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WISDOM TOOTH REMOVAL

Wisdom teeth usually appear between the age of 16 and 25. Most adults have four wisdom teeth, but it is possible to have fewer or more. Wisdom teeth commonly affect other teeth as they develop, becoming impacted or "coming in sideways." They are often extracted when this occurs.

Due to evolution, the jaw size in humans has reduced leaving no room for wisdom tooth to erupt hence resulting in ectopic eruptions (abnormal position) of the wisdom tooth or impaction (complete failure of eruption) of it , so the need for extraction of wisdom tooth. At FDOC, the procedure of painless removal of tooth is performed under effective local anesthesia by a knowledgeable oral surgeon.

Wisdom tooth removal is best carried out by an oral surgeon.

For wisdom tooth removal we will take an x ray of your mouth to help determine the type of impaction,root position,relation of tooth to nerve , amount of infection etc.

Anaesthesia

Before having your wisdom teeth removed, you'll be given local anaesthesia to numb the tooth and surrounding area.
If you're particularly anxious about the procedure, our oral surgeon may give you a sedative to help you relax. This will usually involve an injection into your arm.
General anaesthesia is rarely necessary. When it is needed, your wisdom tooth will be removed in hospital, although you should still be able to go home the same day as the procedure.

Removing the wisdom tooth

If the tooth hasn't come through the gum, a small cut (incision) will be made in the gum to access it. A small piece of the bone covering the tooth may also need to be removed.
The tooth may be cut into smaller parts to make it easier to remove through the opening. There's less need to make an incision if the tooth has broken through the gum.

You'll feel some pressure just before the tooth is removed. This is because our oral surgeon needs to widen the tooth socket by rocking the tooth back and forth before taking it out.
Surgery to remove wisdom teeth shouldn't be painful because the area will be numb. However, if you feel pain during the procedure, tell our oral surgeon so they can give you more anaesthetic.
The length of time it takes to remove the tooth will vary. Simple procedures can take a few minutes, but it can take longer than 20 minutes if it's more complicated.

After surgery

If an incision has been made, stitches may be used to seal the gum. Your dentist will tell you to remove the stitches within 7 to 10 days.
Our dentist may place gauze over the site of the extraction and ask you to keep pressure on it by biting your jaws together for up to an hour. This is to allow a blood clot to form in the empty tooth socket. Blood clots are part of the healing process, so try not to dislodge them.

Antibiotics & analgesics are must for a quicker pain-free recovery
For the 24 hours after removing your wisdom tooth, you should avoid:
• rinsing your mouth out with liquid
• drinking alcohol and smoking
• drinking hot liquids such as tea or soup
• strenuous physical activity

Do wisdom teeth have to be removed always?

No, wisdom teeth do not always have to be removed;healthy wisdom teeth that fit in the mouth are usually not extracted.Wisdom teeth that have not erupted and are in a good position can also be left in the mouth.However, wisdom teeth will be removed if they cause repeated symptoms or show signs of disease on examination, or if removal is required for some other dental or general condition

Do wisdom teeth cause crowding of other teeth?

No.Changes in dental occlusion and tooth position take place during the entire lifespan; these changes are most often seen as crowding, especially of the lower front teeth.Wisdom tooth eruption takes place around the same time as the crowding of lower front teeth begins.

The area of my lower wisdom tooth was giving me trouble.Why was an upper wisdom tooth removed during my emergency dental appointment?

An erupted upper wisdom tooth may make inflammation in the lower wisdom tooth area worse by causing pressure in the lower wisdom tooth area. •

How long does local anaesthesia last?

Two to six hours.The duration depends on the amount of local anaesthetic used and the area that was anaesthetised (upper/lower jaw).

I’m scared of having my wisdom teeth removed.Can I have a sedative?

You should discuss your fears with your treating dentist.Pre-medication before the removal is possible.You can ask your dentist for more specific instructions.

Can we use general anaesthesia or nitrous oxide (laughing gas) in Wisdom tooth removal ?

Wisdom tooth removal can be performed under general anaesthesia. Treatment with nitrous oxide is available .

How are wisdom teeth removed? Does it involve surgery or can they be just ‘pulled’ out?

The need for a specific removal technique is evaluated separately each time;the choice is affected by tooth position, root shape and how much room there is in the mouth.

How long does the place of removal bleed?

While the bleeding usually stops on the day of the removal,you may experience slight bleeding and a taste of blood in the mouth for several days.If the wound bleeds, cover the wound witha tightly wrapped gauze bandage or some other clean compress andbite down on it for about 30 minutes.A cold pack over the cheek may also be helpful.Repeat the procedure if the bleeding continues.Please note thatspit will be stained red even by a small amount of blood in the mouth.

When can I eat again?

You must not eat or drink for two hours after the removal. If your mouth feels very numb you should not eat or drink until the local anaesthesia has worn off somewhat; otherwise you may accidentally bite your cheek or tongue while your mouth is still numb. It is also possible that the corner of your mouth may not hold food or drink very well, and hot food may cause burns in the mouth.

Can I smoke after I’ve had my wisdom teeth removed?

You must not smoke for two hours after the removal, so that the healing process can begin properly.

How long does recovery take after removal or surgery?

Symptoms may appear seven to ten days after a surgical removal. The ache and the swelling are at their worst three to five days after the procedure.The recovery is normal if painkillers alleviate the ache.

However, if there are any general symptoms, such as fever or increasing swelling, you have an inflammation that requires treatment.In that case contact your dentist.Recovery after a normal upper wisdom tooth removal is usually quick, as long as you remember to avoid any strenuous activities, at least on the day of removal.

Can I get sick leave after removal or surgery?

Not automatically.If the procedure is difficult or long, you mayget a couple of days off sick leave.In any case, you should remember not to exercise or overstrain yourself for a few days.

When can I exercise again?

After a normal removal you should avoid exercise or other physical strain for at least aday; after more complex removals you should wait two to three days.

How quickly can I get an appointment for wisdom tooth removal?

Your treating dentist will evaluate the urgency of removal on the basis of factors such as signs of disease, tooth position and development stage and the age of the patient.In urgent cases attempts are made to have the tooth removed as soon as possible. However,in less urgent cases with a preplanned procedure the waiting time may be up to one year.If you are planning on going abroad on an exchange programme you should inform your dentist during a standard appointment well in advance before leaving.

Do I have to do anything special before the removal?

Follow your treating dentist’s instructions.
It is usually a good idea to eat properly before the procedure.
Follow the instructions regarding medication given to you by your treating dentist.

What to expect after wisdom tooth removal?

Recovery after wisdom-tooth surgery is generally quite straightforward, but you are likely to experience pain and swelling, particularly in the first 2 days. Rarely, complications can occur, such as poor healing of the tooth socket or nerve injury. If you have had adult intravenous sedation or a general anaesthetic, you will require someone to escort you to and from surgery, and it is important to take it easy for a day or two after the operation.

Pain

You are likely to experience pain for the first 48 hours, although your mouth may well be sore for up to a week or so after the operation. Local anaesthetic injections given during the procedure ensure that you have no pain for the first 3–4 hours after surgery, but once the anaesthetic wears off, you need to take the painkillers given to you. You should take these regularly to ensure that you sleep well on the first night; this will maximise your recovery. You will normally be prescribed paracetamol and ibuprofen. When these two drugs are taken together, they enhance the effect of each other because they work in different ways. Be sure to follow the directions given to you by your surgeon or the pharmacist. Some patients may not be able to take these medications due to medical problems, but in these cases, alternatives will be provided.
The area around the extraction sites will be sore and you may find it difficult to clean your teeth. Follow the instructions for decent oral hygiene as this is very important to minimise the risk of infection. Antibiotics will only be prescribed if there is active ongoing infection.

Swelling

Swelling, particularly in the cheek area and both inside and outside the mouth, is common. Again, it is worse for the first 2 days, after which it will gradually subside. It can be relieved by using ice packs, starting shortly after surgery. Bruising to the skin of the face may also occur.

Jaw stiffness

You may have difficulty opening your mouth and experience pain or stiffness of the jaw joint. This will normally disappear after a couple of days, but can occasionally last for up to 2 weeks. You may need to eat a soft diet for a week or so.
Be careful not to force your jaw open before it is ready and do allow time for the swelling to go down. Ibuprofen will help to relieve this pain.

Teeth sensitivity

Sensitivity of the teeth next to the wisdom-tooth socket is common; decent oral hygiene will resolve this, although it may last for several weeks.

Bad breath

You may experience bad breath; this is unlikely to last more than a week.

Stitches

Stitches will dissolve by themselves and do not need removing, but it is important that 3–4 days after surgery you start brushing the sutures away to minimise food trapping.
When the tooth is removed the roots leave a ‘socket’ in the bone. This hole in the gum may last for up to 3 months. As your wound heals, blood clots form over the empty tooth sockets; it is important not to dislodge these.

Bleeding

If later bleeding occurs from the extraction site, you will need to bite on a cotton gauze or handkerchief for 3–5 minutes to stop it. Avoid drinking or eating food that is hot or very cold as this may restart bleeding.
Follow-up appointments are not usually booked after wisdom-tooth surgery. However, if you have complications or your bleeding does not stop, you should contact your surgeon.

Tiredness

Your body is using energy to heal itself, so you may feel more tired than usual – this is perfectly normal.

Exercise and sport

It is important to avoid strenuous activity and exercise for the first few days. While you’re building up your activities, you probably won’t feel like doing much, but walking is the best way to return to fitness. If you play rugby or do martial arts, you should discuss returning to these activities with your surgeon before the operation.

Complications

Dry socket happens in 5–10% of patients; it presents as intense and persistent pain occurring 3–5 days after the initial pain has subsided. If this occurs, it is important that you contact your surgeon as soon as possible, who will wash out the socket and remove the trapped debris that is causing the pain.

Nerve injury is far less common and is normally caused by bruising of the nerve(s) that lie very close to the roots of the lower wisdom teeth. Rarely, it can be caused by the injections given during surgery. Nerve injury occurs in up to 2% of patients and is generally temporary, but it can be permanent in 0.5% (1 in 200) of patients.

Nerve injury can cause pain, tingling, altered sensation (pins and needles) or numbness, and may occur to the inferior alveolar nerve (the sensory nerve supplying your lower lip, inside and outside, and your lower gums and teeth) or lingual nerve (the nerve that supplies feeling to one or other side of your tongue and adjacent gums).

If your lower wisdom tooth is positioned close to the ‘lip’ nerve, you will be advised that the likelihood of nerve injury is more common (20% of patients are likely to experience temporary injury and 2% permanent injury). If this is the case, you may need an additional special X-ray investigation (cone beam CT scan) and be offered a different surgical approach to minimise the injury (coronectomy).

Damage to adjacent teeth may also occur if they are heavily restored.

It is very important that you maintain good oral hygiene and brush your teeth as usual as best you can, gradually brushing nearer to the wound day by day, eventually brushing away the stitches after several days. You may be recommended to use an antimicrobial mouthwash and often you will be prescribed salt-water rinses to help with wound healing. Do this gently on the first postoperative day to avoid dislodging the clots that will have formed over the wounds.

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