|Oral and Maxillofacial Procedures » Surgical Removal of Wisdom Teeth|
|Removal of Wisdom Teeth - The Good News
Everyone worries about having their wisdom teeth removed. But, with Dr. McBride, it is usually a very simple process with a very comfortable recovery. With Dr. McBride's extensive experience with anesthesia and surgical care, most patients are back to their normal activities the next day.
Why Your Wisdom Teeth May Need to be Removed
Studies have shown that early evaluation and treatment result in a superior outcomes. Patients are generally first evaluated in the early teenage years. With an oral examination and x-rays of the mouth, Dr. McBride can determine if the wisdom teeth should be removed.
When wisdom teeth align properly, and the gum tissue is healthy, they do not have to be removed. Most people do not have a large enough jaw to permit the wisdom teeth to erupt properly. There is simply not enough room in most mouths for the teeth to come in to a healthy position. When they are prevented from properly erupting within the mouth, they may grow sideways, become partially exposed, or remain trapped beneath the gum and bone. If the wisdom teeth get trapped by the teeth in front of them, and cannot erupt into a normal position, which is a very common condition, the the teeth are called impacted.
Wisdom teeth, and the tissue around them, may become infected, or tumors and cysts may form resulting in damage to the jawbone and adjacent healthy teeth. Pressure from erupting wisdom teeth may move adjacent teeth and disrupt the orthodontic or natural alignment of teeth. Patients may experience pain and pressure as the teeth try to erupt and get close to the surface. Swelling and drainage may develop around the teeth. If any of these problems develop, you should seek evaluation to see if the teeth should be removed.
The Best Time to Remove Impacted Wisdom Teeth
The ideal age for removal of wisdom teeth varies between 12 and 18. In general, Dr. McBride suggests removing the wisdom teeth before the roots begin to grow. Once the roots form, the teeth get larger and extend deeper into the bone, making them more difficult to remove and increasing the potential for complications. The growth status of the wisdom teeth can be determined with a simple x-ray. The position of the teeth, the potential for uncomplicated eruption, the amount of root growth, and other factors can be evaluated to determine if and when the teeth should be removed. It is a good idea to take x-rays between ages 12 and 14 to see if the wisdom teeth are beginning to pose a problem.
When it is determined that there will not be enough room for the wisdom teeth to erupt satisfactorily, plans should be made to remove the teeth at a convenient time. Patients have less pain and swelling when the teeth are removed before the roots completely form. Dr. McBride uses the safest and most effective anesthetic and surgical techniques to remove the wisdom teeth with the least bother to the patient.
It is much easier to remove the wisdom teeth when the surrounding tissue is healthy and not infected or inflamed. There are also fewer complications when the teeth are healthy and have not completely developed. As impacted wisdom teeth continue to develop, the roots may grow down deeper and curve or get close to the nerve that supplies sensation to the lower teeth, lips and chin. When this occurs there is an increased risk of complications including numbness of the lower lip and chin, extensive swelling, infection and bruising. When wisdom teeth are impacted they are more easily removed when they are small and have not completed their growth.
A consultation is performed to evaluate the stage of eruption of the wisdom teeth and to decide if, or when, they should be removed. An x-ray is taken to evaluate the position and development of the teeth and whether there is room for eruption into a healthy position. These findings are reviewed with the patient and a treatment plan is developed. The details of the anesthetic and surgical procedures are reviewed, and the preoperative and postoperative care, and potential complications, are discussed in detail so the patient and family will know what to expect. With a little planning, the whole process should be simple and surprisingly comfortable.
Impacted Wisdom Teeth
#1 The wisdom tooth is angled back and is partially erupted through the gum tissue.
#2 The wisdom tooth is missing at this site because it never developed. There is solid bone where the tooth should be.
#3 This wisdom tooth is angled back and is impacted up under the gum tissue. There is no room for it to come in to a healthy position.
#4 This wisdom tooth is angled horizontally and is impacted against the 2nd molar tooth in front of it. It may push against the teeth in front of it and cause crowding. It will never come into a healthy position.
Impacted Wisdom Tooth with Cyst
#1 Impacted wisdom tooth very deep in the bone
#2 A black halo around the top of the tooth shows that a cyst has formed around the tooth
and has destroyed the bone around the wisdom tooth and the tooth in front of it.
#3 The roots of the tooth have been pushed through the bone at the bottom of the jaw.
#4 The black area between the roots of the tooth in front of the wisdom tooth indicates that
the bone has been destroyed and that tooth must be removed along with the wisdom tooth.
Good Healing After Removal of the Impacted Wisdom Tooth with the Cyst
#1 Healing where the wisdom tooth was removed
#2 Healing where the 2nd molar tooth was removed
The Surgical Procedure
Most patients elect to have the procedure performed under light general anesthesia in our office surgical suite. This provides the most relaxation and comfort. An IV is started so the anesthetic drugs can be administered. The vital signs including blood pressure, pulse, blood oxygen saturation, and respiratory rate are monitored. After the patient is asleep, local anesthetic is injected to numb all of the areas involved in the surgery. A long lasting local anesthetic is usually used. It will keep the areas numb for about six hours. This is frequently long enough that very little discomfort develops as it wears off. If it gets uncomfortable, taking the pain medication as directed will keep you very comfortable.
If the teeth are impacted, a short incision is made in the tissue over each tooth, the tissue is retracted to expose the tooth, and the tooth may be removed in one piece, or it may be cut into small pieces so it can be removed through a small opening. Dr. McBride places some special medications in each tooth socket to stop bleeding and to help prevent postoperative pain from a dry socket. The gingival tissue is closed securely over the socket with sutures that will dissolve in about one week.
Our new instruments, techniques and drugs permit most wisdom teeth to be removed, and recovery to proceed with very little discomfort.
The patient rests in the recovery room for 15 to 30 minutes until they are ready to go home. A friend or relative must drive you home. The bleeding usually stops before the patient leaves the office because Dr. McBride places some special medication to stop bleeding in each surgery site. The home care instructions are reviewed, and an appointment for a checkup is scheduled.
When home, the patient may eat breakfast and take a pain pill before there is any discomfort. As the local anesthetic wears off, additional pain pills may be taken as prescribed if necessary. Each patient is encouraged to review the home care instructions when they get home. If an antibiotic, steroid, or oral rinse was prescribed, it should be taken as directed. A soft diet is suggested, but the patient may eat anything that is comfortable. An ice pack on the cheeks next to the lower surgical sites can be soothing. Anti-inflammatory drugs can help with the muscle soreness for the first few day.
If bleeding develops after you are at home, bite on a moist tea bag placed at each bleeding site for about twenty minutes. The tannic acid in the tea bag helps to form a clot by making the blood vessels contract. To minimize further bleeding, sit upright for a while, do not become excited, and avoid exercise. If bleeding does not subside, call our office for further instructions.
Most patients have very little visible swelling after having their wisdom teeth removed. Normal swelling is usually proportional to the extent of the surgery. Mild swelling in the cheeks is not uncommon. This is the body’s normal reaction to surgery. The swelling will not usually become apparent until the day following surgery, and will not reach its maximum until two to three days after surgery. The swelling may not be visible but it can make your chewing muscles stiff so they are sore when you open your mouth widely.
Ice packs may help some patients to minimized the swelling. For other patients, they are more trouble than they are worth. Two small plastic bags filled with a little ice and some water, or commercial ice packs, may be applied to the sides of the face where the surgery was performed. The ice packs may be left on continuously while you are awake. After 36 hours, ice has no beneficial effect. Swelling or jaw stiffness may persist for several days. This is no cause for alarm. This is a normal reaction to surgery. Thirty-six hours following surgery, the application of moist heat to the sides of the face may be helpful in reducing the swelling. Use an electric heating pad, never use a microwave heating pad because it may cause severe burns.
Patients usually return to their normal activities the next day.
Healed Bone After Removal of Wisdom Teeth
This x-ray shows that the bone heals very well where the wisdom teeth have been removed. The arrows point to the solid bone at the healed sites.