Wisdom Teeth Removal

Wisdom Teeth (Third Molars)

Wisdom teeth are the last teeth to erupt into the mouth and are the third set of molars. Most people have four third molars but sometimes one or more may be missing or even extra ones can occur. They usually erupt around the ages of 16-20 years or even older. If the jaws are large enough, they can erupt fully into a functional position and if well maintained with healthy gums they do not need to be removed. However this is most often not the case. Wisdom teeth may be partially or fully trapped under the gum and bone which is called impaction. These impacted teeth can also turn in different orientations as they try to erupt.

Why do wisdom teeth need to be removed?

Wisdom teeth can cause a number of problems the most common of which is infection which may be mild but can develop into a serious condition. They can develop periodontal disease or tooth decay possibly affecting the adjacent second molars. They could contribute to movement or crowding of the other teeth and may even resorb the root of an adjacent tooth. Occasionally wisdom teeth develop pathology such as cysts, particularly if they are in place for many years.  Early removal of wisdom teeth is recommended to avoid such future problems and the procedure is easier with decreased the surgical risk if it is carried out at a younger age.

Wisdom teeth are assessed by a clinical examination and special panoramic radiographs (OPG, Cone Beam). These are used to predict if they are likely to cause problems in the future and you will be advised on the requirement and best timing for their removal.

Surgical Removal of Third Molars

Wisdom teeth can be removed in the chair with local anaesthesia alone, with the addition of intravenous sedation or in private hospital under general anaesthesia. The choice will depend on the number of teeth to be removed, the degree of difficulty or the length of the procedure and whether you would prefer to be asleep. Drs Lim and Rix have vast experience in carrying out this procedure, operating in their surgical suite at Chatswood for local anaesthetic and intravenous sedation procedures or at Hunters Hill Hospital, Dalcross Adventist Hospital or Sydney Adventist Hospital for general anaesthesia.

How is the surgery done?

Incisions are made in the gum behind the last molar teeth. Bone overlying the impacted tooth is removed and if required the tooth is split into sections to allow for easier removal. The tooth is then elevated from the socket and the area cleaned and resorbable (dissolving) sutures are placed. Gauze pads are placed over the area on which you bite down to help control any residual bleeding. The procedure takes approximately one hour for four teeth. If the procedure is carried out in our surgical suite under local anaesthetic or intravenous sedation you will be ready to go home after 10-15 minutes. If you have had a general anaesthestic in hospitable you will recover there for about 4 hours and be provided with soft food and registered nurses will be checking you.

What is the recovery like?

Straight after surgery your mouth will be numb from the local anaesthetic used. After about 4 or more hours this will wear off and you will be advised to start taking analgesics (painkillers) regularly and possibly antibiotics. Swelling of the face and difficulty opening wide is normal and occasionally bruising may be noticed. Like the pain the swelling will take about a week to subside. During this time you will be restricted to a soft diet and advised to carry out frequent mouthwashing.  You may require a week off study, work and vigorous activity.

What complications can occur?

Some bleeding may occur in the first week and is controlled by using gauze packs. Dry socket may develop after a few days causing a constant throbbing pain which is treated by using a special dressing in the socket. Occasionally an infection may develop after a few weeks and this is treated with antibiotics. More unusual problems include problems with the sinus from an upper third molar or nerve injuries. The nerves that give feeling to the lower lip and feeling and taste sensation to the tongue lie close to wisdom teeth. When these teeth are removed there can be pressure or stretching of the adjacent nerves. This can result in numbness, tingling or pain in the lip, chin, tongue and teeth. This would normally recovery over the next few weeks or months. It is rarely permanent. There have been cases of a jaw fracturing after surgery. This is very rare and may be related to teeth with pathology, very deep teeth and older patients.