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The definitive wisdom
tooth FAQ page
Wisdom teeth are a pain.
Most of us don’t have room for them and end up having them removed.
The long and the short of it is, "If you have impacted wisdom
teeth, you should have them removed, and the sooner you do this, the
better."
We can help you determine
whether or not you should be worried about your wisdom teeth, what
treatment might be required in your individual circumstances, and what
the costs might be.
Chances are, we will be
able to carry out any necessary procedure in our pleasant, comfortable
offices at a time that suits you. With the benefits of a little sedation
and some local anaesthetic, you will find the experience a lot less
dramatic than your ‘friends’ would have you believe.
If you really want to
know more, you should find the answers to your questions below.
Q. What are wisdom
teeth?
A. Wisdom teeth (also
known as third molars) are teeth that usually appear at the very back of
the mouth between the ages of 18 and 25 years. They are the last of the
adult permanent teeth to develop.
Q. Are all wisdom
teeth problematical?
A. No. If wisdom teeth
come fully through, they can be useful teeth. If they are kept healthy
by careful cleaning, they will last a lifetime.
Q. What are
‘impacted’ wisdom teeth?
A. Because they are the
last teeth develop, there is usually not enough room for wisdom teeth,
so they only come through part-way or not at all. These cases are called
‘impacted’ wisdom teeth.
Q. Why are impacted
wisdom teeth a problem?
A. There are a number of
reasons:
-
Decay. Wisdom teeth
can be very difficult to clean, and therefore often get decayed. It
is usually not possible to repair such teeth – simply because they
are so inaccessible.
-
Infection. Impacted
wisdom teeth very often have a flap of gum over the back. This area
is always chronically infected and will undergo occasional acute
flare-ups. When there is an acute flare-up, the gum around the tooth
can get quite swollen and tender. There is often a discharge of pus
from such areas, and a foul taste or odour. Swelling can spread to
the cheek and to the area and glands under the jaw. Before the days
of antibiotics, infections in this area were considered
life-threatening, because of the risk of airway obstruction.
-
Damage to
neighbouring teeth. Another common way that impacted wisdom teeth
can be a problem is the risk they pose to adjacent teeth. It is
common for an impacted lower wisdom tooth to affect the second molar
immediately in front. Impacted wisdom teeth can rapidly damage this
second molar too, and result in the loss of the second molar tooth
in addition to the wisdom tooth.
-
Tooth crowding. Some
authorities believe third molars can also affect the teeth further
forward, and some orthodontists ask that third molars be removed to
reduce the risk of unwanted tooth movement or crowding.
-
Cysts. Impacted third
molars can form cysts, and this can produce significant deformity
and require extensive surgery.
-
Tumours. Tumour
formation around impacted third molars is uncommon, but does occur.
Some of these tumours are very nasty (malignant).
-
Jaw fracture.
Individuals who play contact sports have a greater risk of jaw
fracture if they have impacted wisdom teeth.
Q. Do I need to have
my impacted wisdom teeth removed?
A. It depends. If you are
25 years old or younger and have impacted wisdom teeth, you are almost
certainly better off having them removed. If you are over thirty, the
situation is a little more complicated. For ‘over-thirtys’, if the
wisdom teeth are completely covered with bone on an X-ray, they can
probably be left (such teeth should be periodically reviewed by your
dentist). If the wisdom teeth are partially through into the mouth,
however, they should probably removed in most cases. As with any
surgical procedure, a risk analysis should be undertaken by an
experienced dental or oral surgeon, to determine the risks profile of
surgery as opposed to the risk profile of leaving the teeth in place.
This will require a clinical examination, history taking and a special
X-ray.
Q. Why should I have
my impacted wisdom teeth removed if they have not given any trouble?
A. Impacted wisdom teeth
are almost certain to cause problems if left in place. This is
particularly true of the lower wisdom teeth. Such problems can occur
suddenly, and often at the most inconvenient times.
Q. When should I have
my impacted wisdom teeth removed?
A. Immediately after any
acute infection has been controlled. It is now recommended by most
specialists that impacted wisdom teeth should be removed between the
ages of 14 and 25 years, whether they are causing problems or not.
Surgery is technically easier and patients recover much more quickly
when they are younger. What is a relatively minor operation at 20 years
of age can become quiet difficult in patients over 40. Also, the risk of
complications increases with age, and the healing process is slower.
As a rule, removal of
wisdom teeth is regarded as an elective procedure, but should be carried
out at the earliest convenient time. Don’t wait until you have pain,
swelling or infection.
Athletes who have
impacted wisdom teeth should have their surgery carried out in the
‘off-season’, if possible.
Q. How are wisdom
teeth removed?
A. There are three
options here:
-
Local anaesthesia
alone. This is just like when a dentist numbs your mouth for a
filling. This technique is adequate for single tooth extractions
where the surgical difficulty is assessed as routine.
-
Intravenous sedation
and local anaesthesia. With this technique, a sedative agent is
administered intravenously (by injection into a vein in your arm or
the back of your hand). Local anaesthesia always follows. The
advantages of this technique are that it makes you feel very
relaxed, time passes quickly and you experience no pain. Although
you are actually awake throughout the procedure, you will have
little or no memory of the procedure afterwards. Intravenous
sedation does not carry the risks associated with general
anaesthesia and is the best option for the removal of most wisdom
teeth.
-
General anaesthesia.
This is where an anaesthetist administers a full (general)
anaesthetic, so that you are completely ‘asleep’ throughout the
procedure. This option is only available at facilities such as
public and private hospitals and other places where fully equipped
operating theatre facilities are present. This option is the most
appropriate for complicated procedures or where there are specific
risk factors which are better managed under general anaesthesia.
Q. If my wisdom teeth
need to be removed, who will do it?
A. Straightforward
removal of wisdom teeth may be done by your regular dentist. More
complex extractions will often require referral by your dentist for
treatment. We receive referrals from a large number of dentists for
wisdom tooth surgery on a regular basis. Dr
Khouri is very experienced at the surgical management of impacted
wisdom teeth, and he is certified to administer intravenous sedation. It
is very likely that he will be able to help you.
If your are assessed as
requiring a general anaesthetic, we can assist you to find a surgeon and
facility that will be able to help you.
Q. How does it all
work?
A. Make an appointment
for a consultation with your dentist or call our office. If your dentist
is not prepared to undertake treatment, they will refer you to someone
else.
If you are referred to us
(or come to us on your own), our office procedure is as follows:
You will need to have a
special X-ray done (often called an OPG or Panex) and this should be
available to us at your consultation appointment (we can arrange this
for you).
We will then need a
consultation appointment to meet you and discuss treatment with you
before scheduling an appointment for surgery. At this initial
consultation appointment, your specific complaint will be assessed and
discussed. Your general health and medical history will be reviewed. Any
risk factors will be identified, explained and discussed. The procedure
will be explained to you and you will have an opportunity to ask
questions. An estimate will be prepared and a consent form presented to
you for your signature. You will then be able to make an appointment for
surgery.
Q. What do I have to
do to prepare for surgery?
A. Please take note of
the following if you are having surgery under intravenous sedation:
-
You should not have
anything to eat or drink (‘nil per mouth’) for four hours before
surgery (insulin dependent diabetics may require special attention
– please discuss with Dr Khouri).
-
Ensure you have
arranged for a responsible adult friend or relative to drive you
home and look after your for 2-3 hours after surgery.
-
Wear comfortable,
loose-fitting clothing.
-
Remove contact lenses
and any lip, tongue or nose ‘jewellery’ before coming in.
-
Disclose all
medications and health conditions to Dr Khouri.
Q. Will it hurt?
A. You will not feel any
pain during the procedure.
Q. How much does it
cost?
A. This varies depending
on the number of teeth involved, the need for special tests or X-rays,
the time required and the complexity of the surgery. As a guide, our
recent fees for wisdom tooth surgery under intravenous sedation have
varied between NZ$700 and NZ$1700. A written estimate will be given to
you after your consultation appointment (before you make your surgery
appointment). We do require payment in full on the day of surgery.
Q. How long will it
take?
A. You should plan on
being at the surgery about an hour, sometimes a little longer. Please
instruct your escort/driver to arrive 45 minutes after your appointment
begins, so that we can go over your care instructions with them and
answer any questions they may have.
Q. What can I expect
after wisdom tooth surgery?
A. Surgical removal of
wisdom teeth does cause more discomfort than routine extractions. After
the local anaesthetic wears off, usually several hours after you get
home, you may experience:
-
Some pain or
discomfort. Prescribed medication will help you cope with this.
-
Some swelling. This
will usually peak at 24-48 yours and then resolve. There may be some
associated bruising which becomes obvious with time, then fades.
-
Some bleeding. This
should not be a feature after the first 24 hours and should be
readily controlled with pressure dressings. Blood stained saliva is
to be expected for 2-3 days.
-
Difficulty in opening
your mouth and chewing. This will gradually improve as swelling
reduces and healing occurs.
-
A change in feeling
(tingling or numbness) of your tongue, lip and/or chin.
All these symptoms are
temporary , and in most cases your mouth will be feeling normal within a
few weeks.
You should be seen a week
after surgery to check healing and remove any sutures (stitches). This
is usually a short appointment of 5-10 minutes duration.
Q. What is a ‘dry
socket’?
A. This is a painful
condition that usually begins 2-3 days after tooth extraction. It most
commonly occurs after the removal of lower wisdom teeth, and is seen
much more often in smokers. It is characterized by an empty tooth socket
(no blood clot), and increasing pain. Treatment usually consists of
placing a dressing in the wound to disinfect the area and make it more
comfortable while healing occurs. Antibiotics are sometimes also
prescribed.
Q. Is it normal to
still have tingling or a numb feeling in my lip, chin or tongue several
days after having wisdom teeth out?
A. No, but this is a
well-known complication of wisdom tooth surgery that is explained during
the initial consultation and consent procedure. It is generally due to
injury to one of the nerves that lies close to the wisdom tooth that was
removed. The tingling/numbness usually returns to normal with time,
although it may be permanent. This complication is said to occur in up
to 10% of people, but is much less common in younger patients (under the
age of 20 years). You should contact us if you experience this
complication.
Q. Will the
antibiotics prescribed make my oral contraceptive less effective?
A. Yes, this is a
distinct possibility. While you are taking the antibiotics and for the
next seven ‘real’ pill days, you should use additional contraceptive
measures.
Q. What should I do
after surgery?
A. You will be given
specific written instructions. In general:
-
Have a responsible
adult friend or relative drive you home.
-
Do not drive a motor
vehicle or operate any sort of machinery for 24 hours.
-
Do not undertake any
responsible decision-making for 24 hours.
-
Do not drink alcohol
for 24 hours.
-
Do not take any
medication unless it has been prescribed by your doctor or dentist.
-
Rest, preferably in a
seated position. Do not undertake any physical activity for 24
hours.
Q. What about
post-operative care of my mouth?
A. You will be given
specific written instructions. In general:
-
Do not disturb the
wound. In doing so you may invite irritation, infection and/or
bleeding. Chew on the opposite side for the first 24 hours.
-
Do not smoke for 36
hours. Smoking will promote bleeding and interfere with healing.
-
Do not spit, suck on
the wound(s) or suck through a straw. These activities will promote
bleeding and may dislodge the blood clot, which could result in a
‘dry socket’.
-
Control of bleeding.
A pack made from a damp folded sterile gauze pad (which we will
supply) should be placed over the bleeding wound, under firm biting
pressure. It is important that this pack stay in place, under
pressure, to control bleeding and to encourage clot formation for 15
minutes by the clock. If the bleeding has not stopped when the
original pack is removed, place a new gauze pad over the extraction
site and exert pressure by biting for another 15 minutes. If you run
out of gauze packs, tea bags are good. Report persistent bleeding to
us.
-
Pain control. Pain
relief medication will usually be prescribed by Dr
Khouri after wisdom tooth surgery. You should not take
medication that contains aspirin if you are experiencing any
post-operative bleeding. Inform us immediately if you experience any
undesirable side effects from prescribed medication.
-
Diet and nutrition.
There are no specific restrictions, but a soft diet may be more
comfortable for a few days following surgery. Food may have to be
cut up into smaller pieces for a few days. It is most important to
keep fluid intake up in the days following surgery.
-
Encouraging healing.
After the first 24 hours, it is advisable to rinse gently with very
warm salty water every two hours (one level teaspoon of salt to a
small glass of very warm water). Do this for 3-4 days.
-
General. Following
the removal of your wisdom teeth, you should call us if any unusual
bleeding, swelling or pain occurs. The first 24 hours after a
surgical extraction are typically the worst, but are manageable with
prescription medication. You should plan to see us approximately one
week after surgery to ensure everything is healing well, and to have
any sutures (stitches) removed.
Q. How long before I
can go back to work?
A. Different people
recover from wisdom tooth surgery at different rates. Depending on the
nature of the surgery, your age and your individual recovery capacity,
you should expect to get back to regular work in 2-4 days. In our
practice, most people choose to have their surgery on a Thursday or
Friday and almost all are fine to return to work by the following
Monday.
NOTE:
If you are uncertain whether or not to proceed with any suggested
treatment, it is a good idea to get a second opinion. The decision to
proceed with treatment (or not) is yours, and should be made only after
you are fully informed. |
