Definition and Overview

A wisdom tooth extraction is an oral surgery used to remove a wisdom tooth. Although not all wisdom teeth need to be removed, there are several reasons why dentists sometimes prescribe an extraction. In most cases, the tooth is removed due to the complications it causes, such as an impacted wisdom tooth or when it pushes against adjacent teeth. It is possible, however, for a wisdom tooth to grow fully without causing any problems.

Wisdom tooth extractions are routine procedures that dentists perform on a regular basis. The risks associated with the procedure are minimal compared to the potential benefits in terms of better teeth positioning, reduced risk of infections and gum disease, and relief from pain and discomfort caused by complicated wisdom teeth.

Who Should Undergo and Expected Results

A wisdom tooth extraction is performed when:

  • There is not enough space in the jaw for teeth to grow properly
  • The tooth is impacted or does not fully break through the gums
  • A flap of gum grows over the tooth, causing food to accumulate under the flap, placing the patient at risk of infection
  • The tooth becomes infected
  • The tooth pushes against adjacent teeth, thus potentially damaging them
  • A cyst develops
  • The tooth grows at an awkward angle or position
  • The tooth causes the back teeth to become crowded
    Some situations, however, call for the surgery to be performed at a later time. One such example is when the patient has an ongoing infection, in which case the dentist will wait for the infection to heal before performing the extraction. The patient may also be given antibiotics to speed up the healing process.

There are also some special cases in which the wisdom teeth are extracted pre-emptively, such as when the patient has a medical condition that is expected to worsen or progress over time. Thus, it is best for him to have his wisdom teeth extracted while he is still in good health.

How Does the Procedure Work?

A wisdom tooth extraction is typically done in a dentist or oral surgeon’s office. However, there are instances wherein the procedure is performed in a hospital’s operating room, such as when the patient is having all his wisdom teeth extracted in one surgery or if he faces a high risk of complications.

Before the procedure begins, the dentist administers local anaesthesia to numb the area where the wisdom tooth is located. It is also possible to perform an extraction while the patient is under general anaesthesia, but it is usually not necessary unless the patient is having several teeth extracted during the same surgery. In this case, general anaesthesia will provide better relief from pain.

Once the anesthetics take effect, the surgeon will begin the surgery by making an incision in the gum tissue covering the wisdom tooth. If the tooth is covered by a bone, the dentist will have to take the bone out to gain access to the tooth. He will then separate the tooth from the bone and proceed to extract the tooth. In some more complicated cases wherein the tooth is especially difficult to remove, the dentist may first cut it into smaller pieces and remove each of the pieces one by one.

In most cases, dentists stitch the gums back together following a wisdom tooth extraction. If this is the case, the patient will be advised to return for a follow-up, during which the stitches will be removed.

After the surgery, the dentist will place a dressing over the wound to help control the bleeding and to protect it while the gum heals. This period usually takes just a couple of days, during which the patient will be advised to take pain relievers to help with any discomfort caused by the extraction. Using ice packs also helps; these, however, should be applied only for 15 to 20 minutes at a time.

The dentist will also give post-surgical instructions that will help speed up the patient’s recovery, such as changing the wound dressing when it becomes soaked with blood or sleeping with the head propped up to minimise bleeding. It is also best to refrain from performing strenuous physical activities as doing so will prolong the bleeding and extend the recovery period.

It is normal to have some difficulty chewing and eating solid food during the first few days after the procedure. Thus, it is best to go on a soft diet and gradually add more solid food as the gums continue to heal.

Possible Risks and Complications

A patient who undergoes a wisdom tooth extraction will be at risk of:

  • Bleeding – Although bleeding is normal after surgery, patients should guard against prolonged bleeding, which may indicate an underlying problem.
  • Infection – During dental surgery, there is a risk that the bacteria in the mouth could enter the bloodstream. This places the patient at risk not only of wound infection at the surgical site but also of various infections in other parts of the body.
  • Allergic reaction to anaesthesia – A wisdom tooth extraction, like any other surgery, carries with it a certain risk of complications caused by the anaesthesia used during the procedure.
    In order to keep the affected area from becoming infected, it is important to keep the mouth clean. Rinsing and brushing the teeth carefully will help achieve this. Dentists also typically prescribe antibiotics prior to and following the surgery to prevent infections. This is especially important in cases wherein the patient suffers from an existing condition that compromises his immune system.

Other rarer and more serious side effects include:

  • Fractured jaw – This usually occurs only if the tooth was firmly attached to the jawbone, a problem that the dentist may detect before the surgery and can thus prevent.
  • Opened sinus cavity – This usually occurs when an upper jaw wisdom tooth is removed.
    It is normal to experience some pain and swelling after the procedure. However, the patient should watch for signs of complications, which include:

  • Trismus, or difficulty opening the jaw

  • Gums that heal very slowly
  • Dry socket, also called alveolar osteitis – This is a painful inflammation that occurs when the blood clot that protects the wound disappears too soon. This complication most commonly affects women, as the blood clot sometimes disappears during their menstrual cycle. Thus, women who are on oral contraceptives are advised to undergo a wisdom tooth extraction at the end of their menstrual cycle to reduce the risk of dry socket.
  • Numbness in the mouth and lips shortly after the procedure, which may indicate an allergic reaction to the anesthesia used
    At the first sign of these problems, patients should consult their dentist immediately for treatment.

    Reference

  • Hupp JR, Ellis E, Tucker MR. Principles of Management of Impacted Teeth. In: Hupp JR, ed. Contemporary Oral and Maxillofacial Surgery. 6th ed. Philadelphia, PA: Elsevier Mosby; 2014:chap. 9.

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