Most people have four wisdom teeth, two in the upper jaw and two in the lower jaw, it is not uncommon for these teeth to become "impacted." An impacted tooth is one which is in an abnormal position, it may have grown through the gum or it may have grown only part way through.
Because wisdom teeth come through at the back of the mouth, and often become stuck, they can cause a number of problems and therefore it is recommended that they are removed. around the gum overlying the tooth. This can be extremely painful and on rare occasions can cause serious infections. Because the wisdom teeth are difficult to clean at the back of the mouth and particularly when they are only part way through, they often get decayed or cause decay in the tooth in front when they are leaning against it.
Impacted wisdom teeth are also one of causes and contributing factors to crowding of the front teeth, especially in the lower jaw. They result in an area of weakness, which may lead to a broken jaw following a blow to the face during contact sport or a fall. If the tooth fails to come all the way through the gum, a fluid sack called a cyst may form and by gradual enlargement endanger the health of the nearby bone and teeth.
Recently, it has been shown that partly erupted wisdom teeth in older patients can lead to a variety of medical problems and there are concerns that they may contribute to heart disease, diabetes and other systemic conditions. These problems can be prevented by the surgical removal of the teeth.
Oral Surgeons are specialists. They have special training and expertise in the surgery of the mouth, face and jaws including the removal of the teeth. A minimum of five years of specialist training is required to become an oral surgeon. They also have specialist training in sedation techniques and working under general anaesthetic.
General anaesthetic is where a patient in completely asleep. The whole body is asleep. This must be performed at a proper day hospital with an anaesthetist. A number of procedures and surgeries can be performed with local anaesthetic and intravenous sedation. The intravenous sedation (injection in the arm) completely relaxes the patient and is often called "twilight sleep." Most often patients do not remember the surgery and think they were asleep. Local anaesthetic is where only the area to be operated on (the teeth and gums) is put asleep and patient remains awake. This is usually an injection into the gums.
There is always a hole in the bone when the tooth is removed. Often a blood clot forms and the hole is not completely obvious. The hole is slowly filled in from the bottom and completely disappears. This usually takes about eight weeks. Sometimes food can get stuck in a hole and if necessary you will be given a syringe which you fill with water and squirt the area to dislodge the food.
Dissolving sutures can last from three to four days to three to four weeks depending on which stitches are used and which type of operation you have had.
Oral and Maxillofacial Surgeons have extensive training in all aspects of surgery of the mouth, face, and jaws. They have passed rigorous assessment examinations to ensure that they have the necessary knowledge, skills and expertise to undertake your surgery as safely and effectively as possible.
This minimises the risks of complications. They routinely undertake the types of surgery that are listed on this website and you have been referred for. This routine nature of the procedures ensures a higher level of skill.
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.
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 Cathro, Dr Harrison, or Dr Lewis 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.
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.
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 Cathro, Dr Harrison, or Dr Lewis 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 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, 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 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.
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.