Wisdom Teeth

Third molars or wisdom teeth are very common among the general population. Third molars can erupt and function just like any other tooth in the mouth. They can also get impacted and be very problematic. The decision to keep or extract wisdom teeth and the risks and benefits of doing so should be discussed with your dentist. It is very likely that someone you know has had their wisdom teeth removed. Tooth removal is usually accompanied by stories of discomfort from pain and swelling.

Guide to third molar extraction

Not all third molars need to be extracted. Some of the reasons for not extracting wisdom teeth are:

  • Having missing teeth. Someone that lost a back tooth or teeth might have a gap that could be filled with the wisdom tooth.
  • Large jaws, which provide sufficient space to accommodate extra teeth in the jaw without causing problems with existing dentition.
  • Oral hygiene practice. If there is sufficient space for the wisdom teeth to erupt the patient has to show the ability to maintain good oral health.
  • Unerupted, asymptomatic teeth that are completely surrounded by bone and show no potential for eruption in the future.

Some of the common reasons for extractions of wisdom teeth are:

  • Infected tooth. This can be either a cavity within the tooth or infected supporting structures.
  • Insufficient space in the jaws to allow for normal tooth eruption.
  • Difficult to keep clean due to positioning, size, or partial eruption. If the tooth is partially coming through the gum tissue the tooth or the supporting tissue will get infected and potentially cause swelling and severe pain.
  • Poor oral hygiene by patient. This means that the tooth will most likely get infected in the future and will need some attention (a filling or deeper cleaning around the tooth.) Healthy teeth are easier to extract than teeth with large cavities.

Any combination of the conditions mentioned above can compromise adjacent teeth and supporting structures, such as the gum tissue. Failing to address potential problems with wisdom teeth in a timely manner can lead to loss of other teeth, loss of supporting bone, pain, swelling and inability to chew.

Choice of anesthesia

The procedure of third molar extraction is usually done under local anesthesia. This means that the whole area around the tooth is numb, and the patient is awake for the procedure and should not feel any discomfort. Another option for a fearful patient or someone who will undergo more than one extraction is deep sedation with local anesthesia. The patient is put to sleep and doesn’t remember anything about the procedure. Patient comfort is the main advantage of deep sedation. The main disadvantage is the extra cost associated with the added procedure.

Before, During, And After Surgery

In certain situations where the tooth or the supporting area around the tooth is infected, anesthesia can be difficult to obtain. Also if the swelling is extensive it can diminish the patient’s ability to open their mouth. Both occurrences can compromise the dentist’s ability to extract the problem tooth or teeth. At that point antibiotics are prescribed to control the infection, reduce pain and swelling and improve patient’s overall health which will allow for a smoother recovery after dental surgery.

Depending on the overall health of the patient, the condition of the surrounding tissue, the presence or absence of an infection and the patients pain tolerance the dentist might either recommend or prescribe medication to reduce post surgical pain. Antibiotics can also be prescribed in certain situations to speed up the recovery process.

What you should expect if you do decide to go ahead with third molar extraction (single or multiple):

  • It is normal to have pain and swelling in the first 48-72 hours.
  • The pain can be controlled with prescription or over the counter pain medication.
  • The swelling can me minimized with ice packs and anti-inflammatory medication such as ibuprofen or aleve.
  • Mild bleeding from the extraction site is normal and expected.
  • Rest is very important. The body needs to recover from this traumatic episode.
  • You shouldn’t do anything strenuous until about three days after surgery