Wisdom Teeth Extraction
Impacted Wisdom Teeth?
Impacted wisdom teeth can result in pain, damage to other teeth and other dental problems. In some cases, impacted wisdom teeth may cause no apparent or immediate problems. But because they're hard to clean, they may be more vulnerable to tooth decay and gum disease than other teeth are.
Impacted wisdom teeth that cause pain or other dental complications are usually removed. Some dentists and oral surgeons also recommend removing impacted wisdom teeth that don't cause symptoms to prevent future problems.
Impacted wisdom teeth don't always cause symptoms. However, you may experience some of these signs or symptoms:
Red or swollen gums
Tender or bleeding gums
Swelling around the jaw
An unpleasant taste in your mouth
Unexplained sensitivity to hot or pressure in other teeth (in front of the wisdom teeth)
Wisdom teeth (third molars) become impacted because they don't have enough room to come in (erupt) or grow normally. They usually emerge sometime between the ages of 17 and 25. Some people have wisdom teeth that emerge without any problems and line up with the other teeth behind the second molars. In many cases, however, the mouth is too crowded for third molars to develop normally. These crowded third molars become trapped (impacted).
An impacted wisdom tooth may partially emerge so that some of the crown is visible (partially impacted), or it may never break through the gums (fully impacted). Whether partially or fully impacted, the tooth may:
Grow at an angle toward the next tooth (second molar)
Grow at an angle toward the back of the mouth
Grow at a right angle to the other teeth, as if the wisdom tooth is "lying down" within the jawbone
Grow straight up or down like other teeth but stay trapped within the jawbone
Impacted wisdom teeth can cause several problems in the mouth:
Damage to other teeth: If the wisdom tooth pushes against the second molar, it may damage the second molar or make it more vulnerable to infection. This pressure can also cause problems with crowding of the other teeth or orthodontic treatments to straighten other teeth.
Cysts: The wisdom tooth grows in a sac within the jawbone. The sac can fill with fluid, forming a cyst that can damage the jawbone, teeth and nerves. Rarely, a tumor — usually a noncancerous tumor — develops. This complication may require removal of tissue and bone.
Decay: Partially impacted wisdom teeth appear to be more vulnerable to tooth decay (caries) than other teeth. This probably occurs because wisdom teeth are harder to clean and because food and bacteria get easily trapped between the gum and a partially erupted tooth.
Gum disease: The difficulty of cleaning impacted, partially erupted wisdom teeth also makes them a vulnerable site for the development of a painful, inflammatory gum condition called pericoronitis (per-ih-kor-o-NI-tis).
The best way to diagnose the wisdom teeth problem is to do an OPG (full mouth) x-ray as seen above. This x-ray can be done at our facility at Coast Dental or any other medical centres having OPG machine to do the same.
How Wisdom Teeth are Removed?
Your dentist may remove your wisdom teeth, or they may refer you to a specialist surgeon for treatment in hospital.
Before the procedure you will be usually given a local anaesthetic injection to numb the area around the tooth. You'll feel some pressure just before the tooth is removed as your dentist or oral surgeon needs to widen the tooth socket by rocking the tooth back and forth.
In some cases, an incision may be needed in your gum and the tooth may need to be cut into smaller pieces before it is removed.
The time it takes to remove the tooth will vary. Some procedures only take a few minutes, whereas others can take 20 minutes or longer.
After your wisdom teeth have been removed, you may experience swelling and discomfort, both on the inside and outside of your mouth. This is usually worse for the first three days but it can last for up to two weeks.
Post-Operative Instructions Following Wisdom Teeth Extractions
Our goal is for your healing process after an extraction to be as comfortable as possible. the removal of teeth is a surgical procedure, and post-operative care is imperative. Please follow all instructions carefully to avoid any unnecessary pain and possible infection.
If you have any difficulties or concerns following your surgery, please do not hesitate to call us or return to our clinic for a follow-up exam.
Immediately Following Surgery
Keep the gauze pad placed over the surgical area with pressure applied by biting down until the bleeding stops which is approx 20-30 minutes.
You may take pain killers such as Panadol, Panadeine, Maxigesic or Neurofen plus as soon as you begin to feel discomfort.
Do not suck on a straw, spit, rinse, or smoke on the day of extraction.
Restrict your activities the day of surgery, and resume normal activity when you feel comfortable.
For mild discomfort, you may take the above mentioned pain killers. DO NOT take more than 6-8 in 24 hrs. Please avoid taking these medications if you are allergic to any of them.
Vigorous mouth rinsing or touching the affected area following surgery should be avoided. This may initiate bleeding caused by dislodging the blood clot that has formed. Do not rinse your mouth for the first post-operative day or while there is bleeding. After the first day, use a warm salt water rinse every 4 hours and after meals to flush out particles of food and debris that may lodge in the area.
Restrict your diet to liquids and soft food which are comfortable for you to eat.
Bleeding – A certain amount of bleeding is to be expected following surgical extractions. Slight bleeding, oozing, or redness in the saliva is not uncommon. Bleeding is best controlled by the use of pressure. Excessive bleeding may be controlled by placing a gauze pad over the area and biting firmly for 30 minutes. Repeat if necessary. If bleeding has not decreased in 3-4 hrs, bite on a dampened tea bag placed directly over the surgical site. The tannic acid in the tea helps the blood to clot. If the bleeding persists, please contact us or the nearest medical health provider.
Swelling – The amount of swelling that is normally expected after an extraction depends on the type of surgery. Swelling around the mouth, cheek, eyes, and side of the face is not uncommon. The swelling sometimes may not appear immediately, and it may occur up to 2-3 days post-surgery. You can help to minimize the swelling by applying ice packs to the affected area. For the first 3 hrs, apply ice packs directly to the area, alternating on for 20 mins then off for 20 mins. Applying ice after 24 hrs has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm, if the swelling is significant, you may use a moist heat compresses to help suppress it.
Pain – Post operative pain will be the most severe the first day after surgery. It is beneficial to take your pain medication before your numbness wears off. For moderate pain, pain killers may be taken every 4-6 hrs. For severe pain, contact us. DO NOT take the pain medication on an empty stomach as nausea may result. DO NOT drive an automobile or operate machinery, and AVOID alcoholic beverages. Pain or discomfort following surgery should subside more and more each day. If pain persists, it may require attention, and you should contact our office.
Antibiotics – If you have been placed on antibiotics, take the medicine as directed. Antibiotics may be prescribed to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavourable reaction. PLEASE NOTE: If you are currently taking birth control pills, they will be inactivated by the antibiotic.
Nausea and Vomiting – In the event of nausea and/or vomiting following surgery, DO NOT take anything by mouth for at least an hour, including the prescribed medication. You should then sip on water, tea, or juice. Sip slowly over a 15 min period. When the nausea subsides, you can begin taking solid foods and the prescribed medication.
Sutures – If any sutures were required, it will be necessary to return to our office for sutures to be removed which will be 7-10 days after extraction.
Activity – Over-exertion may start or intensify your pain. AVOID excessive work or play. It is not necessary to stay indoors following uncomplicated surgery. However, rest and minimal activity will help to minimize pain, swelling, and bleeding. Normal activity may be resumed the following day as tolerated.
Cleaning – Do not rinse or spit vigorously for the first 24 hrs following surgery. You can brush your teeth the night of the surgery, but rinse gently. The day after surgery, you should begin rinsing 4 times a day and after eating. Do this gently as to not dislodge the blood clot. To rinse, mix a teaspoon of salt and a cup of warm water. DO NOT use a non-prescription rinse for 24 hrs after surgery. Clean the rest of your mouth as usual.
Diet – It is advisable to eat only soft, non-spicy food for the first few days following surgery. AVOID hot food or liquid that could agitate the already inflamed area. AVOID rice, grits, and foods that are very small that may become lodged in the area.
Special Considerations – Trismus (stiffness) in the face muscles may cause difficulty in opening your mouth for a period of days. Moist heat compresses can minimize this condition. You may experience aching from other teeth. This discomfort is caused by referred pain and is a temporary condition. It is not unusual to develop bruising in the area of the extraction. There may be a slight elevation in temperature for 24-48 hrs. If the fever persists, please contact our office.
Dry Socket – A “dry socket” is the loss of the blood clot in the socket. This condition creates a delayed healing at the extraction site and presents symptoms such as pain in the ear, chin, adjacent teeth, and jaw. The discomfort usually begins about the third or fourth day after the surgery and can last for many days. The cause of a dry socket is unknown, but it can be attributed to the difficulty of the surgery, increased age, medications (such as birth control pills), and smoking. Treatment is for the symptoms only.
Precautions To Be Taken Following Extractions
On the day of surgery
- Avoid: hot drinks, food, alcohol, vigorous physical effort, playing with the wound, and rinsing your mouth.
- Drink plenty of cold or warm fluid, and eat soft food.
- Avoid smoking as this delays healing.
- Use Paracetamol or prescribed tablets for pain relief. It is recommended that you start this before the local anaesthetic wears off.
- Slight oozing of blood is normal. If significant bleeding occurs, place a gauze or cotton pad over the bleeding site and apply pressure by biting down firmly for 15-30 mins. This may need to be repeated.
- If bleeding is excessive and uncontrolled by pressure, contact us.
- To minimize swelling, an ice pack (small bag of frozen peas) may be held on the side of the face. Apply 10-15 mins every hour on the day of surgery.
Following a dental extraction, the dentist or oral surgeon will have a very specific set of instructions for caring for the extraction site in the hours and days following the tooth removal. Usually, this involves leaving gauze on the extraction site to minimize bleeding for the first few hours.
Depending on the type of tooth extraction performed, the dentist may also prescribe medication to help relieve pain for the first few days following the procedure. So long as the extraction site is kept clean and patients follow the instructions for care, the gums should heal in a matter of weeks without complication or infection. Furthermore, if necessary and once the extraction site heals, the dentist can replace one or more missing teeth with a bridge, a denture or a permanent dental implant for both functional and aesthetic purposes.