Wisdom Teeth

 

Why Remove Wisdom Teeth?

 

1. Due to the fact that they are mostly impacted, or partly erupted, this can cause clenching resulting in headaches.

2. Soft tissue overlying partly erupted wisdom teeth, can entrap food and debris, causing infection in the surrounding area, resulting in swollen glands, and pain in the area, especially in chewing.

3. Impacted wisdom teeth can be the cause of cysts and tumors developing in the posterior part of the jaws.

4. The most common complication resulting from impacted or a partly erupted wisdom tooth, are the pushing effect on the front teeth, resulting in cramming or extrusion of the incisor teeth, out of alignment. This is particularly relevant after orthodontic treatment. Most orthodontists, would splint the anterior teeth after the removal of the patient’s braces. These splints must stay on until the wisdom teeth have been removed. So, after your orthodontic treatment, remove your wisdom teeth a.s.a.p. Even if it means removing them at a slight earlier age.

5. Wisdom teeth, due to there impaction, can decay, and can cause adjacent teeth to decay as well. The decay, is in the root of the tooth in front of the wisdom tooth, and is in most cases not repairable because it is below the level of the bone. This tooth is usually removed as well. This can ultimately lead to the removal of the unopposed tooth in the opposing jaw as well, resulting in a lot of tooth loss.

 

POSTOPERATIVE SYMPTOMS (after wisdom tooth removal)

 

1. Swelling and bruising for up to 5 days, depending on the severity of the impactions.

2. Pain and discomfort for 2 – 3 days. Pain killers, antibiotics and a mouth rinse are prescribed, and are usually sufficient.

3. Sutures placed afterwards, are usually self dissolvable.

4. In this practice, all patients are anaesthetized while asleep, waking up with no pain afterwards. Once back in the ward, painkillers are administered which help for the transitional period when the local anesthetic wears off.

 

Surgical Removal of Wisdom Teeth

 

1. The surgical removal of impacted wisdom teeth are most probably the most common surgical procedure in the field of Maxillo- Facial and Oral Surgery.

2. Wisdom teeth normally erupt around the age of 16 years in women, and a little later in men.

3. If wisdom teeth are absent in the mouth after the age of 17 – 18 years, they are either absent, in the mouth, or they are impacted.

4. The ideal age to remove wisdom teeth is at the age of 16 – 17 years. At this age, the roots of the wisdom teeth have not formed completely, and pose no threat to the main nerve in the lower jaw.

5. The bone is relatively soft at this age, and the wisdom tooth consists mainly of a crown only. This makes it relatively easy for us as specialists to remove them.

6. Recovery after the procedure, at this age, is also relatively uneventful. The older the patient gets before removing his or her wisdom teeth, the more difficult the procedure gets, and the longer the recovery period is.

 

POSSIBLE COMPLICATIONS

 

1. Permanent damage of the inferior dental nerve of the lower jaw, resulting in a permanent numbness of the lower lip and chin area. This is a result of the roots of the wisdom tooth developing and growing around or in close approximation to the dental nerve. In a younger age, eg. 16 years of age, the roots are not formed yet and posing no threat to the dental nerve.

2. Due to the increased difficulty in the removal of wisdom teeth at a later stage in life, injuries to adjacent structures eg. Lingual nerve, jaw bone and soft tissues like the tongue and adjacent structures, can occur. Numbness to the tongue is a very uncomfortable complication, and permanent numbness to the tongue leads to chronic biting of the tongue, resulting in chronic ulcers and speech impairment.

3. Exposure of the maxillary sinus in the upper jaw, or the intrusion of the wisdom tooth into the maxillary sinus. This will result in an extra procedure, called a Cauldwell – luc, only possible to be performed by a Maxillo- Facial and Oral Surgeon. The sinus is exposed, the tooth is removed, and the sinus must be closed afterward. Nose blowing for 14 days at least, is not permitted.

4. Wisdom teeth, especially in older patients, should always be removed by a specialist Maxillo- Facial and Oral Surgeon. As a specialist, the procedure takes quicker, resulting in less postoperative complications. In the case of any intraoperative complication, the specialist can handle the complication himself.

 

Local vs. General Anesthetics

 

Most procedures for the surgical removal of wisdom teeth are performed under general anesthetic. However, in certain conditions, the procedure can be performed under local anesthetic in the dental chair. Limiting factors in this situation are patient compliance, and the amount of local anesthetic needed. A local anesthetic is therefore ideal for adults with single tooth removals.

 

Medical aid

 

1. Most procedures for the surgical removal of wisdom teeth are performed under general anesthetic.

2. However, in certain conditions, the procedure can be performed under local anesthetic in the dental chair. Limiting factors in this situation are patient compliance, and the amount of local anesthetic needed. Local anesthetic is therefore ideal for adults with single tooth removals.

 

Duration of Operation

 

1. In this practice, the surgical removal of 4 impacted wisdom teeth takes 30 min. on average, constituting a hospital time of approx. 45 min.

2. The cost of the Constantia Day Clinic, is aprox. 50 % of a Private Hospital.

3. The anesthetist’s fees is determined by hospital anesthetic time. Patients go home after 1 hour after the operation and are not allowed to drive themselves. Costs are indicated on the quotation form.

 

GENERAL ADVICE

 

1. Have your wisdom teeth removed at the age of 16 – 17 years of age.

2. Always have a specialist removing them

3. After orthodontic treatment, have your wisdom teeth removed within 6 – 8 months after finishing your orthodontic treatment.

4. Have your operation in a Day Clinic as far as possible. This will save costs, especially if you are on a Hospital Plan only.