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Wisdom TeethYOUR COMPREHENSIVE GUIDE TO

Wisdom teeth 3

Symptoms caused by impacted wisdom teeth 4

Treatment options 5

The removal procedure 6

Important facts to consider with wisdom teeth removal 7

After care post-surgery 8

Complications and possible risks 9

Wisdom teeth

Wisdom teeth are the last teeth to come through the gums and do not normally start to erupt until people are in their late teens, twenties or even later. The number of wisdom teeth and when they erupt is different for each person.

Some people experience no pain or discomfort from their wisdom teeth, however the majority of the time the mouth does not have enough space at the back for the wisdom teeth to come through the gums. This leads to the wisdom teeth becoming wedged or impacted, which is one of the most common reasons patients are referred for wisdom teeth surgery.

Impacted wisdom teeth can cause problems such as tooth decay and infection in the surrounding teeth and gums. Due to these problems, it may be recommended to remove the wisdom teeth.

Removing wisdom teeth is a common procedure and it may be beneficial to remove them before any problems arise.

Wisdom teeth that are impacted can be touching or close to a major nerve which can lead to complications during the removal procedure. This is why a high standard of treatment is needed for wisdom teeth removal.

This guide is for general information only and not to be used as a substitute for advice from your oral and maxillofacial surgeon. Your oral and maxillofacial surgeon will be able to access you individually and will recommend the treatment, which is the most appropriate for you.

Horizontal Impaction Mesial Impaction

Distal Impaction Vertical Impaction

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Symptoms caused by impacted wisdom teeth

Impacted wisdom teeth can lead to a number of issues such as:

Infection in the mouth:An infection can occur when the wisdom tooth starts to erupt through the gum. The infection builds up around the top of the tooth.

An infection can cause inflammation around the tooth and the surrounding area, which can cause pain and swelling. This can lead to problems in swallowing, jaw stiffness and bad breath. Infections in the mouth can also lead to feeling generally unwell.

Cyst:A cyst can form around an impacted wisdom tooth if it is not removed. This can cause damage to other teeth, gums and bone.

Cavities: Food can become trapped between the wisdom tooth and the tooth next to it. This can be difficult to remove, leading to potential cavities in both teeth.

A resorption cavity is caused when a wisdom tooth hits the tooth next to it and keeps pushing against it. This can lead to serious damage to both teeth. Resorption cavities normally lead to serious damage to both teeth and then removal of both may be required.

Pain:Pain can occur due to the wisdom tooth putting pressure onto the nearby tooth. Infections in the mouth can also cause pain around the wisdom tooth area.

Ulcers:Wisdom teeth can grow sideways out of the gum, causing them to rub against the inside of the mouth causing ulcers.

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Treatment options

Infection:If you have an infection around your wisdom teeth your oral and maxillofacial surgeon will likely clean the area and advise you to wash your mouth with warm salty water. It is important to have the water warm, not too hot. You may also be provided painkillers or antibiotics depending on the severity of the infection.

The decision to remove teeth: Your oral and maxillofacial surgeon will make a decision on whether the removal of your wisdom teeth is the most appropriate treatment. This decision will be based on inspection of your mouth and jaw, x-ray examination, results and your overall health.

Early removal: Your oral and maxillofacial surgeon may recommend the early removal of your wisdom teeth if they can see that they are likely to become troublesome in the future.

There are several indications that your wisdom teeth could become a problem. Such as if it is clear there is not enough space for the tooth to push through or if you are having orthodontic treatment and wisdom teeth are going to impact or cause overcrowding. If the wisdom tooth has started to erupt and is already causing pain, it can be removed early to prevent any infections.

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The removal procedure

An impacted wisdom tooth may be close to or touching a major nerve, which may impact on the type of removal procedure that is performed.

X-rays:Your oral surgeon may require x-ray films of your jaw to decide on which is the most suitable way to remove the wisdom tooth.

Anaesthesia: The decision of local or general anaesthesia will be discussed with you by your oral and maxillofacial surgeon. You will be given full instructions from your oral and maxillofacial surgeon before and after anaesthesia.

If the procedure is fairly simple, local anaesthetic might be recommended.

If the procedure is more complex, then a general anaesthetic might be more suitable. This involves being put to sleep to allow for the treatment to be carried out.

The procedure generally takes 60 minutes depending on the complexity of the surgery.

Removal process:In some cases, the tooth can be extracted by performing a similar procedure to what is used when extracting any other tooth. However, in more complex cases, it may be required to make an incision in the gums to open them to be able to remove the tooth. This incision may need to be closed with stitches, which will dissolve.

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Important facts to consider with wisdom teeth removal

As the removal of wisdom teeth is a surgical procedure, the surgeon may have some questions about your dental and medical history. This is due to certain health conditions and medications interfering with surgery, anaesthesia and after care. Blood tests or other health checks may be required.

Truthful information allows for the surgeon to provide the most suitable treatment and aftercare.

Medicines: If you are currently taking medication, or have taken medication recently, the surgeon will need to know. This includes contraception, blood thinners, over the counter medication, vitamins and herbal treatments.

If you have ever had a bad or an allergic reaction to any medication, this is also important information.

Bleeding or blood disorders:If you have a blood disorder, such as haemophilia or are taking blood thinners such as aspirin, clopidogrel or any others, you need to let your surgeon know.

You also need to inform your surgeon if you bleed too much when injured or have bled excessively during surgery before.

Pregnancy: Inform your surgeon if you are or may be pregnant.

Pregnancy could affect the use of anaesthesia, x-ray examinations, pain treatment, antibiotics and whether the treatment should be delayed.

Smoking:Smoking impairs the healing process and increases the risk of infection after surgery. It is recommended to stop smoking at least two weeks before surgery and for three weeks after.

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After care post-surgery

If you are given a general anaesthetic in hospital, a family member or a responsible adult must take you home as it is not recommended to drive after the surgery.

You will be given detailed written post-op instructions to follow strictly. This will allow the most effective care. You may also be issued with painkillers or antibiotics.

At home:After surgery, it is important to let your body rest. It is recommended to take some time off work or usual duties. Do not drive or operate any heavy machinery as you may still be feeling the after effects of anaesthesia.

Do not drink alcohol whilst taking painkillers or other medications.

Pain after surgery is different for each person. Normally the pain starts to decrease after the second day of rest. If you find the pain does not decrease gradually in the days after the surgery, tell your surgeon as further pain medication may be required.

Bleeding: You will be instructed to bite down on a gauze pad to reduce the bleeding. You will need to apply pressure over the area as this helps to stop the bleeding and forms a blood clot.

You will need to be careful with this area because if the blood clot is disturbed, bleeding may start again.

To prevent dry socket, do not rinse out your mouth or brush around the area in the first day after surgery. In the following days rinse your mouth very gently with warm salty water and brush very carefully.

If bleeding does not stop, contact your oral and maxillofacial surgeon.

Swelling: Swelling is very common after surgery. The severity of swelling is dependent on the individual and the type of surgery carried out.

Swelling may take a few days to go down completely. An ice pack can relieve some pain and discomfort caused by swelling.

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Complications and possible risks

Despite the high level of care taken by your oral and maxillofacial surgeon, as with all surgical procedures, there are potential complications and risks. The risks and complications will be discussed with you to make sure you fully understand before any treatment is carried out.

If you are concerned about any side effects, or potential complications, please discuss with your oral and maxillofacial surgeon.

Numbness or altered sensation:An impacted tooth can be close to major nerves in the mouth, which can be bruised or affected during surgery. This can lead to pain, tingling, numbness or loss of feeling.

An injured nerve normally heals and the side effects of tingling and numbness will start to reduce. In some rare cases the nerve does not heal fully and the numbness may become permanent.

Infection:An infection caused by surgery can be usually treated with antibiotics.

Anaesthesia:Whilst recovering from having anaesthesia, some people vomit or feel generally unwell.

Difficulty in opening mouth: After surgery, it is common to feel discomfort when opening and closing the mouth. When the swelling goes down after a couple of days this should reduce.

Excessive bleeding:This is an uncommon complication, which involves excessive bleeding (haemorrhage) after surgery. If this happens, apply pressure by gently biting on a gauze pad. Do not use tissue or cotton wool. If the bleeding persists, contact your oral and maxillofacial surgeon.

Lip sores:As the surgical procedure takes place in the mouth, it is possible for your lips to be bruised or stretched. These problems usually heal by themselves over time.

Damage to other teeth:Wisdom tooth removal is designed to not affect any other teeth, however there is a chance that a nearby tooth could be chipped or loosened, but this is rare.

Dry Socket: Once the tooth has been removed, a blot clot will form over the bone. This is an important part of the healing process. If the blot clot is removed, the bone will be exposed causing dry socket, which causes a throbbing pain. If you have pain unresponsive to your pain medication, please contact your surgeon.

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