Dental
Maxillofacial Surgery
Wisdom Teeth

Removal of wisdom teeth is a very common procedure, often the result of these teeth impacting.

Wisdom teeth, also known as third molars, are the last set of teeth to come into the mouth. They tend to push through the gums during the late teens or early to mid-twenties. Most people have four wisdom teeth, but it is possible to have less or more.

There is often inadequate space at the back of the jaws for the wisdom teeth to come through. If this is the case, the wisdom teeth often emerge at an angle, get stuck and only partially emerge. This is known as an “impacted” wisdom tooth.

Impacted wisdom teeth do not grow in proper alignment. They may be growing forwards pushing up against the tooth in front, growing out towards the side, or growing backwards into the jaw bone. Wisdom teeth which are impacted will never grow through the gum into proper alignment with the rest of the teeth and will never be of any use. It is not uncommon to experience pain, and infections with impacted wisdom teeth.

If your wisdom teeth become troublesome, your dentist may refer you to an oral and maxillofacial surgeon for removal. It is best to remove your wisdom teeth as soon as possible before the problems get worst.

Procedure

Removal of wisdom teeth is a very common procedure which may involve making a cut in the gum and using a drill to remove the teeth. Once the teeth are removed, the gum is stitched back in place. Depending on the difficulty, your surgeon may recommend being put to sleep for the procedure.

Downtime

Following removal of your wisdom teeth, the wounds well heal within 3 – 7 days. During this time, it would be better to take time off work, school or other duties. It is also important to avoid smoking, or drinking alcohol during this time.

Funding Access

Some health funds will cover the removal of wisdom teeth.

Questions about wisdom teeth surgery:

Do I need to have my wisdom teeth removed? 

Not all wisdom teeth need to be removed and not all wisdom teeth needing removal will immediately cause you symptoms. Because wisdom teeth are at the back of the mouth and often not completely through the gum they are difficult to keep clean. Indications for having them removed include the following:

* Repeated infections and pain of the tooth or gum;

* Caries (tooth decay) of the wisdom tooth or adjacent teeth;

* Food getting stuck around the wisdom teeth which can cause decay;

* Cheek ulcers being cause by the wisdom tooth pushing sideways out of the gum and rubbing against the inside of the cheek;

* Crowding of adjacent teeth;

* Cyst formation which can occur when a wisdom tooth is not removed. A cyst is a sack of fluid that forms around the tooth and can displace the tooth, destroy bone and damage other teeth.

In some situations, wisdom teeth may be removed prophylactically. For example, if there is a lack of space, or for orthodontic treatment. If you are heading away to a remote place for an extended period of time where having surgery done would be unsafe, or unsanitary, it may be in your best interest to have them removed.

The presence of wisdom teeth may weaken the jaw and increase the likelihood of suffering from a fractured jaw. Hence, it is not uncommon for professional rugby players, and boxers to have their wisdom teeth removed prophylactically.

Everybody should know what the status of their wisdom teeth are. This can be done be seeing your dentist who will examine you and take an x-ray to determine their presence, position and whether or not they need to be removed.

When is the best time to have my wisdom teeth removed? 

The best time to have your wisdom teeth removed is in your late teens or early 20s. This is because at this age the jaw bone tends to be softer and therefore the teeth are more straight forward to remove. At this age you tend to recover quicker from the surgery and you have a lower post-operative infection and complication rate.

What will happen if I do not have my wisdom teeth removed? 

If you have been advised to have your wisdom teeth removed and do not proceed with it, you will be at risk of repeated infections and pain of the teeth, gum, and jaws. This tends to cause facial swelling and in some cases an abscess may form which may spread infection down the neck or up towards the eye.

In addition to this, the impacted wisdom tooth may cause decay of the adjacent tooth. If a cyst (fluid-filled sack) forms, it may gradually enlarge which will slowly erode away the surrounding bone or teeth.

What can I expect after the surgery? 

Oral surgery including the removal of wisdom teeth is a more invasive procedure than the simple extraction of teeth. As a result, there are more post-operative changes to expect. You may notice some or all of the following after the operation, these are common and do not necessarily indicate a complication:

* Slight oozing of blood mixed with saliva for up to eight hours following surgery;

* Moderate swelling of the face on the same side where the teeth were removed. Ice packs will help during the first 24 hours;

* Bruising of the face and neck on the side operated on;

* Stiffness of the jaw muscles making it difficult to open the mouth for up to a week;

* Dryness and cracking of the corners of the mouth where they have been stretched during tooth removal. Application of a strong moisturiser (such as Vaseline) to the lips will make them more comfortable;

* Tenderness of the adjacent teeth for a short period of time;

* There may be a cavity where the tooth was removed. This should be kept as clean as possible with either warm salty water or a mouth wash. This cavity will fill in with time;

* Numbness of the lower lip, chin and tongue. This is because local anaesthesia has been used to make you feel comfortable during and after the surgery. In very rare cases there may be an area of residual numbness in the lower lip, chin or tongue on the side of the operation. This is usually temporary which will correct itself in time;

You will be prescribed pain killers, anti-inflammatories and possible antibiotics after the procedure.

What are the complications of wisdom teeth removal? 

As with all surgical procedures, wisdom tooth surgery has risks despite the highest standard of care provided by your surgeon. It is common for your surgeon to outline all the possible risks so you can make an informed decision. The majority of people having surgery will not have any complications. The most common risk of wisdom teeth removal are post-operative bleeding and infection. To reduce the risk of infection you may be placed on a course of antibiotics.

In rare situations there may be a change in sensation, numbness or tingling of the lip, chin, gum or tongue which is often temporary but occasional permanent. In some cases, the taste of food may be affected. This is due to the proximity of two nerves to where the lower wisdom teeth are. It the nerve is injured it will usually recover within eight weeks but can take up to 18 months.

After wisdom tooth removal, a blood clot will form in the bone where the tooth was removed. This blood clot is important for appropriate healing and relief of pain. If this blood clot is washed away the bone becomes exposed causing a constant, throbbing, and radiating pain. This is known as a dry socket. This can be easily treated by contacting your surgeon. You can prevent a dry socket from occurring by not rinsing on the first day of surgery, and not smoking for at least two weeks after.

Other complications include damage to adjacent teeth, sinus problems, difficulty opening your mouth, temporomandibular joint problems and poor or prolonged healing. Though exceedingly rare, there is also the possibility of an allergic reaction to the medications administered.

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