Wisdom Teeth

What Are Wisdom Teeth?

Most adults have 32 teeth by age eighteen. The first molar teeth erupt by age six, the second molars a few years later, while the third molars are the last teeth to erupt around age 17 - 20. These four third molars are also known as wisdom teeth.

Do All Wisdom Teeth Have To Be Removed?

If the wisdom teeth are aligned properly and can be reached for cleaning purposes, they generally don’t have to be removed. However, most people have only enough space for 28 teeth in their mouths. Because the wisdom teeth are the last to erupt, they often don’t have enough space to align themselves properly. Wisdom teeth with insufficient space often align themselves in unusual positions in an attempt to find some space to erupt within the mouth. Wisdom teeth with insufficient space may emerge only partly or remain completely embedded within the jaw; these wisdom teeth are called impacted. These unusual positions may jeopardize the health of adjacent teeth and necessitate removal in order to prevent future problems.

What Can Happen If I Don’t Have My Wisdom Teeth Removed?

A wisdom tooth is extracted to correct an actual problem or to prevent problems that may occur in the future. When wisdom teeth come in, a number of problems can occur:

• Your jaw may not be large enough to accommodate them, and they may become impacted and unable to break through your gums.
• Your wisdom teeth may break partway through your gums, causing a flap of gum tissue (operculum) to grow over them. This lead to trapping of food and germs, causing unhygienic conditions underneath these skin flaps; this result in an extremely painful infection, called pericoronitis. It may also occasionally cause abscess formation.
• One or more of your wisdom teeth may come in at an awkward angle, with the top of the tooth facing forward or backward. 
• Growing wisdom teeth also exert pressure on the surrounding tissues, leading to diffuse, ill-defined pain and discomfort. 
• More serious problems can arise when impacted wisdom teeth lead to cyst formation or damage to the roots of adjacent teeth, which often result in loss of these teeth.

How Is A Wisdom Tooth Removed?

The relative ease at which your oral surgeon can extract your wisdom teeth depends on the position of the impacted teeth. Your surgeon will be able to give you an idea of what to expect during your pre-extraction examination. A wisdom tooth that is fully erupted through the gum can be extracted as easily as any other tooth. However, a wisdom tooth that is underneath the gums and embedded in the jawbone will require an incision into the gums and then removal of the portion of bone that lies over the tooth. Oftentimes for a tooth in this situation, the tooth will be extracted in small sections rather than removed in one piece to minimize the amount of bone that needs to be removed to get the tooth out.

What Is The Best Way To Have My Wisdom Teeth Removed?

In general, wisdom teeth can be removed under intravenous / conscious sedation (in the rooms) or general anesthesia (in a hospital); easy cases can sometimes be done under local anaesthesia. Mr. Erasmus will determine which anaesthetic technique is best suited for your particular case.

What Does Recovery Involve?

People differ a lot, so does the effects of wisdom tooth extraction. How quickly you heal depends on the degree of difficulty of the extraction (a simple extraction of a fully erupted tooth versus a tooth deeply impacted into the jawbone). In general, here's what to expect (and some tips to speed up recovery):

During The First 24 Hours

• Bleeding may occur for several hours after tooth extraction. To control it, position a piece of clean moist gauze over the empty tooth socket and bite down firmly. Apply constant pressure for about 45 minutes. A moistened tea bag is an effective alternative. The tannic acid in tea helps blood clots to form. Repeat this process if a small degree of bleeding continues; if heavy bleeding continues to occur, contact Mr. Erasmus. Avoid rinsing or spitting for 24 hours after tooth extraction and avoid hot liquids (such as coffee or soup). These activities can dislodge the clot, causing dry socket to develop. 
• While your mouth is numb, be careful not to bite the inside of your cheek or lip, or your tongue. 
• Do not lie flat. This may prolong bleeding. Prop up your head with pillows. 
• Do not smoke for at least 24 hours after your surgery. The sucking motion can loosen the clot and delay healing. In addition, smoking decreases the blood supply and can bring germs and contaminants to the surgery area. 
• Facial swelling in the area where the tooth was extracted typically occurs. To minimize swelling apply a cold pack or ice wrapped in a cloth, to your face on a schedule of 10-minutes on, followed by 10-minutes off. The scientific benefit of cold application has not been proven as yet, but patients often report a benefit in terms of pain control.
• Pain medication. Mr. Erasmus has prescribed you appropriate pain killers. It is in principle better to prevent pain (by taking the prescribed painkillers according to the indicated schedule for the first 48 hours) as opposed to waiting for pain before the pain killers are taken.
• Antibiotics. Mr. Erasmus may have prescribed you a course of antibiotics. You should commence the antibiotics after your first proper meal AFTER your surgery. 
• Foods. Avoid hot liquids and alcoholic beverages for at least 24 hours. In the case of difficult extractions, consume a soft or liquid diet for the first 24 hours. 
• Continue to brush your teeth, but avoid the teeth directly adjacent to the extraction sites during the first 24 hours. On day 2-3, resume the gentle brushing of your teeth.

After 24 Hours

• Facial swelling is a normal occurrence after wisdom tooth surgery. The swelling normally peaks after 24 hours, remain unchanged for a further 24-36 hours before it starts to go down. As a general rule, cold application may reduce swelling if commenced within the first few hours after surgery but is unlikely to have much of an effect after 24 hours. Swelling normally resolves after 3 days, but in some cases may take as long as 5-7 days to resolve. 
• Rinse your mouth with an antiseptic mouth rinse (if included in your prescription) or salt water (1/2 teaspoon of salt in a cup of lukewarm water) three times daily after meals.
• Stitches. Mr. Erasmus would normally use self-dissolving stiches for dental extractions; these stiches take on average 2-3 weeks to dissolve and need not to be removed.
• Complete healing takes about 4-6 weeks to occur following the removal of wisdom teeth. However, usually within the 10-14 days adequate healing has occurred for you to resume normal eating and chewing.

What Are Potential Complications?

Three of the more important complications include:

Dry socket
Dry socket is a relatively uncommon condition (about 2-4% of cases) that occurs when a blood clot either fails to form or becomes dislodged. Without a blood clot, healing is delayed. A dry socket typically occurs 3 days after the extraction and is accompanied by severe pain. Mr. Erasmus will treat the dry socket by placing a medicated dressing in the socket. Dressing will need to be removed and replaced until the pain has subsided.

Paresthesia*
Long-term numbness of the lip and chin is a very uncommon complication following the removal of wisdom teeth. The roots of some wisdom teeth are often close to the nerve that supplies feeling to your lower lip and chin; in some cases this nerve can be bruised or damaged during the extraction process and result in long-term numbness. In the majority of cases the numbness is transient, but can last many weeks to months, or even longer. However, it is also known that in a small number of cases the numbness could be permanent.
Mr. Erasmus will always assess your individual risk of nerve damage and if indicated, obtain a 3D scan of your jaw to image the nerve and assess this potential risk.

Infection
Infection following the removal of wisdom teeth occurs in around 5% of cases, but is dependent on a number of factors, such as the patient’s oral hygiene after surgery, smoking and healing capacity. You will be prescribed a course of antibiotics and an antiseptic mouthwash in an attempt to minimize the risk of infection, but it can still occur despite our best efforts to prevent it.
We will arrange a check-up appointment some 7-10 days post-surgery as this is the period we are most likely to see infection.

Rare complications
An opening in the floor of the sinus cavity may occur when an upper wisdom tooth is extracted.

Facts to Think About

If your wisdom teeth are not causing problems, it may be difficult to decide whether to have them removed to prevent problems later in life.
Consider the following:

• The mere fact that you don’t feel your wisdom teeth doesn’t mean that you don’t have wisdom teeth. It is better to have an X-ray taken to assess the situation. 
• It is rarely harmful to your health to have your wisdom teeth removed, but there are slight risks involved with any surgery. 
• In younger people (late teens and early 20s), the roots of wisdom teeth are not fully developed and the jaw bone is still relatively soft, so it is much easier to remove wisdom teeth. The easier it is to remove, the quicker your recovery is likely to be. 
• Most problems with wisdom teeth develop between the ages of 18 and 28. 
• If you are older than age 35, you have a slightly smaller risk of developing problems with your wisdom teeth. However, your healing will be slower and older patients in general have more problems with healing after wisdom tooth surgery.
• If you have a medical condition that may get worse over time, consider having your wisdom teeth removed while you are healthy.

What Is My Next Step?

You may consider making a consultation appointment with Mr. Erasmus, who will examine your mouth and take an X-ray to assess the status of your wisdom teeth and determine whether removal is indicated. If indicated, he will advise you on the appropriate anaesthetic technique and possible risks involved in your particular case.

Referrences:
*Esposito M (2004). Impacted wisdom teeth. Clinical Evidence (12): pp 1930–1933.
Bui CH, et al. (2003). Types, frequencies, and risk factors for complications after third molar extraction. Journal of Oral and Maxillofacial Surgery, 61(12): pp 1379–1389.