MODERN SURGICAL DENTISTRY
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 removed.
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 6 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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Packing (food packing)
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Prevention of crowding
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Prophylactic
Note that preventative (prophylactic) removal of asymptomatic wisdom teeth is controversial under modern guidelines and it is not something we routinely recommend. And it is not clear if wisdom teeth do or do not contribute towards crowding.
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 a 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 partially erupted wisdom tooth can also cause cavities on the wisdom tooth itself or neighbouring teeth. Large cavities can cause severe toothaches.
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.
ASYMPTOMATICWISDOM TEETH
Removal of asymptomatic wisdom teeth (ie wisdom teeth that haven't ever caused any pain) is controversial under modern guidelines. Dentist refer patient to us to have asymptomatic wisdom teeth removal very often.
We are hoping to educate dentists and patients on the latest guidelines for wisdom teeth removal suggest that only wisdom teeth that
The latest guidelines (
The are 5 reasons a wisdom tooth may need to be removed
-
Pain
-
Pathology
-
Part of another treatment (ie orthodontic treatment)
-
Packing (food packing)
-
Preventive or prophylactic
Note that preventative (prophylactic) 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
& CROWDING
Wisdom teeth may not cause crowding of teeth. And prevention of crowding is not necessarily a reason to have wisdom teeth removed.
Teeth tend to crowd as we get older regardless of the presence 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.
Currently all that can be said is that the cause of dental crowding is multi-factorial and, whilst wisdom teeth may play a significant role in some patients, the current state of knowledge does not allow us to identify with accuracy who is at risk.
The decision to prophylactically remove wisdom teeth in post orthodontic patients remains a patient preference derived decision. The evidence one way or another is lacking and unclear.
Whilst removal of wisdom teeth may not prevent crowding, the removal of teeth may be required to correct crowding.
It is common for dentists and orthodontist to request teeth be removed prior to starting braces or Invisalign. And your dentist or orthodontist may request for your wisdom teeth to be removed to prevent crowding.
References
1 - Hyam, D. M. (2018). The contemporary management of third molars. Australian Dental Journal, 63, S19-S26.
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 several days of swelling and discomfort. After a complex tooth extraction most patients will be ready for their usual activities after 2-5 days.
On rare occations patients may not be ready for their usual activities for up to 2-3 weeks.
Lower wisdom teeth are often complex whilst upper wisdom teeth are often simple to extract.
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 tooth extraction may 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 at Adelaide Tooth Removals & Dental Implants.
Local anaesthetic only
Local aneasthetic is given with an injection to numb the teeth that will be removed. 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). This method is performed at our rooms, and is suitable for relatively simple extractions on patients that are not overly anxious.
Local anaesthetic with oral sedation
Patients are given tablets to offer a mild level of sedation. We often use diazepam (valium) or temazepam. These are an 'anti anxiety' medications and they are often used as a 'sleeping tablet'. Diazepam and temazepam make patients feel mildly sedated and it helps patients cope with the unpleasant experience. Patient still need an injection to make the teeth numb. This is suitable for relatively simple teeth extractions in patients who are mildly 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. Patients treated with IV sedation are still conscious and should be able to respond to simple commands such as 'open wider', or 'turn your head to the left'. However patients will often will not remember the majority of the procedure. This is suitable for simple to moderately complex wisdom tooth cases in patients who are moderately to severely anxious. Note: We no longer offer IV sedation in our rooms, as The Australian and New Zealand College of Anaesthetists (ANZCA) strongly suggest that is not safe in the event of an adverse event. We now only offer IV sedation in Day Surgery or Private Hospital settings.
General anaesthetic
Patients are 'put to sleep' in a hospital or day surgery setting by a qaulified anaesthetist in an accredited hospital or day surgery. Patients are completely unconcious during a general aneasthtic. 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 costs and hospital fees.
What about 'gas'?
We don't encourage the use of 'gas' or nitrous oxide for sedation. Whilst nitrous oxide can deliver a mild level of sedation, 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 and the level of sedation unpredictible.
HOW ARE WISDOM
TEETH REMOVED
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. In such cases teeth can be gently "pushed" or "pulled" out without too much fuss.
Sectional extractions
Sometimes teeth need to be cut into pieces to get them out. Teeth are often "sectioned" into 2, 3 or 4 pieces using a standard dental drill. Once the tooth is sectioned hand instruments are used to remove the individual fragments.
Surgical extractions
For complex teeth extractions the bone around the tooth needs to be cut away to allow the tooth to be removed. This method often requires stitches as the end.
At your consultation Dr Andrew Chan will inform you about the likely approach he will use to remove each of your teeth.
