Wisdom Teeth Removal: Description, Procedure, Risks, and Recovery

What are wisdom teeth?

The wisdom teeth are the third set of molars to emerge from the mouth. These teeth generally erupt between the ages of 17 and 21 years.

Tooth Removal

Tooth Removal

Sometimes, because of a lack of space, an obstruction, or an improper position, wisdom teeth may become impacted. 

The National Institutes of Health Consensus Development Conference in 1979 settled on a variety of indications for extracting impacted third molars, including infection, nonrestorable carious lesions, cysts, tumors, and destruction of adjacent teeth and bone.

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How can I know if I have third molars?

Your dentist can check your mouth and verify that you have your third molars in each quadrant. However, third molars can be found below soft or hard tissues and require an x-ray to check their presence.

Moreover, the radiographic provides all of the details needed to schedule and prepare the surgical removal of third molars. These details are the position, size, and shape of the third tooth, the depth in bone, and the relation between the tooth and other anatomical structures.

Why is it necessary to extract wisdom teeth?

The most common reasons for wisdom teeth extraction are a lack of space in the arch and pain. However, there are many other conditions for their extraction that are related to pathologies, such as:

    • Pericoronitis: This is a severe inflammation of the soft tissues around the partially impacted tooth. It manifests as intense pain in the affected tooth’s region, radiating to the jaw, temporomandibular joint, and posterior submandibular region. 
    • Cysts and tumors associated with the tooth: While odontogenic cysts and tumors are uncommon in patients with impacted third molars, they can appear.
    • Production of caries: Caries may develop on the posterior surface of the second molar as well as on the crown of the impacted tooth due to food particle entrapment and poor hygiene caused by the presence of the semi-impacted tooth.
    • Root resorption: Some studies have shown that leaving the third molar in place will induce resorption of the adjacent second molar’s posterior root.
    • Initiating or exacerbating orthodontic issues.

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What is Appropriate Timing for Removal of Impacted Teeth?

The removal of wisdom teeth is determined by three factors: the patient’s age, the formation of the root, and the position of the tooth.

The best time to do so is while the patient is young, preventing the potential risks and undesirable situations that may worsen over time. Furthermore, as compared to older patients, younger patients cope well with the overall surgical treatment and stress, and they have fewer complications and quicker post-surgical wound healing. 

Regarding root formation, the optimal moment to extract wisdom teeth is when one-third of the root has formed.

How is wisdom teeth extraction performed?

Your dentist may elect to extract your wisdom teeth or refer you to a specialist surgeon. 

The extraction procedure may differ based on the third molar’s position, size, and depth in the bone, as well as its connection to other structures.

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  • Your dentist or surgeon administers anesthesia which could be:
    • Local anesthesia: Local anesthesia is administered through one or more injections at the site of each extraction. 
    • Sedation anesthesia: An intravenous (IV) tube in your arm is used to administer sedation anesthesia. During the treatment, you will be unconscious due to the use of sedation anesthesia. In addition to sedation, local anesthesia is administered.
  • An incision is made in the gum tissue to expose the tooth and bone. However, there is no need to make an incision if the teeth have fully erupted and are out of the gum line.
  • If there is bone totally or partially covering the tooth, it is removed.
  • Wisdom teeth could be extracted whole or in fragments, depending on the location and how simple the extraction process is.
  • Extraction of the tooth
  • Some residue from the tooth or bone is removed from the extraction site.
  • The suture is used to seal the wound to promote healing, but this isn’t necessarily a requirement.
  • Gauze is placed over the extraction site to control bleeding and facilitate the formation of a blood clot.

What are the potential risks and complications of wisdom teeth extraction?

Wisdom tooth extraction, like every other form of procedure, has certain complications. 

Complications are classified as intraoperative (occurring during the procedure) or postoperative (occurring after the procedure).

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Intraoperative complications are: 

  • Nerve or blood vessel damage or injury.
  • Oroantral communication means communication between the maxillary sinus and the oral cavity.
  • Injury to adjacent teeth.
  • Hemorrhage. 
  • Mandibular fracture.

Postoperative complications are:

  • Dry socket 
  • Bleeding
  • Infection 
  • Pain, swelling, and stiffness in the jaw
  • Difficulty opening the mouth (trismus)
  • Unpleasant taste and odor in the mouth

What should I do after my wisdom teeth extractions?

Apply an ice pack on the side of your face in the surgery area to reduce swelling. Additionally, eat soft food and take your medicines as prescribed by your dentist.

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On the other hand, for the first days after your wisdom teeth extraction, you should avoid:

  • Drinking or eating hot meals
  • Spicy food
  • Drink with a straw
  • Smoking
  • Exercise
  • Mouthwashes
  • Spit
  • Touch the socket or surgical area
  • Chew on your cheeks or your tongue

When should you contact your dentist or surgeon?

If you see any of the following signs or symptoms, which might signal an infection, nerve damage, or other significant problem, contact your dentist or oral surgeon right away:

  • Excessive bleeding.
  • Numbness or a loss of sensation that persists.
  • Fever.
  • Pain that is unbearable despite the use of prescribed pain relievers.
  • Swelling that becomes worse after a few days.
  • Pus in the socket or exude from it.
  • Nasal discharge with blood or pus.

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References

Impacted Mandibular Third Molars: Review of Literature and a Proposal of a Combined Clinical and Radiological Classification. https://pubmed.ncbi.nlm.nih.gov/26229709/

Wisdom tooth removal. (2021). Retrieved 25 May 2021, from https://www.nhs.uk/conditions/wisdom-tooth-removal/

 

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