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The average adult has 32 teeth by age 18 — 16 teeth on the top and 16 teeth on the bottom. Each tooth in the mouth has a specific name and function. The teeth in the front of the mouth (incisors, canine and bicuspid teeth) are ideal for grasping and biting food into smaller pieces while the back teeth, or molar teeth, are used to grind food up into a consistency suitable for swallowing.
However, the average mouth is made to hold only 28 teeth. It can be painful when 32 teeth try to fit in a mouth that holds only 28 teeth. These four other teeth are your Third Molars, also known as "wisdom teeth."
Why Should I Remove My Wisdom Teeth?
Wisdom teeth are the last teeth to erupt within the mouth. When they align properly, and gum tissue is healthy, wisdom teeth do not have to be removed. Unfortunately, this does not generally happen. The extraction of wisdom teeth is necessary when they are prevented from properly erupting within the mouth. They may grow sideways, partially emerge from the gum, and even remain trapped beneath the gum and bone. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to erupt successfully.
These poorly positioned impacted teeth can cause many problems. When they are partially erupted, the opening around the tooth allows bacteria to grow and will eventually cause an infection. The result: swelling, stiffness, pain and illness. The pressure from the erupting wisdom tooth may move other teeth and disrupt the orthodontic or natural alignment of teeth. The most serious problem occurs when tumors or cysts form around the impacted wisdom tooth, resulting in the destruction of the jawbone and healthy teeth. Removal of the offending impacted tooth or teeth usually resolves these problems. Early removal is recommended to avoid such future problems and to decrease the surgical risk involved with the procedure.
Oral Examination
With an oral examination and x-rays of the mouth, Dr. Burger can evaluate the position of the wisdom teeth and predict if there may be present or future problems. Studies have shown that early evaluation and treatment result in a superior outcome for the patient. Patients are generally first evaluated in the mid- teenage years by their dentist, orthodontist or by an oral and maxillofacial surgeon.
All outpatient surgery is performed under appropriate anesthesia to maximize patient comfort. Dr. Burger has the training, license and experience to provide various types of anesthesia to allow patients to select the best alternative. These services are provided in an environment of optimum safety, utilizing modern monitoring equipment and staff experienced in anesthesia techniques.
Wisdom Teeth and Other Impacted Teeth
The Surgical Procedure
Extraction of wisdom teeth usually takes about one hour. Most patients have all of their wisdom teeth extracted at one time. For your comfort, a general anesthesia or IV sedation is recommended. A local anesthetic will also be used around each extraction site. Therefore, one will feel numbness in the lower lip, chin and tongue for a few hours after the procedure. Also, due to the close proximity to the soft palate and pharynx, one may feel difficulty swallowing. There are usually small incisions made in the mouth to extract the teeth. The sutures placed are used to close the wound and, if necessary, will absorb in 2 to 3 weeks. Sometimes, nonresorbable sutures are used and will need to be removed after one to two weeks. Dr. Burger usually would like to see you one to two weeks after the extractions to make sure you are doing well.
Surgical Risks
All surgical procedures have the potential to have risk. The extraction of wisdom teeth is very safe. However, there often are some anatomical variations that may put some patients at risk.
The lower wisdom teeth are anatomically close to nerves in the bone. One of the nerves provides sensation (feeling) to the lower lip, chin and tongue. If the wisdom tooth is on the nerve before the extraction, movement of the tooth during the extraction could injure the nerve. This would cause a lack of feeling (not movement) of the lower lip, chin and sometimes the tongue. Most wisdom teeth are close but not on the nerve. Therefore, the chance of injury to the nerve is small.
Upper wisdom teeth are anatomically close to the maxillary sinus. Sometimes, the bone surrounding the wisdom teeth is very thin and during the extraction the tooth may go into the sinus or there may be an opening into the sinus after the tooth is extracted. Most of the time, the extraction site heals without any problems.
Any extraction has the risk of damage to adjacent teeth, bleeding, swelling and infection.
Each patient is different and these risks will be specifically discussed with you.
Post Operative Period
The following conditions may occur which can be all normal after removal of impacted and other teeth:
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The surgical site may hurt for a few days.
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The surgical area may swell.
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Swelling peaks on the 2nd or 3rd post-operative day
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Trismus (stiffness) of the muscles may cause difficulty in opening your mouth for a period of days.
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You may have a slight earache.
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A sore throat may develop.
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Your other teeth may ache temporarily. This is referred pain and is a temporary condition.
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If the corners of the mouth are stretched out they may dry and crack. Your lips should be kept moist with cream or ointment.
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There will be a space where the tooth was removed. After 24 hours this area should be rinsed following meals with warm salt water until it is healed. This cavity will gradually fill in with new tissue over the next few months.
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There may be a slight elevation of temperature for 24 to 48 hours. If temperature continues, you need to notify us.
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It is not unusual for bruises to develop in the area of an extraction. The bruising may be on the face or migrate to the neck region.
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Dr. Burger will provide you with prescriptions during the consultation period. It is recommended that you take all prescriptions as directed and take pain medications if you are experiencing discomfort. Pain medication (narcotics) can cause side effects such as nausea and should not be taken if there is no pain.
Women please note: Some antibiotics may interfere with the effectiveness of your birth control pills. Please check with your ob-gyn or pharmacist.
Care of Mouth After Oral Surgery
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Do not rinse or spit for 24 hours after surgery.
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Keep fingers and tongue away from socket or surgical area.
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Use ice packs on surgical area (side of jaws) for first 48 hours, apply ice 20 minutes on and 10 minutes off. Bags of frozen peas work well.
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For mild discomfort take Tylenol or Ibuprofen every three to four hours.
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For moderate to severe pain use the medication prescribed to you.
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Drink plenty of fluids. (Do not use a straw)
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If the muscles of the jaw become stiff, chewing gum at intervals will help relax the muscles. The use of warm, moist heat to the outside of your face beginning on the first day will further help with relaxation of the muscles.
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After the first post-operative day, use a warm salt-water rinse following meals for the first week to flush out particles of food and debris, which may lodge in the surgical area. (1/2 teaspoon of salt in a glass of warm water. Mouthwash can be added for better taste.)
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Diet may consist of soft foods which can be easily chewed and swallowed. No seeds, nuts, rice, popcorn, etc.
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A certain amount of bleeding is to be expected following surgery. Applying pressure to the surgical area with gauze controls bleeding. The gauze is rolled and placed over the surgical site and bite down to apply pressure. Applying pressure to the wound will stop the bleeding. Apply pressure for at least 20 minutes and check the extraction sites with a flashlight. After that time, remove the gauze and then you may eat or drink. If the bleeding persists, repeat applying gauze to the wound site and bite down again. If the bleeding still continues, a moist tea bag should be placed in the area of bleeding and bite firmly for one hour straight. This will aid in clotting blood. Repeat if necessary. Call our office if bleeding presists.
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We suggest that you do not smoke for at least 5 days after surgery. Nicotine may break down the blood clot and cause a "dry-socket".
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Numbness of the lip and or tongue may be experienced for a variable period of time. Feel free to contact us if any doubt arises as to your progress and recovery. |
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After the bleeding has stopped or slowed down, remove the gauze and then you may eat or drink. |
Postoperative Instructions
What you should do following oral and maxillofacial procedures:
A certain amount of bleeding, pain, and swelling is normal. Reduce your activity as much as possible for several hours. No heavy lifting, running or exercises or heavy eating during the first few hours after surgery. These activities may hinder proper healing.
Do not be alarmed if your vision is blurred for a time following anesthesia or if a black and blue bruise should appear at the site of an injection. The arm may also be black and blue, swollen and tender to touch due to the IV.
To control bleeding
Immediately following the procedure, keep a steady pressure over the surgical site. Pressure helps reduce bleeding and permits formation of a clot. Gently remove the compress after one hour. If bleeding persists, place another compress and again keep steady pressure on the area for one hour.
After 24 hours, some oozing of blood may persist. After bleeding has stopped, cautiously resume oral hygiene. If the bleeding has not stopped, repeat pressure on the extraction site with gauze. If the bleeding still persists, use a moist tea bag instead of the gauze.
After you get home from the surgical procedure, start to drink water, Gatorade, juices and any other clear liquids. It is very important that the patient start to drink as much as possible the first day to prevent dehydration and minimize swelling.
After you have drunk sufficient amounts of fluids, take the pain medication as directed before the anesthetic wears off and the feeling is back to normal. This will minimize the amount of pain or discomfort you may experience after the procedure. Application of an ice bag can also help relieve discomfort.
To minimize swelling and discomfort
Immediately following theprocedure apply an ice bag over the affected area. Use for 20 minutes on and 20 minutes off for 24 hours to help prevent development of excessive swelling and discomfort. If an ice bag is unavailable, simply fill a heavy plastic bag with crushed ice. Tie end securely and cover with a soft cloth to avoid skin irritation. Frozen bags of peas make wonderful ice packs and can be refrozen for repeated use.
After 24 hours, it should not be necessary to continue with cold applications after 24 hours. You may expect swelling for 7 -10 days and a fever of 99 degrees F to 100 degrees F. If your doctor prescribed anti-inflammatory medication, begin taking the medication with food immediately after the procedure and continue as directed. Take the prescribed narcotic medication only if you experience significant pain. If you were not prescribed any anti-inflammatory medication and you do not have a known allergy to Aspirin or Ibuprofen (Motrin), you can take 600mg of Ibuprofen (Motrin) every six hours to control mild to moderate pain.
Special considerations following removal of impacted teeth:
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Removal of impacted teeth is a surgical procedure. Postoperative problems are not unusual, and extra care must be taken to avoid complications.
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Severity of postoperative pain will depend on the procedure and your physical condition. Take medication for pain precisely as directed.
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Healing of the surgical site varies.
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Swelling can be expected. Be certain to apply ice bags as directed above.
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Difficulty in opening your mouth widely and discomfort upon swallowing should be anticipated.
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Numbness of lips and/or tongue on the affected side may be experienced for a variable period of time.
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Oral hygiene is important
24 hours after surgery, rinse mouth gently with a solution of one-half teaspoonful of salt dissolved in a large glass of water. Repeat after every meal or snack for seven days. Rinsing is important because it removes food particles and debris and thus helps patient healing. Brush tongue with a dry toothbrush to keep bacteria growth down, but be careful not to touch the extraction site.
Resume your regular tooth brushing, but avoid disturbing the surgical site.
Maintain a proper diet
Have your meals at the usual time. Eat soft, nutritious foods and drink plenty of liquids with meals and in between. Have what you wish, but be careful not to disturb the blood clot. Add solid foods to your diet as soon as they are comfortable to chew.
In case of problems
If you should have any problems such as excessive bleeding, pin, or difficulty in opening your mouth, call our office immediately for further instructions or additional treatment recommendations.
Remember your follow-up visit
It is often advisable to return for a postoperative visit to make certain healing is progressing satisfactorily. In the meantime, maintain a healthful diet, observe rules for oral hygiene, and call our office if you have any questions.
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