Wisdom teeth extraction

Wisdom teeth extraction

When teeth are extracted during the teens or early twenties, the conditions are more favourable for healing and there are generally fewer complications. For these reasons, it is often better to make an assessment of the situation and take action at this time.

Understanding wisdom teeth

The development of our permanent dentition (28 of 32 potential teeth) is completed at the age of 14 or 15.  The eruption of our 4 wisdom teeth occurs more slowly and sometimes these teeth never break through the gum tissue. Their root formation is completed on average at the age of 21. Positioned at the very back of the dental arches, these third molars (commonly referred to as wisdom teeth) require attention and particular treatments.

Why is it necessary to remove wisdom teeth?

From a historical point of view, there are different theories explaining why wisdom teeth are causing us problems:

  • Some agree that, due to human evolution, the bones of the jaw are now shorter than in the past;
  • Others believe that changes in the way we use our teeth and further improvement of our dental health help us keeping our teeth longer than before and that we therefore lack space for wisdom teeth.

The location of the wisdom teeth and the current form of our jaws leave very little space available for these teeth to erupt properly.

Is lack of space really a problem?

Is it really necessary that these teeth “come out” whether naturally or by extraction? Following the evaluation by your dentist, it is possible that he or she will recommend that you keep your wisdom teeth if their position does not seem problematic.  However, this recommendation is conditional to regular monitoring and a perfect dental hygiene.  Depending on the potential risk to keep your wisdom teeth, regular dental check-ups are important and a surgical procedure might be needed.

Wisdom teeth can cause many problems

Wisdom teeth, by their position, can cause ailments such as infections and cysts.

A tooth that grows toward the roots of the adjacent tooth will cause pressure, possibly an abscess and the deterioration or even the loss of the tooth nearby, while remaining buried in the jaw. These teeth that do not fully erupt are called impacted teeth.  They represent an insidious potential for damage and pain since nothing is visible to the naked eye.

An impacted tooth that hinders and pushes the second molars

Over the years, an impacted tooth may push and obstruct the second molars.  The displacement of this tooth is possible even after the end of the root formation and this could be promoted by the loss of another tooth, among other things. It is even possible, although less likely, that people over 40 can suddenly feel pain and suffer complications due to their wisdom teeth.

The long eruptive phase of the wisdom teeth (from the age of 14 to 22) can cause various unpleasant symptoms: sharp pains, headaches, pain in the throat, gum inflammation and swelling.

A wisdom tooth that erupts through the surface of the gums can also cause problems

A wisdom tooth that manages to erupt through the gums can also be problematic if it fails to erupt completely. When a wisdom tooth partially emerges and only part of the crown is visible above the gum line, we say that it is partially impacted or partially erupted. This situation creates an ideal trap for food debris and promotes dental decay. Even with strict hygiene measures, infections may develop on these sites and cause discomfort and ailments which are detrimental to your health.

Panoramic x-rays

Wisdom teeth assessment starts with a dental examination using a panoramic x-ray (that allows to see the entire jaws). With that information, the dentist will be able to know if wisdom teeth are present and what is their current position in order to anticipate potential problems.

The device used for x-rays

The device used for taking panoramic x-rays is different from that for routine x-rays.  Indeed, in order to be able to get an image of the entire mouth (including the joints and the position of your teeth), the x-ray apparatus will move around your head (it will be mobile) and will be oriented on your cheek or the front of your mouth.

Regular inspection of the radiology equipment

Rest assured, x-ray devices are rigorously and regularly inspected.  Although the dose of x-ray is calibrated to minimize the risk of radiation exposure, the number of radiographs should be limited for a given period of time.  Thus, a dentist may often agree to lend or duplicate a panoramic radiograph to avoid additional exposure. Nowadays, some dental clinics can be equipped with a digital radiology device, but the procedure for taking x-rays will be very similar.

When to consult a specialist

Depending on your situation, your dentist might decide to perform the surgery or refer you to a specialist: the maxillofacial surgeon.  After obtaining his degree in dentistry, this professional pursued a specialization during four additional years in order to learn how to perform complex surgical procedures of the mouth and face.  Therefore, the complexity of the intervention (which depends on the position of your teeth, the proximity of the lower nerve and the shape of the roots) or simply your dentist’s practice may influence the decision whether or not to perform the surgery.

Whatever the reason, if your dentist chooses to refer you to a maxillofacial surgeon, the cost of the intervention will have to be discussed with that specialist who will also require an assessment to make his own diagnosis and to decide on the procedures to be followed.  When possible, the lending or the electronic transfer of the panoramic radiograph taken by your dentist may reduce the costs of the examination with the specialist as well as your exposure to x-rays.

Preliminary examination for wisdom teeth removal

This assessment can be done during your follow-up exam, but often, a separate appointment is necessary to provide you with explanations about the procedure and its cost.

The dentist will examine the position of your third molars, their formation as well as your joints and your jaw.  He or she will also be able to detect the presence of cysts using a panoramic radiograph.  After studying your case, it is possible that the dentist would recommend the removal of your wisdom teeth.

Since wisdom teeth are rarely in proper position and completely erupted, simple extraction of these four teeth is unlikely and they will possibly require a surgery.

During the evaluation, the maxillofacial surgeon or your dentist will:

  • ask you about your overall health;
  • give you a written estimate of costs;
  • explain the procedure, risks and duration of the surgery;
  • evaluate your anxiety level.

A cost estimate for insurance reimbursement

A written estimate of the interventions and their costs will be given to you so that you can send it to your insurer to obtain a predetermination of benefits. This predetermination is often necessary and therefore strongly recommended because it will facilitate the reimbursement of your benefits according to your dental coverage.

Sending the documentation to your insurance company

Some clinics contact directly your insurer and inform you of the decisions while others leave that step to you.  If this is the case, do not delay in sending the documentation to your insurer because it can take a few weeks until they inform you of the amount that you have to pay for your surgery.

How long is the procedure for wisdom teeth extraction?

Logically, the duration of the surgery will be influenced by the number and type of extractions. If you require two simple extractions and two semi-impacted ones, the time needed for surgery will not be the same as for four impacted teeth.

When is the best time for the surgery?

Ideally, this type of surgery should take place early in the week because the surgeon will be available in the following days if complications arise. In addition, your surgeon will give you the contact information of a resource person you can get in touch with at any time during this period.

Post-surgical treatments such as examination costs, appointments related with complications and post-operative follow-up are included in the cost of your surgery if they are provided by the attending surgeon.

The recovery time is normally from 3 to 7 days, depending on the case.

What happens before and during the surgery?

The day of surgery

  • If your surgery is done under general anesthesia or intravenous sedation, your surgeon will instruct you to follow a certain diet prior to the surgery.
  • If the intervention is done under local anesthesia at your clinic, make sure you avoid eating too much or eating acidic products. Only eat a light meal a few hours before the surgery. You will reduce the risk of nausea and/or vomiting associated with stress and anesthesia.
  • If possible, dress comfortably for the surgery in order to enjoy a good period of rest or relaxation upon your return.
  • Arrange for someone to accompany you and drive you home after the procedure. Ideally, you will give the contact information of that support person to the receptionist who will communicate with him or her when the surgery is over.
  • Have also on hand your insurance forms and your prescriptions or medications.

During surgery

Whether the procedure takes place at your dental clinic or with the maxillofacial surgeon, these four steps will be the same. Only the type of anaesthesia will be different.

Step 1: Anesthesia

Assisted by his staff, the surgeon will first proceed to the anesthesia. Don’t worry, it will be effective before the start of the surgery. Even if the surgery is scheduled for four wisdom teeth, the surgeon will begin working on one site at the time, generally the first two teeth located on the same side of the mouth (top and bottom) for a question of efficiency and duration of anesthesia.

Step 2: Incision of the tissue surrounding the tooth

Depending on the tissue that surrounds or cover the tooth, the dentist will begin by excising (cutting) the gum to reach the bone. Using various instruments including a dental drill, the dentist will remove a little amount of bone surrounding the tooth in order to extract the tooth gently.  To make the extraction easier, the tooth may be crushed to small pieces. During this surgery, the dentist will also use some instruments (elevators) to free the tooth from the ligaments connecting it to the surrounding tissue.

Being under the effect of anesthesia, you won’t feel any pain during the surgery, the sound is essentially the biggest inconvenience you’ll be facing (the sound of the equipment but also the internal sound during the removal of the tooth).

Step 3: Cleaning the tooth socket

Throughout the surgery, the assistant will keep the dental alveolus (socket in which the roots of the teeth were embedded) free of blood and other material obstructing it. The surgeon will eliminate any apparent rough edges to avoid any discomfort after healing.  Over time, the tooth socket will regenerate with bone, but during the procedure, the surgeon will limit the bleeding by applying pressure with a gauze.

Step 4: Closing the tooth socket

Once the tooth is removed, the extraction site will be well disinfected to limit the risk of complications.  A blood clot will form to promote a good healing.  Stitches will be required to maintain the integrity of the gum during recovery.  Dissolvable stitches will disappear by themselves after approximately two weeks, while other types of stitches may be removed during the postoperative follow-up examination or during a subsequent appointment.

Jaw joint pain

Since you have maintained your mouth wide open over a long period of time, your jaw joint may seem sensitive and you can even have difficulty opening your mouth.  This sensitivity should dissipate over time and by taking the prescribed medication.  If however you are unable to open the mouth or if intolerable pain occurs when you try to move your jaws, contact your clinic.

Complications

Even if most wisdom tooth extractions do not result in some complications, some problems could occur.

Here are the most common:

Dry socket

Dry socket (exposure of bone when a blood clot is dislodged or did not form in the extracted tooth socket) can slow down the healing of the extraction site and cause pain. A few months after the extraction of a wisdom tooth, bone will regenerate and fill the hole left in the jaw bone. But shortly after the intervention, the body will first form a blood clot which will cover the extracted tooth socket and form a protective barrier. If the blood clot is lost, the bone will be exposed and this will cause a sharp pain radiating toward the ear. If you feel this kind of pain, contact the surgeon so that he can clean the tooth socket and make sure it is covered. To avoid dislodging the blood clot, do not drink through a straw, spit or smoke during the first 24 hours.

Paraesthesia (nerve injury)

The roots of wisdom teeth are sometimes located very close to a nerve. Their extraction therefore has the potential to touch and damage this nerve. The surgeon will evaluate this risk using panoramic x-rays.

If the nerve is affected, partial or total paralysis of the lower lip or tongue may result. In most cases, this loss of sensitivity will be temporary, but for a few, it may be permanent.

Bleeding

It is normal to experience blood-tinged saliva during the first 24 hours following surgery. On the other hand, if bleeding is most abundant, stop it by biting 30 minutes on a gauze or cotton that you place on the extraction site. Repeat until the gauze shows almost no more traces of blood. Your surgeon possibly gave you sterile gauzes for this purpose. Otherwise, applying a moistened tea bag may also be suitable. If after a few attempts the bleeding does not decrease, don’t delay in contacting your surgeon.

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