INFORMATION REGARDING REMOVAL OF IMPACTED AND UNERUPTED TEETH
IS AN IMPACTED TOOTH?
impacted tooth is one which has been prevented from erupting into the
mouth. The tooth may be blocked by another tooth, or dense bone or a
pathological condition. Any tooth can be impacted, but more often
than not, impacted teeth are wisdom teeth or third molars as dentists
people have enough room in the backs of their mouths for their third
molars to grow out straight and healthy, and they may function well
for a lifetime. However, many others do not have enough room, and
the wisdom teeth are crowded and tilted.
HARM CAN IMPACTED TEETH DO?
Impacted teeth may grow in any direction; however they often grow
forward and push against the adjacent second molar. This can result
in pain in the second molar and possibly damage to the roots or
crown. The second molar may also be pushed out of position. 2. All
teeth develop in sacs deep in the bone. If the tooth erupts
normally, the sac generally disappears. If the tooth is impacted,
the sac can fill with fluid and enlarge to form a cyst. The cyst can
cause destruction of surrounding bone and damage to other teeth in
the area. 3. Whenever saliva can reach the tooth, decay may occur,
and since such cavities cannot be filled severe pain may result.
This may be followed by the formation of an abscess. 4. Bacteria in
the saliva may cause an infection around the crown of the wisdom
tooth and under the flap of gum tissue which may be covering part of
the tooth. This infection may spread to the cheek, throat or neck
and result in severe pain, stiffness of the jaws, fever, and severe
generalized illness. 5. Pressure from the wisdom teeth may cause
crowding of the front teeth. This is why some orthodontists do not
consider orthodontic treatment complete until impacted third molars
have been removed.
IS IT BEST TO HAVE WISDOM TEETH REMOVED?
dentist can study x-rays of the teeth and jaws, and can frequently
tell by the teen years if the wisdom teeth are going to be impacted.
At this stage the roots are usually not fully formed in most people
and the bone is less dense. Therefore, the wisdom teeth are less
complicated to remove and the healing is generally faster.
IS IT LIKE TO HAVE AN IMPACTED TOOTH REMOVED?
the impacted tooth is usually completely beneath the surface of the
gum and often encased in bone, we consider its removal an operation
in every sense of the word. This is said not to frighten the
prospective patient, but rather to give a better understanding about
certain features regarding cost, careful preparations and the need
for good aftercare. Either local and general anaesthesia or local and
sedation may be used. The dentist chooses the method of treatment
based on each individual situation. Having a comfortable patient
helps to control bleeding, allows the dentist to work without haste
and causes less physiological disturbance to the patient. The actual
removal of the tooth is done in keeping with recognized surgical
principles, with meticulously sterile instruments, good light, a dry
operative field, gentle handling of the soft tissue and bone and the
advantages of a well trained team. Depending on the degree of
difficulty of the individual case, the procedure may last from
fifteen to sixty minutes. If sedation or general anaesthesia is used
there will be a recovery period from thirty to ninety minutes. The
surgical wound may be sutured with a material of the dentist’s
choice. Most often dissolving sutures are used.
SHOULD I EXPECT AFTER SURGERY?
any surgical procedure a certain amount of discomfort is anticipated.
For this reason you will be provided with pain relieving medication
before you leave the office. You are to take your pain medication as
directed by the dentist; instructions will be on the bottle. Your
dentist will decide if antibiotic medication is necessary and if this
medication has been prescribed then it should be taken until all
tablets are gone. Swelling after surgery is normal. You should
expect to be most swollen forty eight to seventy two hours after
surgery. The swelling then begins to resolve. Certain individuals
have bruising after wisdom teeth surgery. The bruising may extend
into the neck and chest. This should not alarm you as in some
individuals this is the normal sequence of events.
of the jaws is also normal after wisdom teeth surgery and is usually
at its worst two or three days after surgery. One should start to
exercise the jaws on the second or third post operative day to return
the jaws to normal.
it will probably be difficult to eat after surgery in the mouth one
must remember that the body heals itself by drawing upon its reserves
of protein, vitamins, minerals, calcium and iron. Failure to
replenish the body’s supplies of the above mentioned nutrients can
result in fatigue, infections and even delayed healing. For the
first twenty-four hours following surgery your food and beverages
should be warm or cold NOT HOT. Eggs, custards, yogurt, milkshakes,
baby food, etc., are both nutritious and manageable. Fluid intake
should be approximately two litres or eight juice glasses per day for
the average adult.
post operative instructions will be provided before you leave the
THERE ANY COMPLICATIONS OR RISKS?
operation carries some degree of risk. This risk is minimized by
careful preoperative assessment of your physical condition, by
careful examination of all of the diagnostic materials, by careful
preparation of instruments and all facilities, and by the skill of
your dental team. The most commonly encountered complications will
be discussed below.
bleeding is usually encountered when the patient has not placed the
gauze pack DIRECTLY over the surgical site. Pressure over the site
for forty-five to sixty minutes will control most post-operative
bleeding. If you are still concerned call the office and the problem
will be dealt with promptly.
condition known as dry socket occurs in approximately five percent of
patients. It is more common in smokers and in female patients on the
pill. It is manifest by a dull throbbing pain which starts five or
seven days after the operation and is accompanied by a foul odour
from the mouth. The treatment for this problem is simple and
consists of two or three dressing changes. Healing is slightly
slower than normal.
roots of lower impacted teeth very often rest on and around the main
nerve of the lower jaw. Very rarely, in spite of all precautions,
during the removal of lower third molars this nerve is bruised,
slightly lacerated or even severed. The result will be numbness of
the lower lip, chin, and all of the teeth on that side. This effect
does not last longer than a few weeks in most cases. It improves as
the nerve repairs itself and regenerates. Occasionally the numbness
may last as long as two or five years and even more rarely it may be
permanent .Also in the region of the lower third molar is the nerve
which supplies sensation to the lateral part of the tongue. It may
on occasion be stretched with a resultant numb tongue. This problem
usually resolves within several weeks or months. Upper impacted third
molars lie against the wall of the sinus. Great care is taken to
insure that no injury occurs to this structure but occasionally the
thin wall of bone cracks and blood seeps into the sinus.
Occasionally there may be formed a communication between the sinus
and the mouth. If your dentist suspects this to be the case you will
be informed and additional medication will be prescribed. Infections
after the removal of wisdom teeth are rare. Redness, increasing
swelling after an initial decrease, foul tasting discharge into the
mouth, fever and chills are all signs if infection. If these should
appear call the office and you will be attended to promptly.
large fillings in the second molar teeth may be loosened or cracked
during the removal of the wisdom teeth in spite of immaculate care
and skill. If the possibility of this exists prior to surgery, you
will be informed.
very rare complication is a cracked or fractured lower jaw. This
occurs when the wisdom tooth is very severely impacted. If your
dentist is concerned about this possibility, you will be informed.
Dr. Brian Kumer