DENTAL SURGERY &
POST GRADUATE TRAINING CENTRE
WISDOM TEETH
Wisdom teeth are the very last teeth to develop. They usually erupt between the ages of 18 and 23. Wisdom teeth are also called the 'third molars' or the 8th tooth.
They can cause a variety of problems and unfortunately, they often need to be extracted.
Below you will find some information and answers to common questions about wisdom teeth.
WISDOM TEETH
REASONS FOR REMOVAL
Not everybody needs their wisdom teeth removed, in many cases wisdom teeth never cause any issues. But when wisdom teeth do cause issues they often need to be removed.
The are 4 reasons a wisdom tooth may need to be removed
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Pain
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Pathology
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Part of another treatment (ie orthodontic treatment)
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Preventative
Note that preventative removal of asymptomatic wisdom teeth is controversial under modern guidelines and it is not something we routinely recommend.
At your first consultation at Adelaide Tooth Removals & Dental Implants, Dr Andrew Chan will perform a thorough assessment and run through the reasons you may (or may not) want to remove each of your wisdom teeth, and discuss the risks, potential benifits, alternatives and costs of treatment.
WISDOM TEETH
& PAIN
Wisdom teeth can cause pain in a variety of ways.
The most common way a wisdom tooth causes pain is due to something called 'pericorinitis.' When wisdom teeth fail to erupt properly or fully into the mouth, it is often impossible for patients to brush and floss effectively around the partially erupted wisdom tooth. This allows food debris and bacteria to build up underneath the gum around the wisdom tooth, often causing an infection, swelling and pain.
Not being able to floss or brush around a partialy erupted wisdom tooth can also cause cavities on the wisdom tooth or neighbouring teeth. Large cavities can cause severe tooth aches.
Upper wisdom teeth sometimes erupt sideways and rub on patient's cheeks causing painful traumatic ulcers. An overupted wisdom tooth can cause patients to bite on to the opposing gum, again causing trumatic ulcers and pain.
WISDOM TEETH
& CROWDING
Wisdom teeth do not cause crowding of teeth, contrary to common belief. And prevention of crowding is not a reason to have wisdom teeth removed.
Teeth tend to crowd as we get older regardless of the prescence of wisdom teeth. We are not totally sure why this happens, but our teeth tend to move forward as we get older. This is called 'tertiary' crowding.
Whilst removal of wisdom teeth will not prevent crowding, the removal of teeth may be required to achieve better alignment.
It is common for your dentist or orthodontist to request teeth be removed prior to starting braces or invisalign.
RECOVERY
AFTER WISDOM TEETH REMOVAL
The recovery time after having a wisdom tooth removed is variable and depends on many factors. It can not be accurately predicted.
Simple tooth extractions are often performed at our consultation rooms with only injection to numb the area, and removed whilst patients are awake. A simple tooth extraction can be completed in as little as 5 minutes, in some cases. After a simple tooth extraction patients can often return to their usual activities immediately.
Complex (surgical) tooth extractions are often performed under general aneasthetic in a hospital. After a complex tooth extraction, patients should expect to experience several days of swelling and discomfort. After a complex tooth extraction most patients will be ready for their usual activities after 2-5 days.
Lower wisdom teeth are often more complex whilst upper wisdom teeth are often simple to extract.
On some occasions patients can have a much longer than expected recovery time after a tooth extraction. On rare occations patients may not be ready for their usual activities for up to 2-3 weeks.
The advice above is general in nature. At Adelaide Tooth Removals & Dental Implants Dr Andrew Chan will discuss the specifics of your case and give you an estimate of how complex or simple your extractions appear to be, and advise what your recovery time is expected to be.
WISDOM TEETH
ANAESTHESIA & SEDATION
Anaesthesia and sedation are an important part of teeth extractions. There are 4 'levels' of anaesthesia and sedation we offer patients at Adelaide Tooth Removals & Dental Implants.
Local anaesthetic only
This means the tooth or teeth will be removed at our dental offices with injections to make the area numb. This method is suitable for relatively simple wisdom teeth extractions in patients that are not overly anxious. After the area has been anaesthetised with an injection, removing a tooth is not painful. It is however uncomfortable and unpleasant. Patients will still feel the pressure and pushing aspect of the procedure (but it should not ever be painful).
Local anaesthetic with oral sedation
This means that patients are given tablets to offer a mild level of sedation. We often use diazepam (valium) or temazepam. This is an 'anti anxiety' medication and often used as a 'sleeping tablet'. It makes patients feel mildly sedated and helps patients cope with the unpleasant experience. Patient still need an injection to make the area numb. This is suitable for relatively simple wisdom teeth extractions in patients who are mild to moderately anxious. You can not drive yourself to or from your appointment if you take oral sedation.
IV sedation
A fully qualified anaesthetist administers sedative medications (such as midazolam and fentanyl) intravenously (via a thin plastic flexible needle that is placed in your vein). This is a strong level of sedation, however patients are still conscious and breath for themselves. Patients under the influene of IV sedation should still be able to obey simple commands whilsts sedated such as 'open wider', or 'turn your head to the left'. However patients often fall asleep and snore during the procedure and often will not remember the majority of the process. This is suitable for simple to moderately complex wisdom tooth cases in patients who are moderately to severely anxious
General anaesthetic
Patients are 'put to sleep' in a hospital setting by a qaulified anaesthetist in an accredited hospital and operating theatre. Patients are completely 'asleep'. This is suitable for complex wisdom teeth extractions and/or patients who are highly anxious. If patients have hospital insurance, their insurance will usually cover most of the aneasthetic and hospital fees.
What about 'gas'?
We don't encourage the use of 'gas' or nitrous oxide for sedation. Nitrous oxide offers a mild level of sedation. However it requires the use of a relatively large nasal mask with multiple tubes, and it requires patients to continuously breath through their nose. The nasal mask and tubes are cumbersome and often get in the way during a procedure. And patients often breath through their mouth, especially when anxious, making the administration of the gas unpredictible. Whilst we do have the ability to offer 'gas' for patients that have a strong preference for this method of sedation, we would discuss other more favourable and reliable methods of sedation.
HOW ARE WISDOM
TEETH REMOVED
There are many techniques used to remove teeth. And the techniques used in any particular case depends on many factors.
However many patients are often curious, and want to know 'how are you going to remove my tooth'.
Keeping in mind that the below points are a generalisation there are 3 general categories or 'techniques' for removing a tooth.
Simple extractions
If the conditions and anatomy of a tooth is favourable, teeth can often be extracted with 'simple' techniques using only hand instruments such as forceps and luxators. In such cases teeth can be gently pushed and/or pulled out without too much fuss.
Sectional extractions
Sometimes teeth need to 'cut into pieces' to remove them. Teeth are often cut into 2, 3 or 4 pieces. Teeth are drilled in a similar way as to when teeth are drilled when a filling is performed. Once the tooth is 'cut into pieces' hand instruments are then used to push and/or pull the seperate pieces out.
Surgical extractions
For complex teeth extractions, the gum needs to be cut and a 'flap' of gum needs to be raised away from the bone, and the bone around the tooth needs to be cut away to allow the tooth to be removed. The 'flap' is often stitched back into place with dissovable sutures.
At your consultation Dr Andrew Chan will inform you about the likely approach he will use to remove each of your teeth.
