What you should know about wisdom teeth removal

The human race has evolved drastically from early hominids, neanderthals and primates to become the highly efficient race it is today. Efficiency, by definition means achieving maximum productivity with minimum wasted effort or expense. This need for efficiency has resulted in various modifications in the biology and functioning of the human body, including shrinkage, or compaction of the cranial vault, growth of brain tissue, evolution of the ‘biped’ method of walking, etc.

However, the human body does give subtle hints as a reminder of its evolutionary past, more commonly known as ‘vestigeal organs,’ such as the ‘tailbone’ (coccyx) and the ‘wisdom teeth,’ to be named among a few others.

The ‘wisdom teeth’ or third molars as they are known technically, are a set of 4 teeth that erupt in the late adolescent to adulthood stage i.e., 17–25 years. With the complement of these teeth, the human dentition achieves its total count of 32. They are located far back in the upper and lower jaws behind the second molars. For their successful eruption in the mouth or oral cavity, the jaws should have adequate space to accommodate them. It is quite uncommon to see wisdom teeth in their ideal positions and functioning properly, without causing any discomfort to the person.

But with modification of the jaw size leading to a smaller version, wisdom teeth in most cases fail to erupt in the oral cavity. Thus, these teeth are said to be ‘impacted.’ These teeth are relatively asymptomatic and do not cause any problem. But as the adage says; “absence of symptoms does not mean absence of disease,’ these wisdom teeth are likely to cause a few problems that may or may not be seen.

Conditions which may lead you to visit the dentist are :

1. Pain, infection, caries, difficulty in cleaning the wisdom tooth

2. A semi–impacted tooth , or a tooth covered partially with a gum–flap, may become site of food lodgement and subsequently cause a condition known as pericoronitis, which leads to inflammation of the wisdom tooth.

3. The tooth may be associated with a hidden pathology such as cysts or tumors.

4. Inflammation of the attachment apparatus a.k.a, the periodontal ligament of the second molar, which in turn may cause irritation to the third molar

5. Wisdom tooth erupting in abnormal or awkward positions due to inadequate space in the jaws may also cause discomfort to the patient, more commonly in the form of ‘traumatic cheek bites.’

6. Problems in opening and closing of the mouth, due to associated symptoms in the temporomandibular joint (TMJ)

What does the dentist do?

A dentist or an Oral and Maxillofacial surgeon, will perform a complete evaluation of the wisdom tooth and surrounding structures to check the presence of periodontal inflammation, caries, infections and locate the source of pain.  According to the American Dental Association (ADA), it is recommended that routine radiographs, or X- Rays of the third molar region should be performed every 3–4 years after 20 years of age. This helps the dentist to ascertain the position and presence of any possible deviation in the path of eruption of the tooth and perform an extraction if needed.

What is wisdom tooth extraction?

On determining that the wisdom tooth finally needs to go, your dentist will recommend a third molar extraction surgery. It is a very common procedure and mostly results in an uneventful healing. A thorough medical evaluation is performed focusing on your medical history, such as presence of diabetes, any previous cardiac surgery, metabolic conditions, bleeding disorders, allergies, etc. Then you will be put on a medication of antibiotics and painkillers to reduce the incidence of pain and inflammation.

Techniques used :

Each tooth has its own story, and each story will have a different plot, hence envisaging the use of different approaches for different positions of the third molar. A standard incision is usually given in all cases, thus exposing the tooth for convenient visualization. In some cases, the tooth may be covered by a layer of bone.

The overlying bone needs to be removed. A few techniques employed are :

a) Lingual split technique using chisel and mallet

b) Buccal approach technique using chisel and mallet

c) Buccal approach technique using rotary instruments

After the removal of tooth, the flap is sutured/stitched in its original position with the help of resorbable/non resorbable sutures.

Wisdom tooth surgery is usually a routine outpatient procedure and  performed under a local anesthesia. After anesthesia, the wisdom tooth is removed with the help of surgical instruments and sectioning or cutting bone or tooth if necessary and the empty socket space is covered with a medicated gauze piece. The patient is given a few post–op instructions as:

1. Removal of the gauze piece after half an hour

2. Avoid any vigorous activity by the mouth such as spitting. This may cause the removal of blood clot formed in the extraction socket.

3. Consumption of only soft food or fluids at room temperature. This avoids any pressure on chewing.

4. Completion of the prescribed medication dose to aid in healing

5. Application of a cold pack if swelling occurs. Avoid hot fomentation as this may aggravate the swelling in the area.

What to expect after the surgery?

Normally healing occurs within  a period of 3 days to a week, after which the dentist removes the sutures.

Within normal limits, one can expect or experience the following symptoms :

1. Numbness of the mouth and lips due to effect of local anesthesia. This is nothing to worry about, as it is temporary and wears off in about 3-4 hours.

2. Heaviness of the tongue, if the lower wisdom tooth is removed

3. Swelling in the region, as a result of inflammation in the region

4. Inability to open the mouth (trismus)

5. Bleeding which may stop slowly in about 24 hours

Complications:

Complications during and after surgical removal of wisdom tooth constitute about 2.6% to 30.9 % of the cases. These include :

a) Pain, post–operative swelling, Dry socket (alveolar osteitis)

b) Permanent nerve damage due to impingement of nerve while performing surgery

c) Fracture of the jaw due to use of overzealous force of instruments

d) The transient bacteremia may be a matter of concern for patients with previous history of heart surgeries.

e)  In rare cases, a risk of airway obstruction due to swelling near the  tonsillar or retropharyngeal spaces

f) Infection of the maxillary (upper jaw) sinus

Third molars, with their variable anatomy and unique positions are often capable of messing with the ‘wisdom’ of the person suffering from its quirks. Regular check ups, maintaining good hygiene  and early recognition of the possible deviations is the key to a rather uneventful  problem. Get the more information about wisdom tooth extraction here.

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