WISDOM TOOTH SURGERY

Many rumours, urban myths, horror stories and inaccuracies are associated with wisdom teeth. In fact, they are simply just our third set of molars and the last teeth that we cut, usually in the late teens or early twenties.



wisdom-teeth
An X-ray reveals impacted wisdom teeth in the lower and upper jaws. All four were successfully removed

At this point in life, all the other teeth are in place so its common for the wisdom teeth not to have enough space. As a result they often erupt in an unfavourable position. This is where some of the problems arise.

So why don’t we have enough space for our wisdom teeth? Two main theories have been put forward:

  • We now eat a diet that is much softer than the diet eaten by our ancestors. Eating tough and gritty foods would have allowed the other teeth to wear and create more space for the wisdom teeth.
  • During evolution our jaws have decreased in size, but our teeth have remained the same size.

Which wisdom teeth give us the most trouble?

We normally have four wisdom teeth, one on each side at the top and the bottom. The majority of problems arise from the lower teeth compared with the upper wisdom teeth. This is because upper wisdom teeth are usually easier to remove and are therefore taken out at the first sign of trouble. And because food and debris tend to accumulate more around the lower teeth.

Problems with wisdom teeth

A few lucky people get all four of their wisdom teeth with nothing more than a little teething discomfort. Others experience more pain and maybe a mild infection but this clears up as soon as the tooth has erupted.

Other people can have a variety of more serious problems:

  • Pericoronitis – Infection around the gum of the erupting wisdom tooth. This an be very severe and can occur many times causing problems with eating and general malaise.
  • Caries – Dental decay either in the wisdom tooth or the tooth in front of the wisdom tooth (the second molar tooth)
  • Cyst formation – It is quite common for a wisdom tooth to be impacted in the jaw bone and it just never erupts. It may cause no problems throughout life. However these teeth may grow cysts around them which are found incidentally or when the cyst starts to cause problems.
  • Abscess formation – if the infection spreads to the tissue spaces nearby, a collection of pus may form.
  • Root resorption of the second molar tooth – The contact of the wisdom tooth on the root of the adjacent tooth causes the root to be eaten away.
  • Periodontal disease – if cleaning cannot be accomplished around the wisdom tooth, the gum and bone may recede. This may also affect the second molar tooth as well.
  • Fractures of the jaw bone – a wisdom tooth acts as a stress concentrator and trauma to the lower jaw can cause a fracture through the wisdom tooth.
  • An impacted wisdom tooth – If the wisdom tooth erupts into the mouth but not into the desired location, this is known as an impacted wisdom tooth that is partially erupted. This type of tooth has the potential to also cause many of the problems already listed.

Removal of wisdom teeth

If your wisdom teeth require removal, Mr Hodges will see you and take a detailed history and undertake a thorough examination of your neck and mouth and teeth. At this stage any scans that are required to image the roots and surrounding structures are requested. When all the information has been gathered, Mr Hodges will make a treatment plan for the management of your wisdom teeth.

At this stage, the treatment options will be discussed and if removal of the wisdom teeth is decided on, Mr Hodges will discuss with you which type of anaesthetic will be used. Once your treatment plan has been personally tailored to your needs, a date for surgery will be set.

Anaesthetic options

  • General anaesthetic (GA) – this is where the surgery takes place with you completely asleep (unconscious). The GA is give by a fully accredited consultant anaesthetist.
  • Intravenous sedation – this is where the surgery takes place with you under sedation. Sedation is where you are conscious but extremely relaxed. Local anaesthetic is also used to completely numb the tooth and surrounding structures. The sedation is given by a fully accredited consultant anaesthetist.
  • Local anaesthetic – this is where you are fully awake but the tooth and surrounding structures are numbed using local anaesthetic injected around the area. This is similar to, but not the same as, having a filling at the dentist.

Extraction options for the wisdom tooth

  • No extraction – if it is not in your interests to remove the wisdom tooth, leaving it where it is may be the best option.
  • Simple extraction – the tooth can be removed simply as you would have it removed at the dentist.
  • Surgical extraction – where the wisdom tooth requires exposure, this can be achieved by lifting the gum, removing bone around the tooth and sectioning the tooth, which can then be removed in pieces.
  • Coronectomy – This is where just the crown (top part of the tooth) is removed and the roots are left behind. Why would we contemplate leaving part of the tooth behind, I hear you say? Well, if the roots of the wisdom tooth are close to the nerve that runs through your jaw bone, removing the tooth may cause numbness or tingling to your lower lip and chin permanently. Because the roots are usually close to this nerve, leaving the roots undisturbed may prevent any injury to the nerve. This is a fairly new technique and therefore has not been fully evaluated over the long term, and there are also recognised complications with this approach. Mr Hodges will discuss this very carefully with you if he feels this is the best option for you.

Risks and complications of wisdom tooth removal

Lower wisdom teeth:

  • Pain
  • Swelling
  • Bruising
  • Infection
  • Bleeding
  • Dry socket
  • Difficulty opening one’s mouth fully (trismus)
  • Numbness/tingling for life of the lower lip, chin tongue and inside cheek
  • Sensitivity of tooth in front
  • Jaw fracture

Upper wisdom teeth:

  • Pain
  • Swelling
  • Bruising
  • Infection
  • Bleeding
  • Dry socket
  • Difficulty opening one’s mouth fully (trismus)
  • Oro-antral communication
  • Tuberosity fracture
  • Sensitivity of tooth in front