Surgical Extraction of Impacted Wisdom Tooth

Wisdom teeth erupt last in the dental arch, they appear at the back of the mouth from the late teens onwards. Most people have four wisdom teeth, but it is not unusual to have fewer - or even none. Because they are the last teeth to form, there might be no room for them, so they may come through at an angle, pressing against the teeth in front or the bone area behind them. They can show a little bit in the mouth only and their bulk to remain trapped in the jaw bone, in which case they are called partially impacted wisdom teeth. Partially impacted wisdom teeth often give the impression to the patient that they are coming through, while in fact they are not and are only getting inflamed in their awkward position. Sometimes they might even stay completely trapped in the deep corner of the jaw bone and not show at all in the mouth. These are called fully impacted wisdom teeth, they can still cause infection and problems and they can only be seen by radiographic examination.

My wisdom teeth are growing and are giving me problems. What should I do?

In our dental surgery we watch how your teeth and jaws grow as part of your regular dental care. Do tell your dentist if you think there might be a problem. Once the concern is raised the dentist will observe the clinical appearance of the wisdom tooth and also take an x-ray with a small mouth intra-oral digital sensor. This radiograph will show:

where the wisdom tooth is in the bone
how much room is there for it to come through
if it is causing any damage to the tooth in front
if it is completely impacted

According to the findings your symptoms will be assessed and a decision will be made to look further into the matter or not.

Many times wisdom teeth cause temporary problems during their eruption that can subside just by keeping good oral hygiene and using a mild mouthwash.

However sometimes a persistent infection called pericoronitis can settle in the gum area around the wisdom tooth, caused by bacteria that occupy the space around the tooth. Pericoronitis infection causes inflammation and soreness of the surrounding soft tissues. Sometimes it can be more severe, causing swelling and severe pain and preventing the patient from being able to open the mouth.

Pericoronitis at first should be treated with antibiotics which will make the symptoms subside in about a week. However pericoronitis infection is often reoccurring and that is when surgical extraction of the wisdom tooth should be planned.

My dentist recommended my wisdom teeth out, what will he do?

Once the clinical symptoms of recurrent pericoronitis subside with the use of antibiotics, the patient will be having a panoramic x-ray or OPG. This radiograph depicts fully the dental arches and jaw bones and reveals the best view of the wisdom tooth’s position in order to assess its extraction.

Panoramic radiograph is easy to take, all the patient needs to do is bite on a little plastic jig and the machine rotates around to complete the Pantomograph.

Then a consultation will take place, with the dentist explaining the situation and assessing the difficulty of the possible extraction. The main thing to be discussed here is the possibility of nerve damage during the extraction. Wisdom teeth are categorised in low, medium and high risk for injuring the inferior alveolar nerve during their extraction. The panoramic x-ray is an invaluable tool for assessing this risk. If the dentist is experienced with wisdom teeth removal he can perform an extraction of low or medium risk wisdom teeth. In our practice You Smile Dental Care in Market Rasen, the principal dentist dr Alexakis has completed post graduation studies in oral surgery and has all the necessary experience and specialised equipment for this procedure. However it is our belief that wisdom teeth in high risk for nerve damage should be referred to the hospital to be performed under sedation by a maxilofacial specialist surgeon.

For low and medium risk surgical extractions we will offer you a well planned appointment. The patient must make considerations to fit this around his commitments and take in mind that the next few days after the extraction, care must be taken to rest and avoid stress and to keep a soft diet for 2-4 days, so little time off work is recommended.

On the day of the extraction a local anaesthetic will be used and the procedure will be painless.

The procedure usually would take around 1 hour to 1 hour and a half.

Please make sure that you have somebody to drive you home in case you need to travel and feel dizzy. On your way out we will provide you with analytical aftercare which is also found at the end of this page and better to read prior to your extraction.

Why should I have my wisdom teeth removed?

We only recommend having a wisdom tooth removed when it is repeatedly causing you problems. Having a troublesome wisdom tooth removed will require some temporary effort but the long-term benefit will worth it as there will be no more reoccurring pain and infection, no more damage pushing against the other teeth and it will also be easier for you to clean your whole mouth properly and have a fresh breath.

What happens if I suffer nerve damage during the surgical extraction of an impacted wisdom tooth?

The most serious complication associated with the extraction of a wisdom tooth is the nerve damage of the inferior alveolar nerve or the lingual nerve of the tongue. Although this complication is rare it requires a lot of attention to be prevented. There are different degrees of severity that this trauma can take place. In the most simple forms the nerve is just touched or scratched leaving the patient with a prolonged numbing effect that goes away in a few days. If the nerve suffers a small cut the tingling sensation can follow the patient for many weeks or even months. In the worst scenario where the nerve is cut throughout the numb lower lip or tongue or chin area may follow the patient for life. This complication is called hypoesthesia and is a rare but real threat. In our dental surgery we take every single measure to prevent this complication from happening. We believe that the key for success is the initial assessment of the associated risk, by closely examining the panoramic radiograph. If the patient is found to be in high risk then we try every alternative to the extraction possible or make sure it is done only after the patient’s consent to the risks, at the specialised maxilofacial surgery department in the hospital. Dr Alexakis claims to have never seriously injured a nerve during the many surgical removals he has performed.

What should I do after I had my wisdom tooth extracted? What are the most common complications after surgical extraction of wisdom teeth?

Surgical extraction of wisdom tooth aftercare instructions:

Bite firmly on a piece of gauze for 20 minutes immediately after the extraction. More gauze is given to you for home. In case of excessive bleeding later on, bite on that gauze again firmly for 20 minutes. Avoid rinsing in an effort to stop a bleeding socket as it makes things worse. In the rare case where bleeding cannot be controlled at home please give us a ring at the out of hours emergency line and visit your local a & e
Leave the practice only if you are feeling relatively fit and for your best interest arrange to have somebody to escort you home
Take over the counter painkillers immediately when leaving the practice as these work better when taken before the anaesthetic wears off and before post-op pain onsets. Wisdom tooth surgical extraction can be followed by significant bruising ache so pack well on those but never exceed their dosage. Combination of strong versions of paracetamol with ibuprofen in alternating intervals of 3 hours has been known to work well. Do not take anything that you are not allowed to take by your doctor
If you were given by us an antibiotic prescription please follow that as well for a week. We only give antibiotics when it is absolutely necessary
Expect swelling of the face that can sometimes reach the size of an orange around the extraction side. Use cold applications for the first 48 hours. Best way is to wrap an ice pack in a towel and hold it on the extraction area for 5 to 10 minutes. Repeat a few times every hour for the first 2 days to significantly reduce the swelling. Do not confuse this normal swelling from the trauma with being an abscess
Expect a situation called trismus, where the patient cannot open his mouth properly. Stick to your aftercare and soft diet and be patient. Improvement will come in a few days
Another common and sometimes severe complication is the dry socket. This is a long and painful healing associated with a nasty smell or taste coming from inside the socket. The dry socket pain can be excruciating and can last for 2 to 3 weeks after the extraction. Please give us a call and we can arrange to see you for treating and facilitating your dry socket. Do not confuse the dry socket with more mild forms of post operational bruising ache or swelling
Avoid any alcohol as it can impair healing and reduce the effectiveness of your antibiotics, or even worse interact with them and make you more poorly
Avoid smoking as it impairs healing and increases the chances of suffering from a dry socket
Avoid brushing directly on the wound for the first 48 hours. Brush the rest of your teeth gently with a soft brush
Avoid using a mouthwash for the first 24 hours. Let the socket form its own clot without disturbing it. After one day you should start washing your mouth frequently. For best results make your own mouthwash by diluting a full spoon of salt in a small cup of warm water. Repeat every 3-4 hours for the first 3-5 days
Avoid drinking through a straw that builds up negative pressure in the mouth and may disturb the healing clot and cause bleeding
Keep a soft diet for one week following the extraction
Avoid any stress or great physical effort for a week and of course any sports
In the rare event of a prolonged numbing sensation please give us a call
Visit us in our dental practice in Lincolnshire after one week to remove any sutures that we might have used and have a look at the healing wound