What are the Indications for
Removing Wisdom Teeth ?
Wisdom teeth generally cause
problems when they erupt partially through the gum. The most common reasons
for removing them are:
Decay
Saliva, bacteria and food
particles can collect around an impacted wisdom tooth, causing it, or the
next tooth to decay. It is very difficult to remove such decay. Pain and
infection will usually follow.
Gum Infection
(Pericoronitis)
When a wisdom tooth is partially
erupted, food and bacteria collect under the gum causing a local infection.
This may result in bad breath, pain, swelling and trismus (inability to open
the mouth fully). The infection can spread to involve the cheek and neck.
Once the initial episode occurs, each subsequent attack becomes more
frequent and more severe.
Pressure Pain
Pain may also come from the
pressure of the erupting wisdom tooth against other teeth. In some cases
this pressure may cause the erosion of these teeth.
Orthodontic
Reasons
Many younger patients have had
prolonged orthodontic treatment to straighten teeth. Wisdom teeth may cause
movement of teeth (particularly the front teeth) when they try to erupt and
this will compromise the orthodontic result.
Prosthetic
Reasons
Patients who are to have
dentures constructed should have any wisdom tooth removed. If a wisdom tooth
erupts beneath a denture it will cause severe irritation and if removed, the
patient will need to have a new denture constructed as the shape of the gum
will have changed.
Cyst Formation
A cyst (fluid filled sac) can
develop from the soft tissue around an impacted wisdom tooth. Cysts cause
bone destruction, jaw expansion and displacement or damage to nearby teeth.
The removal of the tooth and cyst is necessary to prevent further bone loss.
Rarely, tumors may develop within these cysts or the jaw may fracture
spontaneously if the cyst grows very large.
Why Should an Impacted Wisdom
Tooth be Removed if it Hasn't Caused any Trouble?
Impacted wisdom teeth are almost
certain to cause problems if left in place. This is particularly true of the
lower wisdom teeth. Such problems may occur suddenly, and often at the most
inconvenient times.
When is the Best Time to Have my
Wisdom Teeth Removed?
It is now recommended by
specialists that impacted wisdom teeth be removed between the ages of 14 and
22 years whether they are causing problems or not. Surgery is technically
easier and patients recover much more quickly when they are younger. What is
a relatively minor operation at 20 can become quiet difficult in patients
over 40. Also the risk of complications increases with age, and the healing
process is slower.
Travel to Inaccessible
Places
If you are going to an area
where specialist dental services are not available and your wisdom teeth are
impacted, it may be advisable to have them removed
beforehand.
Should a Wisdom Tooth be Removed
When an Acute Infection (Pericoronitis) is Present?
Generally, no. Surgery in the
presence of infection can cause infection to spread and become more serious.
Firstly, the infection must be controlled by local oral hygiene, antibiotics
and sometimes the extraction of the opposing wisdom tooth.
The Pro's and Con's of Wisdom
Tooth Removal
Some Pro's of Removing a Wisdom
Tooth:
- Wisdom teeth may be hard to
access with your toothbrush or floss. Over time, the accumulation of
bacteria, sugars and acids may cause a cavity to form in the tooth. If it
is not restored with a filling, the cavity may spread and destroy more
tooth structure causing severe consequences to the tooth and surrounding
supportive structures.
- Due to the difficulty of
keeping these teeth clean with your daily home care (brushing and
flossing), bacteria and food debris remaining on the wisdom teeth may
present a foul smell-causing bad breath.
- A wisdom tooth that is still
under the gums in a horizontal position (rather than a vertical position)
may exert pressure to the surrounding teeth, causing crowding and crooked
teeth. This also may occur if there is not enough space in the mouth for
the wisdom tooth. This may warrant braces to repair the damage.
- A wisdom tooth that is still
under the gums may become irritated. The gum tissue that lays over the
tooth may harbor food debris and bacteria that gets trapped under the gum,
resulting in an infection in the gums.
Some Con's of Removing the
Wisdom Teeth:
- Depending on the size shape
and position of the tooth, removal can vary from a simple extraction to a
more complex extraction. With a simple extraction, there is usually little
swelling, bruising and/or bleeding. More complex extraction will require
special treatment which may result in more bruising, swelling and
bleeding. However, your dental professional will provide you with post
treatment instructions to minimize these side effects.
- Following an extraction, a
condition called "dry socket" may occur. If the blood clot that formed in
the extraction area becomes dislodged, it exposes the underlying bone.
This condition is very painful, but resolves after a few days. It is
preventable by following the post treatment instructions provided by your
dental professional.
- The longer you wait and the
older you get, there is the potential for more problems to occur. This is
because as you get older, the bone surrounding the tooth becomes more
dense, making the tooth more difficult to remove. The healing process may
also be slower.
Post Operative
Care
Do Not Disturb the
Wound
In doing so you may invite
irritation, infection and/or bleeding. Chew on the
opposite side for the first 24
hours.
Do Not Smoke for 12
Hours
Smoking will promote bleeding
and interfere with healing.
Do Not Spit or Suck Through a
Straw
This will promote bleeding and
may dislodge the blood clot, which could result in a dry
socket.
Control of
Bleeding
If the area is not closed with
stitches, a pressure pack made of folded sterile gauze pads will be placed
over the socket. It is important that this pack stay in place to control
bleeding and to encourage clot formation. The gauze is usually kept in
place for 30 minutes. If the bleeding has not stopped once the original
pack is removed, place a new gauze pad over the extraction
site.
Control of
Swelling
After surgery, some swelling
is to be expected. This can be controlled through the use of cold
packs, which slow the circulation. A cold pack is usually placed at the
site of swelling during the first 24 hours in a cycle of 20 minutes on and
20
minutes
off.
After the first 24 hours, it
is advisable to rinse with warm saltwater every two hours to promote
healing. (one teaspoon of salt to eight ounces of warm
water).
Medication for Pain
Control
Anti-inflammatory medication
such as Aspirin or Ibuprofen are used to control minor discomfort
following oral surgery. Stronger analgesics may be prescribed by the
dentist if the patient is in extreme discomfort.
Diet and
Nutrition
A soft diet may be prescribed
for the patient for a few days following surgery.
Following the removal of your
wisdom teeth it is important that you call your dentist if any unusual
bleeding, swelling or pain occurs. The first 6-8 hours after the
extraction are typically the worst, but are manageable with ice packs and
non-prescription pain medication. You should also plan to see your dentist
approximately one week later to ensure everything is healing
well.
It is very important to
talk to your dentist about extraction procedure, risks, possible
complications and outcomes of the removal of these teeth. The actual
extraction may be done by a dentist or it may be referred to an oral
surgeon, who is a specialist. This decision is based on the dentist’s
preference and the unique features of each individual case. If you are
unsure about whether or not to proceed with the treatment suggested
by your dental professional, it is a good idea to get a second opinion. If
you decide after consulting with a dentist to not have any teeth
extracted, they should be monitored at every dental visit.
