Wisdom Teeth Removal in Sydney
OVERVIEW
Wisdom Teeth
The four wisdom teeth, or third molar teeth, are the last permanent teeth to erupt in the mouth behind your second molar teeth, usually around middle teenage to mid-twenties (17-25 Y), an age traditionally associated with the onset of maturity and the attainment of wisdom.
Impacted wisdom teeth
Although most people develop and grow 32 permanent adult teeth, many times their jaws are too small to accommodate the four wisdom teeth. Due to lack of space, tooth bud position, obstruction, or pathology, the wisdom teeth may remain trapped in the gum or partially erupt, a condition known as impacted. When they are impacted, normal hygiene is either difficult or impossible – even for the hygienist. This leads to most of the detrimental issues caused by impacted wisdom teeth.
Problems associated with impacted wisdom teeth
It has been estimated that up to 85% wisdom teeth will eventually require removal due to some associated problems.
- Crowding of teeth
- Pain or discomfort in the back jaw
- Localised gum disease (pericoronitis)
- Dental infection which can be serious
- Infection or cavities in adjacent teeth
- Cheek, gum trauma and ulcers
- Pathology such as cysts and tumours
- Difficulty in opening and closing the mouth (trismus)
Potentially problematic wisdom teeth may remain asymptomatic, hence an OPG X-Ray is mandatory around the age of 18 years to rule out any hidden pathology such as tumour and cyst.
Assessment of wisdom teeth
Potentially problematic molars may remain asymptomatic. Issues related to wisdom teeth can be diagnosed during routine check-ups. OPG X-Rays are taken by surgeons to determine the position of wisdom teeth in the bone, their relationship with adjacent teeth, and the position of the roots related to jaw nerve.
Removal of wisdom teeth
Removal can be done under local anaesthesia in the dental chair (awake), or under general anaesthesia (asleep) in the hospital, under strict infection control standards. The surgical procedure may involve exposure of the tooth, removal of a small amount of bone for access, and in some cases tooth sectioning. Following removal of the wisdom tooth, the site is cleaned with saline and closed with resorbable sutures.
Most patients can resume routine activities in 4-7 days. Slight pain, bruises, swelling, bleeding, and limited jaw movement in the first 24-96 hours are normal. A medical certificate is provided for one week to rest and allow uneventful healing.
Treatment of impacted wisdom teeth
The most predictable treatment of impacted wisdom teeth is the removal of wisdom tooth/teeth under local anaesthetic, or removal under general anaesthesia in hospital. Sometimes a procedure called “Coronectomy” is performed when the roots of wisdom teeth are in contact with the jaw nerve. Coronectomy is the removal of crown of the tooth and leaving the roots in the bone buried to prevent serious surgical complications.
Preventative measure to prevent impacted wisdom teeth
There is no way to avoid having impacted wisdom teeth. Removing wisdom teeth as a teenager when the roots are only partially formed for few reasons. Soft bone, underdevelop roots, prompt healing of the site in young healthy people may have lower incidence of complications as opposed to old people. Partially developed teeth do not have a complex root structure yet and significantly lower risk of injury to the jaw nerve. Furthermore, older patients often have medical conditions that complicate surgery and anaesthesia. Older patients have a higher incidence of post-operative complications and take longer to heal than younger patients.
Untreated wisdom teeth
The problems and risks of leaving impacted wisdom teeth untreated may include pain, facial swelling, infection, decay, bone loss, damage to adjacent teeth and formation of cysts or tumors. Untreated wisdom teeth may develop infection in the soft tissue around the impacted tooth which comes and goes. In some situation, this infection can spread too deeper structure developing a serious infection called Ludwig’s angina which may compromise airway and can be life threatening. It has been reported that impacted wisdom teeth may develop cyst and tumour which may grow to a very large size without causing any signs or symptoms.
Key takeaways about impacted wisdom teeth
- Don’t wait until it becomes an emergency to remove impacted wisdom teeth
- Assess impacted wisdom teeth before they complete growth
- If you can’t clean them, they should be removed to avoid serious problems
Call Sydney Oral Surgery & Implant Specialists today on 1300 798 701 to schedule a preliminary screening to see if a dental implant is right for you.
Potential risks related to wisdom tooth surgery
Like all surgeries, the generalized risks are pain, swelling, infection and bleeding. Pain and swelling are usually mild to moderate with the worst being the first 48-72 hours. Most patients are out of pain or close to it about one-week post-surgery. Infection is unlikely, especially in young healthy patients. Bleeding usually stops within a few hours after the surgery from biting on gauze. While it is normal to have a bit of blood in your saliva for a few days after the surgery, problem bleeding is exceedingly rare.
Upper wisdom teeth frequently stick up into the sinuses to some degree and in rare cases there can be a small perforation into the sinus floor. This can lead to symptoms such as stuffiness, nose bleed, sinus infection or feeling air or fluid passing between the mouth, sinus and nose. This issue is treatable and usually resolves within 1-3 weeks and is fixable with minor surgery in the even more rare case that it does not heal on its own.
Lower wisdom teeth are close to and sometimes touching the inferior alveolar nerve, which is responsible for sensation in the lower lip, chin and jaw on either side. This nerve is for feeling only and does not move any muscles so if it is affected by the surgery the patient would feel numb or tingly in those areas but would not have any change in appearance or function. The overall incidence of nerve injury with lower wisdom teeth is 0.3% and is almost always temporary with feeling returning to normal in weeks to months. The position of the teeth to be removed in relation to the nerve is determined by X-Rays and in cases in which the risk is elevated a CT scan, which is a 3D X-Ray, will be taken to further evaluate.
Any invasive or surgical procedure may carry risks. Before moving forward, it is recommended that you seek a second opinion from an appropriately licensed professional.