Wisdom Teeth
 
Both minor and major oral surgical procedures may be undertaken within the Dental and Implantology Unit or operating theatres. Minor and intermediate procedures such as wisdom tooth surgery, implants, bone grafting, etc. may be performed under local anaesthesia with or without intravenous sedation. Major procedures are carried out under general anaesthesia within the operating suite.
 
Wisdom Teeth
 
One of the most common oral surgical procedures carried out is wisdom tooth extraction. Wisdom teeth, also known as third molars, normally erupt into the mouth between the ages of 17 and 25. Unfortunately, wisdom teeth become impacted either due to lack of space for the teeth or because the developing wisdom tooth has an abnormal position to allow normal eruption.
 
There are various forms of wisdom tooth impaction; the tooth could be deeply impacted, that is, totally covered by bone and gum or partially erupted, that is, part of the crown of the wisdom tooth visible in the mouth. The crown of the impacted wisdom tooth may be facing forward, upwards or backwards. The roots of the wisdom teeth continue to develop despite its failure to erupt into the mouth and occasionally may become closely associated with a nerve that runs within the lower jaw. This nerve supplies the lower teeth and lower lip with sensation on that side of the jaw.
 
Impacted wisdom teeth do not always cause problems and many people retain them without developing any significant symptoms. However, a good percentage of people are troubled by impacted wisdom teeth as follows:
  • Infection around the wisdom tooth (pericoronitis). This is caused by food trapping, difficulty to keep the tooth free of plaque and trauma to the inflamed gums by the opposing tooth.
  • Caries or tooth decay in the wisdom tooth or adjacent molar tooth. Due to food trapping or difficulty cleaning the area, plaque may cause tooth decay in either of the mentioned teeth resulting in pain.
  • Cysts. As the teeth develop within a sac (known as a follicle), an impacted wisdom tooth may develop a cyst around it.
Nowadays, we do not believe that impacted wisdom teeth cause crowding (twisting) of the anterior teeth. This process will happen in many people whether wisdom teeth are present or not. It is known as ‘mesial drift’.
 
Reasons to remove Wisdom Teeth include:
  • Infection
  • Caries/Tooth Decay
  • Cysts
  • Chronic food trapping which will lead to infection /caries.
  • Occasionally prior to orthodontic treatment.
  • Prior to other operations such as an osteotomy (an operation to shorten or lengthen the jaw).
Surgery to remove wisdom teeth

Once it has been decided that the wisdom tooth / teeth need to be removed, an X-ray is required to assess the wisdom tooth anatomy, position and relationship to other structures within the jaw. The surgical procedure normally involves reflecting the gum away from the wisdom tooth site, removing some bone and / or splitting the wisdom tooth to allow the tooth to be fully removed and finally suturing the gums back in place again.
 
This treatment may be performed under local anaesthesia, intravenous sedation or general anaesthesia. The surgeon will prescribe post-operative pain killers and may or may not prescribe antibiotics.
 
Once the operation has been performed, recovery varies between one patient and the next. The post-operative symptoms would depend upon the severity of the impaction, the number of teeth removed and patient’s tolerance to discomfort. It is normal to have swelling, which may last from a few days to a week, discomfort, difficulty opening and closing the mouth and bruising. There is a tiny chance that the nerve below the lower wisdom tooth may be traumatised, resulting in transient numbness of the lower lip on the same side and extremely rarely, permanent numbness. The risk of this actually happening is assessed pre-operatively by means of an X-ray and must be discussed with you.
 
Advice to patients following wisdom teeth extraction
  • You are advised to go home and rest.
  • Take any medications prescribed.
  • Thorough attention to MOUTH care is vital to prevent post-operative infection. As from the day after surgery you may regularly use lukewarm salt-water mouthwashes to clean your mouth. It is advisable to purchase a soft toothbrush to clean the gum areas gently. Vigorous brushing will cause trauma and bleeding.
  • In the first 12 – 24 hours, post-operatively you should avoid hot drinks because they can trigger off bleeding from gums.
  • If you experience bleeding from your gums you should take wet tissue/gauze, place it in your mouth and bite very hard on it for 20 minutes. If bleeding continues you should contact your Dental Surgeon.
  • You may experience swelling around your mouth, this will subside after a few days.
  • If you have had general anaesthetic or intravenous sedation you MUST not drive or operate machinery for 24 hours, as your responses will be impaired, even if you feel back to normal.
 
 
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