The emergence of wisdom tooth normally occurs between 18 to 24 years of age. The prevalence for at least one impacted (which the path of eruption of the tooth is blocked by another tooth or bone which therefore prevents it from assuming a normal position in the mouth) lower wisdom tooth is 72.7% in an age of 20 to 30 years. An impacted tooth is not a disease in itself but is considered an abnormal state.
However, not all impacted wisdom teeth need to be removed. Surgical removal of wisdom tooth in absence of wisdom teeth pain or any other signs and symptoms is not usually indicated. However it should be monitored from time to time by clinical examination and x-rays. Decisions about surgery vary widely.
When to have wisdom teeth extraction
- Recurrent pericoronitis (inflammation of the gums partially covering the tooth)
- Unrestorable tooth decay in the wisdom tooth or its neighbor that cannot be restored
- To facilitate placement of orthodontic appliance or prosthesis
- In presence of pus or severe pain
- Eating away (resorption) of the tooth or adjacent teeth
- Broken wisdom tooth
- Related to a cyst or tumor
- Tooth/teeth preventing jaw reconstruction surgery
- Satisfactory tooth for use as donor for transplantation
Guide to wisdom teeth removal
- Before wisdom teeth removal is done, the tooth is assessed through x-ray(s) or radiograph(s). A simple impacted wisdom tooth can be removed by a dentist or dental surgeon but should the wisdom tooth removal be complicated due to certain factors, the procedure is usually referred to an oral maxillofacial surgeon.
- A consent form will be given and you will be required to sign it before the surgical procedure is performed. If you have any doubts, ask your dental surgeon before placing your signature.
- You will be asked to rinse your mouth with an antibacterial mouthwash to reduce the amount of bacteria in the mouth.
- Anesthesia is given. Ensure that you inform the dental surgeon of any medical conditions you have to avoid any complications later. You can opt for local (loss of bodily sensation without loss of consciousness) or general (loss of bodily sensation loss of consciousness) anesthesiathough the latter is normally given when more than one wisdom tooth is to be removed.
- The gum flap surrounding or over the wisdom tooth is opened up or elevated to expose the tooth.
- Bone around the impacted tooth especially on the sides and the back of the tooth is guttered using a round bur.
- According to the type of impaction the tooth is taken out with or without splitting the tooth.
- Tooth is removed or elevated from the tooth socket using elevators.
- The leftover socket is cleaned and washed.
- The gum flap is stitched back or sutured using a non-dissolving thread. An appointment is scheduled a week later to observe healing and remove the stitches.
Factors that can cause the wisdom tooth surgery to be more difficult
- The position of the tooth facing backwards towards the jaw
- The tooth is totally embedded in the jaw bone
- Long thin roots
- Widely curved roots
- Close to the nerve running in the lower jaw
Possible complications from wisdom tooth extraction
- Swelling and pain after wisdom tooth extraction
- Bleeding after surgery
- Tearing of the gums
- Damage to nerves around the region leading to temporary or permanent loss of sensation at the concerned region of the face
- Damage to the neighboring teeth
- Damage to the gum tissues
- Fracture of jaw bone due to excessive force
- Sores at the angle of the mouth and cheek
- Dry socket
What to do after wisdom tooth removal and during wisdom teeth recovery
- Bite on a gauze pack as instructed by your dental surgeon for about 30 minutes. If bleeding still persists, replace the gauze pack and repeat process till bleeding stops. Avoid talking during the process.
- Take rest and avoid physical activities.
- Stop smoking as it can delay healing.
- If pain is felt, take painkillers as prescribed by your dental surgeon.
- Ensure that you finish the antibiotics prescribed to you.
- Avoid eating till the numbness of the anesthesia has faded away.
- Avoid hot or spicy food as it can result in bleeding. In addition, soft diet is advised.
- An ice pack may help reduce inflammation and swelling.
- Avoid brushing the involved area on the day of surgery. After 24 hours rinse mouth with warm saline solution to keep wound clean. Resume normal oral hygiene routine two days after surgery.
- Avoid biting the lips or cheek when numbness persists.