Wisdom teeth extractions- By Dr Amir Mostofi DDS, Dip. MSc

Overview

The four permanent adult teeth known as wisdom teeth are placed at the top and bottom back corners of your mouth. A wisdom tooth extraction is a surgical procedure to remove one or more of these teeth.

You'll probably need to have a wisdom tooth removed if it is impacted, causing you pain, an infection, or other dental issues. An oral surgeon or a dentist can remove a wisdom tooth.

Even if impacted teeth aren't currently causing issues, some dentists and oral surgeons advise wisdom tooth extraction to avoid potential future issues.

How did it get done?

The final permanent teeth to erupt in the mouth are the wisdom teeth, sometimes known as third molars. Between the ages of 17 and 25, these teeth typically erupt. Some individuals never get wisdom teeth. Others do not experience any issues when their wisdom teeth erupt naturally, just like their other molars did.

Wisdom teeth that don't have enough room to erupt into the mouth or develop normally are known as “impacted” wisdom teeth. Impacted wisdom teeth may partially or completely fail to emerge.

A wisdom tooth that is impacted can:

• Toward the following tooth, grow at an angle (second molar)

• Grow at an angle with your mouth's roof.

• Grow at a right angle to the neighbouring teeth, appearing to "lye down" in the jawbone.

• Like other teeth, they can grow straight up or down, but they cannot come out of the jawbone.

Impacted wisdom teeth issues

If your impacted wisdom tooth causes issues like these, you'll probably need to have it extracted:

1. Pain

2. food and debris becoming stuck behind the wisdom tooth

3. Infections or gum disease (periodontal disease)

4. tooth decay in a wisdom tooth that has partially erupted damage to the tooth next to it or the surrounding bone

5. creation of a cyst (cyst) around the wisdom tooth that is filled with fluid

6. problems with the orthodontic procedures used to straighten other teeth

Avoiding future dental issues

Dental experts disagree on the benefits of removing impacted wisdom teeth when they are not causing issues (asymptomatic).

With impacted wisdom teeth, future issues are impossible to forecast. Here is the justification for pre-emptive extraction, though:

• Even wisdom teeth without symptoms could be diseased.

• It's frequently challenging to reach the tooth and give it the required cleaning if there isn't enough room for it to erupt.

• In younger adults, severe wisdom tooth issues are less common.

• Surgery-related problems and difficulty for older patients are also possible.

Risks

The majority of wisdom tooth extractions don't cause long-term issues. However, sometimes a surgical procedure that involves making an incision in the gum tissue and bone excision is necessary to remove an impacted wisdom tooth. Rare problems may arise from:

• When the post-operative blood clot is lost from the site of the surgical wound, a painful dry socket or exposed bone results (socket)

• bacterial or food-particle-trapped infection in the socket

• damage to the bones, sinuses, nerves, or teeth close

  How you get ready

The procedure might be carried out in the dental office. However, your dentist could advise seeing an oral surgeon if your tooth is severely impacted or if the extraction calls for a complex surgical procedure. Your surgeon may advise sedation in addition to local anesthesia to numb the area and make you more comfortable throughout the treatment.

Issues to raise

You might wish to ask your oral surgeon or dentist the following questions:

• What number of wisdom teeth must be extracted?

• What kind of anaesthetic am I going to get?

• How difficult do you anticipate the process to be?

• How long will the process probably take?

• Have the other teeth been harmed by the impacted wisdom teeth?

• Is there a chance I could sustain nerve damage?

• What other dental procedures might I require in the future?

• How long does it take to fully recover and resume daily activities?

Getting ready for surgery

Almost always, wisdom tooth extractions are done as outpatient procedures. You will therefore return home that day. The staff at the hospital or your dentist will give you information on what to do the day before and after your scheduled procedure. Query these things:

• Is it necessary for me to plan for a ride home following the procedure?

• Do I need to fast and refrain from eating, drinking, or both? If yes, when should I start?

• Can I take my prescribed drugs before the procedure? If so, when can I start taking a dose before the procedure?

• Is there anything I should stay away from taking before the operation?

What to anticipate?

Throughout the process

Depending on how comfortable you are and how complicated the removal of your wisdom teeth is predicted to be, your dentist or oral surgeon may choose one of three types of anesthesia.

Options consist of:

A local anesthetic

Each extraction location receives one or more injections of local anaesthetic from your dentist or oral surgeon. Your dentist or surgeon will probably numb your gums with a chemical before administering an injection. During the tooth extraction, you are awake. You won't feel any discomfort, although feeling some pressure and movement.

Anesthesia and sedation.

Through an intravenous (IV) line in your arm, your oral surgeon or dentist administers sedative anesthesia to you. During the surgery, a sedation anaesthetic subdues your consciousness. You won't remember much of the process and won't experience any pain. Additionally, you'll need local anesthesia to make your gums numb.

General sedation

You might be given general anaesthesia in certain circumstances. You might either have an IV line in your arm or inhale medication through your nose. You subsequently go unconscious. Your medicines, breathing, temperature, hydration intake, and blood pressure are all continuously monitored by your surgical team. You won't feel any pain and won't remember the process. Additionally, local anaesthetic is administered to ease discomfort following surgery.

Surgical procedure

When removing wisdom teeth, your dentist or oral surgeon will:

• Creates a cut in the gingival tissue to reveal the tooth and bone

• bone that prevents access to the dental root is removed

• if it's easier to remove the tooth in sections, divide it.

• takes out the tooth, removes any dental or bone debris from the area where the tooth was removed.

• Closure of the wound with stitches is done to aid in healing, albeit it is not always necessary.

• Apply gauze to the extraction site to stop bleeding and promote the formation of a blood clot

Following the procedure

After the procedure, you are transferred to a recovery room if you underwent general or sedation anaesthesia. If you had local anaesthetic, you would probably spend the short recovery period in the dental chair.

Follow the advice from your dentist as you recover from your procedure.

Bleeding.

Blood may ooze on the first day following wisdom teeth removal. Spitting excessively should be avoided to prevent removing the blood clot from the socket. As instructed by your dentist or oral surgeon, replace the gauze over the extraction site.

Management of pain.

An over-the-counter pain treatment like Paracetamol or Ibuprofen or a prescription painkiller from your dentist or oral surgeon may help you manage pain. If bone was removed during the treatment, prescription pain medication might be especially beneficial. A cold compress applied to your jaw may help provide pain relief.

Bruising and swelling.

As advised by your dentist or surgeon, use an ice pack. Your cheek swelling often goes down in two to three days. It can take a few more days for bruises to heal.

Activity.

Plan to rest for the rest of the day after your procedure. The following day, return to your regular routine, but refrain from any strenuous exercise for at least a week to prevent losing the blood clot from the socket.

Beverages.

Water is important to drink after surgery. In the first 24 hours, refrain from consuming any alcoholic, caffeinated, carbonated, or hot beverages. For at least a week, refrain from drinking using a straw since the sucking motion could push the blood clot out of the socket.

Food.

For the first 24 hours, stick to soft foods such as yogurt or applesauce. Once you can tolerate soft meals, start eating them. Avoid things that can stick in the socket or irritate the wound by avoiding hard, chewy, hot, or spicy foods.

Smoking

Smoking should be avoided for at least 72 hours following surgery, and ideally for longer. Don't chew tobacco for at least a week if you do. After oral surgery, using tobacco products might hinder recovery and raise the possibility of problems.

Stitches.

You might not have any stitches at all or have stitches that fall out in a few weeks. Make an appointment to have your stitches removed if they need to be taken out.

When to call a surgeon or dentist?

If you suffer any of the following warning signs or symptoms, which could point to an infection, nerve damage, or other severe problem, call your dentist or oral surgeon right away:

• Breathing or swallowing challenges

• A lot of blood

• Fever

• Severe pain that is not alleviated by painkillers as prescribed

• Swelling that gets worse two or three days later

• A foul taste in your tongue that saltwater rinsing cannot cure

• Pus in the socket or leaking from it

• Enduring numbness or a loss of sensation

• Nasal discharge with blood or pus

If problems arise, speak with your dentist or oral surgeon..

How long to wait following an extraction for a implant placement?- By Dr Amir Mostofi DDS, Dip. MSc

How long following an extraction should you wait before having an implant placement to fill the gap? In reality on the same visit you can have an implant inserted, but such approach is not always possible. The reason could be because there are not enough bone in the extraction socket to support a new implant, or severe infection in the site. However, if you wait too long following an extraction, the jaw bone in extraction socket will start shrinking and you have less bone in extraction site. Numerous studies have been carried out to find out the optimum waiting time prior to an implant placement in an extraction site. It appears that optimum time is between 8 to 12 weeks following extraction for a new implant placement.