Many people require removal of their third molars also known as wisdom teeth. As with any surgical procedure, there are some possible risks and complications. The decision on third morlar removal should be decided by a patient and their oral surgeon.
Is it necessary to remove wisdom teeth?
Wisdom teeth are a valuable asset to the mouth when they are healthy and properly positioned. Often, however, problems develop that require their removal. When the jaw isn't large enough to accommodate wisdom teeth, they can become impacted (unable to come in or misaligned). Wisdom teeth may grow sideways, emerge only part way through the gum or remain trapped beneath the gum and bone.
Extraction of third molars is generally recommended:
- when wisdom teeth only partially erupt
- when there is a chance that poorly aligned wisdom teeth will damage adjacent teeth
- when a cyst (fluid-filled sac) forms, destroying surrounding structures such as bone tooth roots.
The most common reason people choose to remove their wisdom teeth is that their mouth is t too small for these teeth to normally erupt behind the second molare into a good position. This can result in one of the following situations:
- complete bony impaction when the wisdom teeth are completely covered in bone. When the tooth is completly covered with bone it will remain completly covered with its "developmental sack" in which all teeth develop. Later in life, this sack may undergo changes and enlarge and develop ionto a cyst. This cyst will enlarge at the expense of the bone of the jaw. These cysts should be removed and and examined by a pathologist.
- partial bony impaction whenThe teeth begin to erupt but are not able to erupt completely. In this situation, the upper third molars usually are poisitoned towards the cheek while the lower third molars usually lean forward with only part of the crown sticking through the gum. This situation can to decay and gum disease around the second molar directly in front of it.
The most common complication of the partial bony impaction, is that the flap of gum tissue which partially covers the erupting third molar, creates a pocket where bacteria that are present in the mouth can grow and and cause an infection known as pericoronitis. The swelling and infection can become very serious. The treatment for pericoronitis is extraction of the third molar tooth.
Wisdom tooth removal usually is effective in preventing:
- crowding of the back teeth
- a wisdom tooth becoming stuck in the jaw (impacted) and never breaking through the gums
- red, swollen, and painful gums caused by a flap of skin around a wisdom tooth that has only partially come in.
- gum disease and tooth decay in the wisdom tooth, which may be harder to clean than other teeth, or in the teeth and jaw in the area of the wisdom tooth.
- In most cases, the recovery period lasts only a few days. Take painkillers as prescribed by your oral surgeon. The following tips will help speed your recovery.
- Bite gently on the gauze pad periodically, and change pads as they become soaked with blood. Call your dentist or oral surgeon if you still have bleeding 24 hours after your surgery.
- While your mouth is numb, be careful not to bite the inside of your cheek or lip, or your tongue.
- Do not lie flat. This may prolong bleeding. Prop up your head with pillows.
- Try using an ice pack on the outside of your cheek for the first 24 hours. You can use moist heat-such as a washcloth soaked in warm water and wrung out-for the following 2 or 3 days.
- Relax after surgery. Physical activity may increase bleeding.
- Eat soft foods, such as gelatin, pudding, or a thin soup. Gradually add solid foods to your diet as healing progresses.
- Do not use a straw for the first few days. Sucking on a straw can loosen the blood clot and delay healing.
- After the first day, gently rinse your mouth with warm salt water several times a day to reduce swelling and relieve pain.
- Do not smoke for at least 24 hours after your surgery. The sucking motion can loosen the clot and delay healing. In addition, smoking decreases the blood supply and can bring germs and contaminants to the surgery area.
- Avoid rubbing the area with your tongue or touching it with your fingers.
- Continue to brush your teeth and tongue carefully.
- Risks/complications of the removal of third molars
The upper third molars have roots which often are separated from the maxillary sinuses by only a very thin layer of bone. Occasionally, a small communication is established between the sinus and the oral cavity when one of the upper third molars is removed. If this is the case, the normal procedure is for the area to be sutured closed, the patient to be informed of the finding, appropriate antibiotics and decongestants to be prescribed, the patient to be instructed to avoid Valsalva maneuvers (tasks which build up pressure in the sinus like nose blowing and bearing down forcefully) and the patient reappointed for followup. Most often this results in an uneventful healing period with no further treatment being required. Occasionally, the area will heal open rather than closed in which case an additional small surgical procedure will be required to close the communication.
The lower third molars often have roots that lie very near or even wrapped around the inferior alveolar nerve. This is the nerve that supplies feeling to the lip, teeth and tongue on each side of the mouth. Occasionaly, when a lower third molar is removed, that nerve will be bumped or bruised and if so a change in sensation may be noted on that side. It is important to understand that this is a sensory nerve and does not affect the ability to move the parts of the oral cavity to which it gives sensation (feeling). In most cases, the nerve heals itself but, because nerves heal slowly, it may take six months to one year before return of normal sensation. Very rarely, the damage to the nerve is permanent.
Finally, the normal precautions, risks and benefits of extraction of any tooth also apply here and should be discussed with the oral surgeon prior to beginning any procedure.