Reasons for Wisdom Tooth Extraction in Dentistry.
Why are there so many different opinions about the surgical removal of wisdom teeth?
Three dentists were asked whether a wisdom tooth should be extracted or not – and came up with four different answers!
There are many different reasons, e.g. different levels of awareness of the indication concerned, economic considerations, different approaches, climatic conditions and presumably because only very few dentists can surgically remove wisdom teeth. Actually only oral surgeons and/or Facio/mandibular/oral surgeons are qualified to do so. Very few doctors like to send their patients away, out of fear of losing them to a colleague and so they are put on hold until problems crop up.
First of all, let’s define them:
- The teeth concerned – the so-called wisdom teeth – often do not reach chewing height. They remain just under the gums and regularly cause pain and/or sweetish smells in the mouth. Doctors speak of ‘retained rear teeth’. The term retention means a position of the wisdom tooth whereby after the completion of the growth of the root the chewing level is not reached.
- As partially retained we define a tooth of which part of the crown reaches the mouth, or which crosses the periodontal apparatus (the gum pocket) and reaches across to the 12-year molar (the 7th).
- As completely retained molars we define teeth which have no exposure at all to the mouth.
- The term impacted describes a wisdom tooth which is completely embedded in the bone.
- As displaced we define a tooth which varies in its axis or position from the regular breaking-through direction.
When should wisdom teeth be removed and when not?
They should be removed in the case of:
- an acute or chronic infection in the area of the wisdom tooth (dentition difficilis)
- advanced caries with involvement of the dental nerve (teeth damaged beyond repair by caries or inflammation of the dental nerve which cannot be treated)
- indications that the wisdom tooth is clearly the source of pain
- untreatable radiographical changes in the wisdom tooth (e.g. development of cysts)
- reabsorption of the neighbouring tooth
- as part of the treatment of and limitation of the progress of periodontal illness
- disturbance of the teeth in orthodontic and/or reconstructive surgery
- teeth which are in the break of a broken jaw and which would hinder the treatment of the break
- use of the teeth for transplantation purposes
- elongated or tilted wisdom teeth which disturb one’s bite
An indication can exist due to:
- tooth extraction due to unavoidable circumstances (e.g. unavailability of medical treatment in the past)
- when other procedures will be done under anaesthetic and a repeat of the anaesthetic would be required for the extraction of a wisdom tooth
- in planned prosthetic treatment, if a later eruption of the tooth due to further atrophication of the bone and/or the pressure load due to a removable prosthesis is expected to occur
- to simplify orthodontic tooth movement (braces)
An indication to extract doesn’t exist:
- as long as an unassisted, regular position of the wisdom tooth in its row is to be expected
- when the extraction of other teeth and/or orthodontic treatment including correcting the teeth makes sense
- in the case of deeply impacted and deep-lying teeth without associated illness, where a high risk of operative complications exists
Transplanting Wisdom Teeth!?
What does an implanted tooth cost? The cost of an implant? Wisdom tooth op? A lot of research is done on the Web about these questions but it’s just as wise to ask: What does a wisdom tooth transplant cost? In detail: Wisdom teeth don’t always need to be extracted, they can be transplanted too. Thus, a badly root-treated tooth can be extracted and replaced by means of a transplanted 8th tooth. A bridge or an implant isn’t always necessary, one’s own teeth are often sufficient – just ask your dentist!
Generally speaking outpatient treatment is enough. The extraction can take place singly, more than one or all together. Treatment under (general) anaesthetic/sedation may be indicated in the case of cooperation of the patient, of large dental interventional measures, of risk-factors or because of the express wish of the patient. In-patient treatment may sometimes be indicated in the case of serious illness or because of particular operational requirements. The significance of treatment with antibiotics before and after the operation has not been consistently evaluated scientifically. It is generally recommended. Whilst treatment for the pain can be effective in reducing swelling later it is not always required in every case.
After a wisdom tooth op the swelling generally increases for up to three days and then goes down again. What’s important to be observed afterwards? The recommendations below are general, just in case your dentist hasn’t given you enough information, and should be observed.
- Leave the bite-pad in your mouth for half an hour before removing it, unless your dentist has given you other advice
- Cool the operated area with a freezer pack or ice. Do not put ice directly in contact with the skin – it should be wrapped in a cloth
- No food for as long as the anaesthetic lasts and then no chewing on the operated side
- Avoid nicotine and alcohol and spicy, crumbly and raw foods as well as dairy products for the first three days after the operation
- Don’t pull at or stretch your lips or cheeks – no pouting in front of a mirror
- Revert to oral hygiene after 2 days. Don’t use a toothbrush in the operated area, use a cotton-bud dipped in 3% H2O2 solution.
- Rinsing twice daily for up to 2 weeks with a mouthwash containing chlorhexidine (Chlorhexamed for example) and more often with a 3% solution of H2O2 is also recommended. Rinsing with camomile tea is recommended to promote healing of the wound
- Do not use mouthwash in the operated area
- Do not be alarmed if, after the operation, one or more of the following occur: bruising, noticeable facial swelling (increasing for up to 4 days after the operation), difficulty in opening the mouth and running a temperature of up to 38.5°C.
- Avoid the sun and strenuous activity for the first few days after the operation (no sauna, sport, hiking, etc.)
- In the case of operations in the upper jaw and an opening of the maxillary sinus it is absolutely forbidden to blow your nose for 8 weeks; do not hold your nose when sneezing
This post is also available in: German