best age to have impacted wisdom teeth removed?
What is it like to have an impacted wisdom tooth removed?
Known risks and complications of wisdom tooth surgery
Any questions?

Wisdom teeth or third molars are usually the last teeth to develop, and are located in the back of your mouth. They usually have developed between the ages of 17 and 24. The jaws of modern humans are normally not large enough for the wisdom teeth to enter into the mouth and become fully functional. When this occurs they are classified as ‘impacted’, meaning that they are blocked by another tooth or bone and are therefore prevented from entering and assuming a normal position in the mouth. A special x-ray of your teeth and jaws called an OPG (orthopantomogram) can determine if your wisdom teeth are impacted.

What harm do impacted wisdom teeth do?

1. Infection: The gum tissue around the crown of the wisdom tooth becomes irritated, inflamed and infected. This infection may spread to the cheek, throat or neck resulting in pain, swelling and stiffness of the jaws.
   
   
2. Damage: Difficult to clean the wisdom teeth may be harmful to the tooth in front of it (second molar) resulting in bone loss, gum disease or cavities. In addition, the wisdom tooth itself can decay resulting in severe toothache.
   
   
3. Disease: Non-infectious diseases may occur around impacted wisdom teeth. A cyst can form around the crown of the impacted wisdom tooth and this can cause destruction of surrounding bone and damage to other teeth and nerves in the area. Although rare, a benign tumour may develop from the walls of the cyst surrounding the impacted wisdom tooth and a more complicated surgical procedure with more potential risks may be necessary.
   
   
4. Crowding of teeth: Although somewhat controversial, many clinicians feel that impacted wisdom teeth may contribute to crowding of your teeth, which is most noticeable in the lower front teeth. This is most commonly seen after the patient has had braces. Your orthodontist may recommend preventative removal of your impacted wisdom teeth for space or crowding considerations.

Unfortunately, impacted wisdom teeth can be 'dormant' for many years, but then cause problems and pain at an unexpected and inconvenient time. Unless you have an active problem at the time of your consultation, the reason for removal of your impacted wisdom teeth is primarily preventative to avoid long-term problems. Oral and Maxillo Facial Surgeons have extensive training in the diagnosis and management of impacted teeth and surgical removal of these teeth. With an oral examination and an OPG x-ray of the teeth and jaws, an Oral and Maxillo Facial Surgeon can assess the position of the impacted wisdom teeth and predict if there may be present or future problems.

What is the best age to have impacted wisdom teeth removed?

In most patients this will be between 17-18 years of age. A young patient will heal faster, more predictably and have fewer complications (eg.infection and delayed healing) than an older patient. Surgery is clearly more difficult if you are in your 30s, 40s or beyond. Studies have shown that early treatment results in a superior outcome for the patient.

What is it like to have an impacted wisdom tooth removed?

Since an impacted wisdom tooth is usually beneath the gum surface and covered by bone, it is considered an operation in every sense of the word, comparable to a tonsillectomy. This will allow you to better understand certain features regarding careful pre-operative preparation and the need for good post-operative care.

The removal of wisdom teeth is usually performed on an outpatient basis either in my office (under local anaesthesia or local anaesthesia/sedation) or in an accredited day surgery (under general anaesthesia) to ensure that the patient is comfortable during surgery. The Oral and Maxillo Facial Surgeon in consultation with the patient determines the method most suitable in each individual case.

Depending on the difficulty of the case, the procedure may take from 20-60 minutes (surgical time). Recent advances in medicine and technology allow patients to undergo impacted wisdom tooth removal and Amanda which promotes rapid healing and minimal post-operative discomfort. State-of-the-art sterilisation and strict infection control techniques are used at all times.

The removal of an impacted wisdom tooth is accomplished by making an incision in the gum tissue to expose the tooth and the surrounding bone. Some of the bone usually needs to be removed before the tooth is extracted. In some cases, the tooth may be cut into sections that are individually removed. The area from which the tooth has been removed is cleaned thoroughly and stitches are placed to sew the gum tissue back into place. The stitches assist in control of bleeding, however, there may be some slight oozing which should stop within 24-48 hours. The stitches dissolve in 10-14 days and do not have to be removed.

Immediately following surgery, the patient will require ' recovery ' time varying from 15 minutes to several hours. During this period, the patient is monitored by trained staff until it is safe for them to go home. Prior to discharge, a trained nurse reviews the post-operative instructions with the patient and their escort, and a post-operative instruction sheet is given to the patient. It is very important that these instructions are followed closely to maximise comfort post-operatively and to avoid potential problems. A prescription for pain medication and antibiotics is provided as well as a follow-up review appointment in 2 weeks. It is normal to have some discomfort, swelling (part of the normal healing process), bruising and jaw stiffness following the surgical removal of impacted wisdom teeth. By following the post-operative instructions provided and taking the prescribed medications as directed, these post-operative symptoms can be significantly minimised.

In most cases patients can resume normal activities within a few days depending on the degree of surgical difficulty and the number of impacted wisdom teeth removed.

Known risks and complications of wisdom tooth surgery

The surgical removal of wisdom teeth is a routine procedure that has few associated serious complications. However, as with any surgical procedure, there are potential complications, which although occur rarely,you should be aware of and discuss fully with the Oral and Maxillo Facial Surgeon:

1. Infection: Infections are rare and and any post-operative signs of infection should be taken seriously and reported to the Oral and Maxillo Facial Surgeon promptly. Signs of infection include fever, abnormal swelling and pain, a bad taste in the mouth, and pus discharge. It may be appropriate to prescribe antibiotics to eliminate the problem or in some rare instances, drainage of the infection may be required.
   
   
2. Injury or Damage: to adjacent teeth, fillings and crown and bridgework.
   
   
3. Dry Socket (Osteitis): This is where a blood clot does not form properly in the tooth socket for some reason such as smoking, use of oral contraception, or poor oral hygiene. A dry socket heals more slowly than normal, and is a very painful condition because the bone within the socket is exposed. The pain associated with a dry socket is not usually relieved by the prescribed pain medications. However, the condition is easily treated by washing out the socket and placing a sedative dressing into the socket. Dry sockets usually subside within several days.
   
   
4. Prolonged or Permanent Numbness: Sensory nerves serving the mouth can be in close proximity to impacted wisdom teeth, especially the lower ones. Occasionally, in spite of all precautions, if one of the nerves becomes irritated during the surgery, patients experience partial or total loss of feeling in the areas served by the nerve. This numbness or tingling sensation can affect the lip, tongue, cheek, chin, gums, or teeth, depending on the nerve involved. The nerves involved are purely sensory (transmit sensation or feeling), so there is no change in the patient’s appearance, speech, or eating ability. In the vast majority of cases the numbness is temporary and short lived, but in rare instances can be permanent. The exact duration of the numbness cannot always be predicted. However, young patients have the best chance for full recovery of nerve function. Also, the likelihood of nerve damage is much lower if the wisdom teeth are removed before root development is complete.
   
   
5. Sinus Complications: The roots of upper wisdom teeth sometimes penetrate into the maxillary (upper jaw) sinus cavity. Sometimes an opening into the sinus with drainage or sinus pain ( sinusitis) may occur following upper wisdom tooth removal. Usually these complications are temporary. If a significant opening into the sinus cavity does occur, an additional procedure may be necessary to close or repair the opening or communication.
   
   
6. Root Fragment Fracture: Roots may be extremely long and fragile, and a piece of root may break off during surgery most of the time, the fragment is removed, however, if it lies close to a nerve or a sinus cavity, or its removal would jeopardise and adjacent tooth, the surgeon may elect to leave the fragment in place. This usually presents no long term problems with normal bone growing around the retained root fragment.
   
   
7. Jaw Weakness or Fracture: In extremely rare instances, jaw fracture can result if the jaw is thin and the wisdom teeth are deeply impacted. The Oral and Maxillo Facial Surgeon can treat this problem if it occurs, although every possible precaution is always taken to prevent this occurrence. Even if the jaw has not been fractured, extensive bone removal during surgery may weaken it. Care should be taken to avoid eating hard foods that place undue stress on the jaw during chewing until healing is advanced (approximately 8 weeks).
   
   
8. Jaw Joint Pain: This is rare following wisdom tooth removal but can occur. If it does, further treatment by the Oral and Maxillo Facial Surgeon may be necessary.
   
   

Any questions?

If the above information, combined with the information you receive at your consultation appointment does not answer all of your questions, please feel free to contact Dr D’Rozario at his practice.