Wisdom teeth are the last teeth to erupt and often there is not enough room for them to come through completely at the back of the mouth. This means that they may become trapped (impacted) at the back of the mouth or remain partially covered by gum. Saliva and food particles which are normally present in your mouth can get caught around the teeth or under the gum. This can mean that they become a source of infection.
Do I need treatment?
We have strict guidelines for this operation but you are likely to need treatment if:
- you have had repeated infections in the gum around the wisdom tooth
- your wisdom tooth is decayed or has caused decay or damage to the tooth in front
- there is a cyst associated with the wisdom tooth. These are uncommon and are caused when a cavity forms in the bone around the wisdom tooth. The cavity fills with fluid and can enlarge or cause infection if not treated.
- Sometimes wisdom teeth need to be removed to make other types of jaw surgery easier. Your surgeon will discuss this with you if this is the case.
It is important to remember that wisdom teeth do NOT cause:
- Crowding (overlapping) of the teeth at the front of the mouth
- Pain in the jaw joint
What does treatment involve?
If the wisdom tooth is not fully erupted into the mouth, it is often necessary to make a small cut in the gum over the tooth. Sometimes is also necessary to remove some of the thin bone around the tooth or, rarely, the tooth may need to be cut into 2 or 3 pieces to remove it. This is done using a dental drill similar to that used by your dentist for fillings. Once the wisdom tooth has been removed, the gum is put back in place using some fine stitches. In the majority of cases these stitches are dissolvable and disappear between a few days and two weeks.
What type of anaesthetic is used?
A number if options are available depending on how difficult the wisdom tooth is to remove and your surgeon will discuss this with you.
Local anaesthetic - Many wisdom teeth are removed this way which involves an injection in the mouth and around the wisdom tooth.
This is rather similar to that you may have had at your dentist for a filling. The injection takes a couple of minutes to numb the area after which you will feel no pain while the wisdom tooth is removed.
Local anaesthetic and sedation - In addition to a local anaesthetic, an injection is administered into the arm. This makes you feel more relaxed and less aware of the procedure. Your surgeon will give you further information on sedation if it is felt this is an appropriate option.
General anaesthetic - Some wisdom teeth are removed under general anaesthetic and this is usually ‘day case’, meaning that you can go home on the same day as the procedure.
How long does it take to remove a wisdom tooth?
This is variable. Some wisdom teeth take only a few minutes to remove. For more difficult wisdom teeth extraction may take around 20 minutes.
What should I expect afterwards?
Some discomfort and swelling is normal after removal of a wisdom tooth. The gum around the tooth will be tender and there may well be some swelling in the cheek at the back of the lower jaw. This is usually worse for the first 3 days but it may take up to 2 weeks before all the soreness goes.
You may also find that your jaw is stiff so you may need to eat a soft diet for a week or so. There may be some bruising of the skin of your face that can take up to a fortnight to fade away. Your surgeon will advise you on painkillers or prescribe these if necessary. Sometimes a short course of antibiotics is necessary.
What else should I do after the extractions?
- Take regular painkillers at least for a few days
- Avoid rinsing on the day of surgery as this can cause bleeding by dissolving the blood clot which forms in the tooth socket.
- Rinsing should be started the day after surgery and carry on for a period of 2 weeks. Dissolve a teaspoon of salt in some luke warm water and gently rinse around the mouth for a couple of minutes. Do this first thing in the morning, last thing at night and after meals. Keep this up for 2 weeks as it will keep the sockets clean whilst they heal over.
- Brush the other teeth as normal; it may be difficult to clean the teeth near the site of the extraction for a couple of days. The salt mouth rinses will help keep these areas clean.
- Keep to a soft diet, i.e. foods that require little or no chewing (soup, ice cream, bananas, mashed potato).
Are there any other possible problems?
- There are two nerves which run close to the roots of lower wisdom teeth. One of these supplies the feeling to your lower lip, chin and lower teeth. The other supplies the feeling to the tongue and helps with taste. Up to one in 10 people can have some tingling or numbness in these areas which can last several weeks. Less that one in a hundred people will have problems that last more that a year. The risks may be higher if your tooth is in a difficult position. The surgeon will tell you if you are considered to be categorised as increased risk.
- A small amount of bleeding is normal on the day of extraction.
- The blood clot which forms in the tooth socket dissolves in the saliva which can make the saliva look pink.
- If any active bleeding occurs, roll up a small piece of gauze or a handkerchief into a small sausage shape. Place this at the back of the mouth over the wisdom tooth socket and bite firmly for 20 minutes. This should stop any active bleeding. If it does not, contact the department.
- Dry socket: an infection that can occur about 3 days after surgery. This is unpleasant but not dangerous, the risk is worse in those who smoke and women on the "pill".
Do I need to take time off work?
Usually it will be necessary to take a couple of days off work and avoid strenuous exercise. You should not drive for 24 hours if you have had sedation or for 48 hours if you have had a general anaesthetic.
Additional information or advice regarding this procedure can be obtained by contacting St. Peter’s Hospital – telephone 01932 872000 ext 2493 or Ashford Hospital – telephone 01784 884009.
Additional information relating to Removal of Wisdom Teeth can be obtained by logging on to www.baoms.org.uk
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