Wisdom Teeth & Other Extractions
In the past, people often had teeth extracted due to dental problems. These days, teeth are extracted less frequently because retention of teeth is nearly always better than extraction. However, there are times when extraction is the best treatment option.
Teeth may have to be removed for several reasons:
- Extensive Damage to a Tooth: If a tooth is badly decayed or damaged due to trauma.
- Periodontal Disease: Due to poor dental hygiene and a build-up of plaque and calculus on a tooth, the gums may become inflamed and infected. If not treated promptly, periodontal disease is likely to damage the underlying bone and other tissues around the tooth’s root. The infection may cause the tooth to become loose in its socket. Despite treatment, saving a tooth may not be possible.
- Prevention of Complications: If badly diseased teeth are not extracted promptly, complications such as infection or abscesses in the teeth or roots, or the spread of infection through the blood stream to other parts of the body, may occur. This may affect your general health.
- To Improve Appearance: As part of orthodontic treatment or a treatment plan to improve the appearance of your teeth, your dentist may recommend removing a tooth that is interfering with another.
- Teeth with no Function: A tooth without an opposing partner to grind against during chewing may be better removed.
- Cracks in a Tooth Root: A root may crack or split completely. If repair is not possible, extraction will be necessary.
Removal of a tooth or teeth is only done after careful consideration and discussion with your dentist. Every effort is made to preserve teeth because they function better than artificial teeth such as dentures, bridges and implants. In the attempt to save a tooth, your dentist may suggest a root canal treatment, however, it is not suitable in all situations and is recommended only if successfully treatment is likely.
A missing tooth may cause nearby teeth to move out of their normal position and tilt into the gap. This often makes chewing and biting difficult. It may also cause more decay and gum disease around the tilted teeth as thorough cleaning can become difficult. To prevent neighbouring teeth from moving into the gap, a bridge, denture or dental implant may be necessary.
X-Rays may be taken to help plan the best and safest way to remove teeth. In some cases you may be referred to a specialist due to complications with the extraction, such as the roots of the tooth being too close to the nerves
What are Wisdom Teeth?
Wisdom teeth (also called “third molars”) usually do not push through the gums until people are in their late teens, twenties or even older. Wisdom teeth are usually the last teeth to come through the gums.
Most people have 4 wisdom teeth. Some people have none, and some may have less or more than 4. In many people not enough space is at the rear of jaws for wisdom teeth to come easily through the gums. If the jaw does not have enough space for the tooth to come through, the tooth will become wedged in or “impacted”.
Often one or more wisdom teeth will cause problems and must be removed. Removal of wisdom teeth is a very common procedure and it is usually recommended for them to be removed sooner than later to avoid possible worsening of the situation.
If your removal of your wisdom teeth are likely to be very difficult or complicated to remove, your dentist may refer you to an oral and maxillofacial surgeon.
Should I have my Wisdom Teeth removed?
After examination of your mouth, jaw and any necessary x-rays are taken and studied, your dentist will then be able to discuss the diagnosis with you. Your dentist may recommend the removal or one or more of your wisdom teeth, or other options.
In some cases wisdom teeth never cause any problems, or may stop causing problems once they have punched through the gum line. In the end the decision to have your wisdom teeth removed is always yours.
The recommendation to remove your wisdom teeth early may be made for the following reasons.
There is not enough room for the tooth to push through the gum line
The tooth has started to cause trouble. It should be removed soon so that pain, infection or other problems to not occur or worsen.
It is best to have troublesome wisdom teeth removed when young, as the root of the Wisdom tooth may not have formed totally and the bone surrounding the tooth is softer. This will allow for easier removal and less risk of damage to nerves, bone or teeth.
What is the procedure of a Tooth Extraction?
The method of extraction will vary depending on the type of tooth, its roots and its position in the jaw. Some teeth are relatively easy to remove, while others can be difficult due to:
- Extensive decay and/or large restorations in the tooth
- Adjacent teeth having crows or large restorations.
- The tooth is in an abnormal position that affects neighbouring teeth
- An unerupted or impacted tooth or a tooth that is fused to the jaw bone
- A nerve lying near the tooth to be extracted
- Roots that are large and curved, or that penetrate deeply into the jaw bone
In difficult cases involving molars or premolars, the tooth may need to be divided into segments and removed separately in the same appointment.
Do I need to be sedated?
Sedation is not often necessary for any extraction, including Wisdom Tooth extractions. However should it be recommended, necessary or you decide that is how you would like it done, then a referral to a specialist may be required that has access to an anaesthetist to provide with general anaesthesia.
Otherwise we offer, as with all our treatment, local anaesthesia. A local anaesthetic is injected into the gum to numb the area around the tooth or teeth to be extracted. We recommend that the patient has something to eat before having an extraction (unless they are going under general anaesthetics).
What are the complications of a Tooth Extraction?
Possible complications can be reduced if the following is observed:
- Rest at home after the extraction
- Depending on the number of teeth removed, you may need to take time off work, school or other duties.
- Avoid drinks that contain alcohol if you are taking pain killers or antibiotics.
- Eat soft foods such as soups (but not too hot), blended (pureed) vegetables and meat and jellies for the first two days)
- Drink a lot of fluids
- Use ice packs to reduce any swelling and pain.
- If you have had any form of sedation, do not drive a car or ride a motorcycle or bicycle, operate machinery or engage in active exercise for the rest of the day, and possibly the following day.
All types of surgery are associated with some risk. Despite the highest standards of practice complications can occur. It is not usual for your dentist to dwell at length on every possible side effect or rare but serious complications of any dental procedure. Information is issued that covers this or available here for you to have enough information to weigh up the benefits and risks of extraction. Most patients will not have complications, but if you are concerned, then make sure to discuss these concerns with your dentist.
Complications can include:
- Bleeding: Although uncommon, haemorrhage may occur. It can normally be stopped by putting a gauze pack over the wound and applying pressure by biting gently on the gauze for 15 minutes. If this does not stop the bleeding then please contact your dentist at once.
- Dry Socket: This occurs if the blood clot that normally forms in the socket is washed away or dissolves, exposing the bone underneath. The blood clot is important for proper healing and relief of pain. A dry socket causes constant throbbing pain which may last for some days. To help prevent a dry socket:
- Do not rinse out your mouth or spit with force for the first 24 hours after surgery.
- Do not brush your teeth around the area of the surgery for the first 24 hours, then gently after the first 24 hours.
- Do not smoke for two weeks after surgery, as it impairs the healing process.
- After the first day, you can rinse your mouth with warm salt water, or mouth wash if supplied. Rinse every four hours or more often if needed. This will help with reducing the swelling, pain, and the risk of infection.
- Infection: An infection in the gum or bone may occur after the extraction. If you develop a fever, bleeding or increasing pain, then infection may be the cause. Contact your dentist immediately.
- Sinus Problems: The roots of some upper teeth may be close to the sinuses. Sometimes, a sinus may be opened when a tooth is removed. The opening will usually heal quickly. However, if infection sets in or other problems start, more treatment may be necessary.
- Numbness or altered sensation: if a nearby nerve is bruised or damaged during the extraction, numbness, tingling and a loss of feeling in the teeth, gums, cheeks, lips, chin and tongue may occur. This effect will usually disappear over a few weeks as the nerve recovers. In some people, complete healing may take 6-18 months. In rare cases where the nerve may not heal completely, numbness or altered sensation may be permanent, and chronic pain of discomfort is possible.
- Damage to a nearby tooth or fillings: Although rare, the tooth or fillings next to the tooth to be removed may be chipped or loosened during an extraction.
- Thinning of the jaw bone: bone at the base of the extracted tooth is likely to thin a little overtime. Thinning and fragility of jaw bone can become significant if many teeth are missing. To reduce thinning, jaw bone needs to have the pressures of daily chewing exerted on it. Your dentist may recommend dental implants or dentures to help prevent thinning.
In most cases your dentist will recommend you to come back for a review (and possibly a removal of stitches if they were used) within a few days of treatment. This is of no cost to you and is to make sure the socket is healing well after surgery.