Wisdom teeth are trouble. Wisdom teeth are also called third molars and it is not unusual for these teeth to become "stuck", wedged in or what we call impacted. They are the last teeth to come through into the mouth and often there is not enough room for them. Most people have four wisdom teeth but up to 10% of the population missing one or more. When wisdom teeth become impacted they cause a number of problems.
Problems caused by impacted wisdom teeth
When a wisdom tooth becomes stuck in the jaw bone there is often a partial flap of the gum overlying the tooth and infection may develop around this area. The area becomes swollen, red and very painful. Swallowing may be painful and sometimes people can feel generally unwell. Sometimes, there can be a discharge of pus and this may have a foul taste associated with it. Often if the infection around the wisdom teeth is severe antibiotic therapy may be required.
Decay: When the wisdom teeth become stuck they are often impossible to clean properly and they can become decayed. Also, they can cause decay in the tooth in front and it can be very difficult to place fillings in these situations prior to the removal of the wisdom teeth.
Pressure from impacted wisdom teeth is one of the causes of crowding of the front teeth. It is not the only cause of crowding as some people with no wisdom teeth still get crowding but it is believed to be a significant contributing factor. This is particularly disappointing if you have undergone orthodontic therapy to achieve straight teeth.
Damage to adjacent teeth:
Pressure from impacted wisdom teeth can also cause damage to the adjacent teeth. Food impaction between the adjacent tooth and the wisdom tooth can cause cavities in both teeth and cause bone loss on the back of the good tooth.
Cysts: A fluid filled sack called a cyst can on rare occasions form around the crown of an impacted wisdom tooth.
Line of weakness in the jaw bone: An impacted wisdom tooth causes a weakness in the jaw bone which could result in a broken jaw if the jaw bone is struck such as during boxing or other contact sports.
Early or timely removal of impacted wisdom teeth can prevent these problems
These problems can be prevented by the timely removal of impacted wisdom teeth. Generally speaking, it is best to have this done if at all possible when you are young as the surgery is a lot more comfortable for younger patients and recovery times considerably quicker. At Oral Surgery Associates, we recommend the removal of impacted wisdom teeth to be ideally undertaken between the ages of 18 and 25 and before they cause problems. However, there are occasions when these teeth are removed earlier if they have started to cause trouble, needed to be removed for orthodontic (teeth straightening) work or are causing problems such as cyst formation. It is often best to have the wisdom teeth removed before they cause problems as symptoms such as pain can be quite severe and occur at very inconvenient times. Also the surgery becomes more difficult and complication rates rise as people get older. Not all wisdom teeth need to be removed,such as those that are erupted into a normal position and not impacted. Another occasion when the wisdom teeth may not need to be removed is if they are deeply buried in the jaw bone and not associated with any pathology. However, this should be carefully assessed with a three-dimensional Galileos scan (see below).
Assessment of your impacted wisdom teeth
At Oral Surgery Associates, we have a special three-dimensional x-ray technique called a Galileos cone beam tomography examination. The special x-ray considerably improves the diagnostic ability for the surgeon in removal of impacted teeth. It clearly shows the position of a nerve which supplies feeling to the lower lip and chin and often lies close to the roots of wisdom teeth. By being able to carefully assess the position of this nerve, we at Oral Surgery Associates are able to plan your surgery to minimise the risk of damage to this nerve.
Why choose a Specialist?
At Oral Surgery Associates, we have a special three-dimensional x-ray technique called a Galileos cone beam tomography examination.
The special x-ray considerably improves the diagnostic ability for the surgeon in removal of impacted teeth. It clearly shows the position of a nerve which supplies feeling to the lower lip and chin and often lies close to the roots of wisdom teeth. By being able to carefully assess the position of this nerve, we at Oral Surgery Associates are able to plan your surgery to minimise the risk of damage to this nerve.
How will I have my impacted wisdom teeth removed?
We at Oral Surgery Associates, offer two alternative ways of having your impacted wisdom teeth removed:
Intravenous sedation: This is also called "twilight sleep". We offer this treatment at our rooms at Ascot Central. We use a combination of drugs which is given through a small plastic tube in your arm which will make you feel extremely relaxed, comfortable, sleepy and the surgery can be undertaken painlessly. You will generally not remember anything of the procedure although you will be "partially awake". We have special monitors to be able to measure how relaxed you are and can adjust the medication to ensure a very pleasant experience. You and your surgeon will be able to discuss whether this option is suitable for you at the time of your consultation.
General anaesthetic: In this technique, you will be completely asleep. It is always undertaken at a private Day Hospital such as Gillies Hospital or Brightside Hospital. It is always done in conjunction with a specialist anaesthetist. You and your surgeon will be able to discuss whether this option is suitable for you at the time of your consultation.
How does it all work?
Generally speaking, most of our patients are referred by their dentist or doctor to us. However, we do accept direct patient referrals and a number of patients come to us recommended by their friends and family. Dr Luyk or Dr Cathro will meet to discuss with you, your history, medical history and examine you at a consultation before the surgery. We will make an assessment as to what x-rays are required and take these if necessary. If you have any questions we are very happy to answer them at this consultation appointment. We will discuss with you your alternatives and options for treatment and make arrangements for the surgical appointment.
Does it hurt?
At Oral Surgery Associates, we pride ourselves on the techniques that we use to minimise any pain during the procedure and during your postoperative period.
How do I prepare for my surgery?
This depends on whether you are having surgery at our rooms with intravenous sedation or having a general anaesthetic. Please do not take any non-prescribed medication such as Arnica as this can cause bleeding during surgery.
If you are having surgery at our rooms at Ascot Central with intravenous sedation, you should take your preoperative medication at the prescribed time. You must have a responsible adult accompany you and drive you to your appointment. Have nothing to eat for four hours and nothing to drink for two hours prior to your surgery time. The only exception is when you take your preoperative medication, you are allowed a small sip of water. Please wear something warm and comfortable with a loose sleeve so that we can place a blood pressure cuff on top of your arm. You are welcome to bring a CD or i-pod to be played during your surgery. Please take all your usual medications prescribed by a doctor at the usual times unless advised by Dr Luyk or Dr Cathro otherwise. Generally speaking,you will be at our rooms for 45 minutes to 90 minutes, depending on how many impacted wisdom teeth need to be removed and how quickly you recover following your surgery.
If you are having a general anaesthetic, this will be at the hospital and you will need to be present at the time allocated to you by that hospital. Generally speaking you will need to have nothing to eat or drink for six hours prior to the surgery. You are usually at the hospital for 2 to 3 hours in total depending on how long your surgery takes and how quickly you recover.
Removal of impacted wisdom teeth
Removal of impacted wisdom teeth usually requires an incision in the gum tissue to expose the tooth and the surrounding bone. Sometimes, some of the surrounding bone must be removed with a drill and/or the tooth may be divided into segments to assist its removal. Any bone that is removed during the surgery will completely reform. The area from which it has been removed is cleansed and dissolving stitches placed to restore the contour of the gum and to stop bleeding.
After surgery what do I need to do?
After surgery, you must be accompanied home and preferably rest for 2 to 4 hours. You must not drive or operate machinery until the next day. Please use your ice packs as much as possible over the first 48 hours following surgery as these significantly help prevent swelling. Do not rinse your mouth out on the day of surgery as this will cause bleeding. Do not drink alcohol on the day of surgery as this also may cause bleeding. Do not smoke for as long as possible following surgery, as smoking causes and postoperative complications and inhibits wound healing. Generally speaking, you will be able to eat and drink after a couple of hours following surgery. However, take care with hot food and drinks as your lips may still be numb following the surgery. For the next few days, you should eat a fairly soft type of diet to protect the sites of surgery and prevent hurting yourself. For example: eggs (scrambled, poached, omelette), pasta, mashed veges with sauce or gravy, soups, noodles, ice cream, yoghurt, custard, rice puddings, and jellies and milkshakes etc. In the event of bleeding, roll up a guaze swab or clean handkerchief and place it over the wound and apply firm pressure with your fingers or bite firmly for 20 minutes. It is normal to experience slight oozing from the wounds for some hours postoperatively and especially when you eat. There will also be considerable bloodstained saliva during the first day. This should not be mistaken for bleeding. On the day following surgery, rinse three times a day after meals with warm salty water (mix half a teaspoon of salt with a glass of warm water). Use Savacol mouthrinse with half a capful undiluted, night and morning around the mouth for one minute and then split out. Rinsing should continue for one week.
After removal of impacted wisdom teeth what can I expect?
After surgery you can expect some swelling which takes 48 hours to reach its peak. This can be minimised by the use of your ice packs. The swelling generally takes about a week to go down. After the surgery you can expect some pain which is minimised by taking the pain medication as prescribed which you will be given at the time of surgery. The discomfort is often the worst around the fifth or sixth postoperative days. Most people take two days off work, the day of surgery and the following day. Often people return to work following these two days but some people do on occasions take up to a week off.
Are there any possible complications following the removal of impacted wisdom teeth?
As with any operation, there are potential complications which can occur. However, these are all comparatively rare and occur in less than 5% of our patients. Occasionally, there may be bleeding or post-operative infection which may require further treatment. Damage to adjacent teeth and fillings may occur but rarely results in the loss of any additional teeth. Sometimes, a decision is made to leave a small piece of tooth root behind in the jaw when its removal does not justify extensive surgery and may lead to damage to adjacent teeth or structures. There is a small possibility of damage to the nerve that supplies feeling to the lower lip and chin, which lies underneath the roots of the lower wisdom teeth if this nerve is lying very close to the roots. We are able to minimise this risk by taking a Galileos three-dimensional scan to visualize the position of the nerve and the roots. The incidence of damage to this nerve is very low in our hands, involving less than 2% of patients and generally speaking if it is damaged it is bruised and does recover. In very rare instances, damage could be permanent. The nerve that supplies feeling and taste to the side of the tongue is also at risk with the removal of impacted lower wisdom teeth. The incidence of damage to this nerve is less than the 1 in 2000 patients and again is generally just bruised and mostly recovers.
After your operation, you will be given written instructions and advice on home care, which are asked to follow. Provided you follow the instructions and seek advice and should anything seem particularly wrong, you should anticipate a reasonably quick and comfortable recovery.
If you have any questions, please contact us or ask your surgeon when you come in to see him.