WISDOM TOOTH SURGERY
WHAT IS A WISDOM TOOTH?
A wisdom tooth is a type molar tooth. Molar teeth are the large back teeth used for biting and crushing food. Adults have three molar teeth on the right and left side of the mouth in both the upper and the lower dental arch. Wisdom teeth are the last of the three molar teeth to develop and erupt.
WHEN DO WISDOM TEETH ERUPT?
Wisdom teeth erupt at the 18 years of age. The roots of wisdom teeth are fully formed by 21 years of age.
HOW MANY WISDOM TEETH DO I HAVE?
At most, you will have four wisdom teeth - two lower wisdom teeth and two upper wisdom teeth
WHY DON'T I HAVE ALL OF MY WISDOM TEETH?
Wisdom teeth are the most commonly missing teeth. Your wisdom teeth may never develop, or you may have less than four.
WHAT PROBLEMS WILL MY WISDOM TEETH CAUSE?
As they erupt, you may experience some short term pain in the area that the wisdom tooth is erupting. Once the tooth has erupted, this pain is likely to stop. Your wisdom tooth may not cause any other symptoms.
If your wisdom tooth does not erupt completely, food and bacteria may get caught between the wisdom tooth and the gum lying over the wisdom tooth. This can cause an unpleasant taste, inflammation of the gum, infection and pain. In the short term, this can be treated by flushing the gap between the gum and wisdom tooth with saltwater or mouthwash, together with a short-term prescription of antibiotics. If the symptoms continue to occur, you may require wisdom tooth surgery.
Food trapping between the gum and the wisdom tooth may not cause any pain. However, over the long term this can cause decay in the wisdom tooth. Depending on the angle of the wisdom tooth, food trapping around the wisdom tooth may also increase the risk of decay in the tooth in front of the wisdom tooth.
IS IT NORMAL FOR MY WISDOM TOOTH TO GROW AT AN ANGLE?
Wisdom teeth grow in four angles - straight, angled forward, completely horizontally and angled backward
DO I NEED X-RAYS BEFORE I HAVE MY WISDOM TOOTH REMOVED?
You will need an x-ray before your wisdom tooth surgery.
A 2D x-ray will show the angle of the wisdom tooth, the number of roots the wisdom tooth has and the shape of the wisdom tooth.
The 2D x-ray will also show the position of a nerve canal. Within this nerve canal sits a nerve that provides the sensation to the lip, chin, teeth and gums on the same side as the wisdom tooth. The 2D x-ray will show how close the wisdom tooth is to the nerve canal.
If the relationship between the roots of the wisdom tooth and the nerve canal is unclear, a 3D scan may be required. The 3D scan will provide greater detail of the relationship between the wisdom tooth and the nerve canal
WHAT ARE THE RISKS OF WISDOM TOOTH SURGERY?
All lower wisdom teeth are close to a nerve that provides the sensation to the lip, chin, teeth and gums on the same side as the wisdom tooth. The removal of a wisdom tooth may causing bruising or trauma to this nerve. You may then experience pins and needles, tingling, numbness, heaviness or a burning sensation to the lip, chin, teeth and gums on the same side of the wisdom tooth. This can be permanent in up to 1% of patients (1 in every 100) and temporary in up to 10% of patients (10 in 100).
The closer the lower wisdom tooth is to the nerve, the greater the risk of nerve injury. A 2D dental x-ray will often show how close the lower wisdom tooth lies to this nerve. If the 2D x-ray does not clearly show the relationship between the lower wisdom tooth and the nerve, a 3D dental scan may be required.
Lower wisdom teeth also lie closely to a nerve that gives the sensation to the side of the tongue. This nerve cannot be seen on an x-ray or dental scan. The removal of a lower wisdom tooth may also result in bruising to this nerve, leaving you with an altered sensation to the side of the tongue. Trauma to this nerve is less common than the nerve that provides the sensation to the lip, chin, teeth and gums.
The removal of the upper wisdom tooth may result in a small opening between your sinus and your mouth. This opening may stop you from properly swallowing drinks. The drink may drip through your nose. If this hole occurs at the time of the removal of your upper wisdom tooth, I may be close this using dissolvable stitches. This hole may also happen after the removal of your wisdom tooth and you may need to return for surgical closure of this in future.
HOW WILL MY WISDOM TOOTH BE REMOVED?
Before I remove your wisdom tooth, I will apply numbing injections in the gums around your wisdom teeth. I will then leave this for 5 minutes for the anaesthetic to work. For lower wisdom teeth your lip, chin, teeth, gums and tongue on the same side as the wisdom tooth will feel heavy and numb. For upper wisdom teeth only the gums around the wisdom tooth will feel numb and heavy.
I will check that the anaesthetic has worked by pressing around the gums using a dental probe. At this point, you will feel pressure but you should not feel pain. If you feel pain, I will leave more time for the anaesthetic to work or apply more anaesthetic depending on what you can feel.
Your surgery will only start when you are happy that you are numb. Depending on the angle of the wisdom tooth, your wisdom tooth may be pushed out whole. If your wisdom tooth has erupted at an angle, I may make a small opening in the gums. I will then make space around the wisdom tooth using a surgical drill. The wisdom tooth will then be divided into several pieces using a surgical drill. Each piece will be pushed out.
Once your wisdom tooth has been removed, the extraction socket will be cleaned out and flushed with sterile water. If I have made an opening in the gums, I will close this with stitches. The stitches will dissolve 10 - 14 days after your surgery.
ARE THERE ANY OTHER TREATMENT OPTIONS?
If the lower wisdom tooth is very close to the nerve, another option for treatment is a procedure called a coronectomy.
A coronectomy is a procedure in which the crown of the wisdom tooth is removed and the roots are intentionally left behind.
A coronectomy is reserved for wisdom teeth that are very close to the nerve that provides the sensation to the lip, chin, teeth and gums.
If the roots of the lower wisdom tooth become loose during the coronectomy these will be removed.
Over time, the roots of the wisdom tooth may erupt and you may require a second surgery to remove these. This is uncommon and usually occurs in the first year after surgery.
WHAT WILL MY RECOVERY TIME BE AFTER MY WISDOM TOOTH REMOVAL?
You may experience pain, swelling and bruising after your wisdom tooth removal.
Pain usually worsens over the first 3 days after surgery. This may take up to a further 10 days to stop, with daily gradual improvements. Provided that you have no allergies, intolerances or reasons why you cannot take them, the following painkillers are advised:
Paracetamol 1g every 6 hours for 7 days
Ibuprofen 400mg every 8 hours for 7 days
I will confirm with you which are best in your case.
Swelling usually worsens over the first 3 days after swelling. This may take up to a further 10 days to disappear, with daily gradual improvements. You may use an ice-pack applied to the outside of the face for 15 minutes in the morning and in the evening to help to reduce the swelling.
Bruising after wisdom tooth surgery is less common. This will usually resolve with any swelling that you may experience.
WHAT CAN I EAT AFTER MY WISDOM TOOTH SURGERY?
Immediately after your surgery while you are still numb, avoid hot food and drink to prevent burning yourself without realising.
Once the local anaesthetic has worn off, you will find a soft diet for the first 3 days after surgery more comfortable. If you feel that you can return to a normal diet you may do so.
Avoid small grains and pieces that may get caught in the extraction socket for 5 days after your surgery.
Avoid alcohol for the first 48 hours after your surgery.
Avoid smoking for at least 72 hours after your surgery - the longer you are able to stop smoking the lower the chances of infection.
CAN I BRUSH MY TEETH AFTER MY WISDOM TOOTH SURGERY?
You should return to toothbrushing as soon as possible after your surgery. Ideally you should start on the same evening as your surgery.
You should not mouthwash with saltwater or mouth wash for the first 48 hours after your surgery. After this, when using rinsing your mouth, ensure that it is a gentle rinse only for the following 5 days.
DO I NEED A REVIEW AFTER MY WISDOM TOOTH SURGERY?
Usually you will not need a review after your surgery. However, depending on your surgery I will arrange a telephone review at least 5 days after surgery.