WISDOM TOOTH REMOVAL
Wisdom teeth, or third molars, usually appear in the late teens/early twenties. There may not be sufficient space for eruption, and a few wisdom teeth remain buried in the bone without causing any problems. Others emerge part of the way but become impacted against an adjacent tooth. Lower wisdom teeth are usually more troublesome than uppers.
WHAT PROBLEMS COULD I GET WITH MY WISDOM TEETH?
It can be difficult to clean around a wisdom tooth resulting in bad breath and tooth decay. There may be soreness of the gum over the wisdom tooth, even when it is erupting normally. The gum flap may cover part of the wisdom tooth and can become swollen if infection develops. The gum infection has to be treated before the wisdom tooth can be removed. Sometimes the gum infection is severe enough to cause difficulty in opening the mouth. Swelling of the cheek and lymph glands of the neck occurs occasionally. The infection can make you feel unwell or cause a fever.
DOES THE WISDOM TOOTH NEED TO BE TAKEN OUT?
Removal of the impacted wisdom tooth is recommended when there have been a few episodes of infection, the adjacent tooth has decay, there is a formation of a cyst or if there is gum disease.
HOW IS THE WISDOM TOOTH REMOVED
Often the unusual position of the wisdom tooth may mean that it needs to be removed surgically. This involves lifting the gum around the tooth, removal of a small amount of bone and sometimes the tooth may need to be sectioned into pieces. During the procedure no pain is felt because of the local anaesthetic’s numbing ability. Only the sensation of pressure is experienced.
If the wisdom tooth removal procedure is particularly difficult, your dentist will recommend that the wisdom teeth are removed under a general anaesthetic by a specialist. For a general anaesthetic procedure, you will be referred to an oral/maxillofacial surgeon who will usually remove your wisdom teeth in a hospital setting.
WILL I HAVE ANY PROBLEMS AFTER THE WISDOM TOOTH IS REMOVED?
Swelling of the face and discomfort in the mouth may occur, which may last for a week. Pain or difficulty in opening your mouth after the wisdom tooth removal should be anticipated, although your dentist’s prescribed pain medications largely mitigate this. Stitches are usually used to close the socket after the tooth is removed. A socket may not heal and can become a ‘dry socket’. Sometimes tingling or numbness of the lower lip and/or the tongue occurs after the operation.
WHAT IS DRY SOCKET?
A dry socket is where the blood clot has been disrupted preventing the healing process occurring. A dry socket generally presents approximately 3 days after tooth removal resulting in tenderness or pain, bad breath and a bad taste. A dry socket is more likely to occur after lower wisdom teeth extraction, and with patients who are smokers. A dry socket can be treated by your dentist.
WHAT IS TEMPORARY NUMBNESS?
A nerve in the canal on each side of the lower jaw carries feeling from the skin of the lip and chin. In some people the roots of the lower wisdom teeth lie close to the canal, and after removal of the tooth a feeling of numbness may temporarily occur. It is not serious as the lip moves quite normally (the nerve to the muscles of the lip are not affected). Most cases take a few weeks for the last bit of numbness to completely disappear, while a small number take a few months. Very rare cases have been known where a small area of numbness lasts for years. Occasionally a similar feeling of numbness may extend along the side of the tongue due to the bruising of another nearby nerve. Again, this feeling of numbness is likely to be of a very temporary nature.
ADVICE FOR AFTER THE OPERATION
Instructions will be given to help you recover following removal of the wisdom tooth. You should rest for a few days after surgery, ideally 2 days off work. You will be given a telephone number in case there are unexpected problems. An appointment is made for you to return 7-10 days after the procedure to have the stitches removed and to ensure healing is occurring.
INSTRUCTIONS FOLLOWING EXTRACTION OF TEETH
After an extraction, the socket fills up with blood which then clots. This is the first stage in normal healing. The following instructions are designed to help you aid normal healing.
- Do not rinse your mouth or spit on the day of the procedure. You may eat and drink, but not rinse or spit.
- Smoking, alcohol, hot drinks and heavy exercise that raise your blood pressure must be avoided on the first day.
- Avoid brushing near the area of the extracted tooth, but brush your other teeth. Keep your mouth as clean as possible.
- On the day after the procedure, start gently rinsing the socket with warm salty water (half a teaspoon of salt in a glass of warm water) four times daily for one week.
- It is important to keep up your fluid and calorie intake in the first few days as this promotes better healing. Soft food such as fruits, mashed vegetables and yoghurt are good.
Bleeding: There might be blood in your saliva for several days, this is normal. However if the tooth socket is oozing blood, place a pad of clean sterile gauze or a clean folded handkerchief or a wet tea bag (the tannins are a great blood clotting agent) over the extraction socket and bite on it for 30 minutes.
Pain: Take the pain medication as prescribed by your dentist. If no pain medication was prescribed then take 2 x 500mg paracetamol, wait 4 hours and then take 2x 200mg ibuprofen. Wait another 4 hours and repeat the cycle alternating between Paracetamol and Ibuprofen every 4 hours.
Swelling: Inflammation and swelling are the body’s natural response to surgery. This is usually at a maximum after 3 days and will often linger for 7-10 days. It is not uncommon for the cheek on the side of the extraction to become swollen. The cheek may also become bruised which may become visible externally. Post-operative swelling can be reduced by using cold compresses. The best way to do this is to take crushed ice placed in a plastic bag and hold it over the cheek on the side the extraction was performed. Alternatively a bag of frozen vegetables will give the same effect. Hold it in the area with a 5min on and 5min off regime for the first few hours following extraction.
Stitches: If stitches were placed, they will be removed after one week at a review appointment or if dissolvable they will dissolve within 2 weeks. Call us if dissolvable stitches are still in place 14 days later.
If bleeding or pain is not controlled by these measures, or if there are any other complications please contact Tooth Fairy Dental. If after hours, please email info@toothfairydental.co.nz for advice.