- Impacted teeth are those that are stuck at angle and so unable to reach their correct position in the mouth.
- If exposed to the mouth, an impacted wisdom tooth can cause infection or damage to an adjacent tooth
- Easy wisdom teeth can be removed under local anaesthesia.
- Difficult wisdom teeth are best removed under general anaesthesia in Hospital.
- Removal of wisdom teeth can have complications. It is better not to remove them unless they are causing or likely to cause problems
- Despite the usual belief, erupting wisdom teeth do not significantly cause front teeth to overlap. Removal of wisdom teeth therefore is not indicated for orthodontic reasons. See NICE Guidelines.
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WISDOM TEETH
This section is intended to give you the relevant information concerning impacted wisdom teeth and their surgical removal under general anaesthesia at one of the local Private Hospitals where I work. What are wisdom teeth? Teeth form within the jaws and reach their correct position in the mouth to enable efficient chewing of food. The last teeth to develop and appear in the mouth are the third molars. There are usually four of these and they grow through the gum at the back of the jaws in the late teens. Supposedly this is the time when most people are becoming wise! Hence the more familiar terminology - wisdom teeth. What is impaction ? Most teeth are upright. Impacted teeth are those that are stuck at any angle against the teeth in front or, less commonly, against the bone at the back of the jaw (distoangular). They are, therefore, either totally or partially trapped within the jaw bones. In other words, they are totally unerupted or partially erupted. Distoangular impactions are usually more difficult to remove. What causes impaction? The food that primitive man ate contained much sand and other abrasives. This resulted in wearing away not only the surface of the teeth, but also between the teeth. They were therefore, smaller. Additionally, the food was tough and required much chewing. Consequently the jaws were more muscular and larger. The combination of these factors meant that there was plenty of room in the mouth for all thirty two teeth. Nowadays, however, the diet of civilised man is soft and the above factors do not apply. So there is insufficient room for the last teeth which try to emerge into the mouth. They become impacted. Problems caused by wisdom teeth
Infection Food
can get trapped under the gum flaps around impacted teeth. Germs can grow in
this rotting food and cause an abscess. If the infection discharges then there
is simply some bad taste. If not, there is swelling of the surrounding
flesh. The resultant pain is proportional to the extent of the infection. The
face can become swollen and the jaw muscles go into spasm.
Decay The abnormally
positioned wisdom teeth are difficult to keep clean. They are more likely to
get decayed and can cause toothache. More seriously, food trapping can also
damage the adjacent tooth .
Crowding All teeth have a tendency
to move forward. Many patients complain of pressure in front incisors when the
wisdom teeth are coming through. Some believe that the additional force of the
erupting third molars can contribute towards the overlapping of the front
incisors. However, the experts, based on many investigations, dispute the
importance of this pressure. Removal of wisdom teeth is, therefore, not
justified purely to avoid the front teeth becoming crooked. Cyst
Formation A
sac called the dental follicle covers the top of unerupted teeth. This sac can
become filled with fluid and enlarge. The resultant space is called a cyst. If
large, such cysts can hollow out and weaken the jaw. Such changes are however
rare. Removal of wisdom
teeth is also indicated for a number of other reasons .For instance
if they get in the way of dentures or interfere in treatment of broken jaws or
jaw deformity.
SHOULD
ALL WISDOM TEETH BE REMOVED? No. They
should only be removed if they are giving problems or examination of the mouth
and the X-rays of the jaws show that the above complications are very likely to
occur in the near future. Generally speaking
therefore it is advisable that disease free wisdom teeth should be kept under
review in case above problems develop. FIRST
APPOINTMENT This is to find out
the sort of problems you have had with the wisdom teeth and to find out about
your general health. After examination of your mouth we normally I give you a form
to have an X-ray taken of your jaw unless your dentist has already provided one
or there is a recent one available. If surgery is decided upon you can consider
a date for your operation during the consultation. Alternatively you
can book your admission later by contacting the Reservations officer at Sloane;
or the office . Please note that
our advice is that you should take a week off work or school following the
surgery, to rest at home.
THE
DAY OF OPERATION Remember
that you cannot drive home following general anaesthesia or sedation, so kindly
arrange for an adult to pick you up from the Hospital . You should take
your routine tablets unless otherwise instructed Please make sure that you are fasted: do not eat at least 5 hours before the anaesthetic. Our anaesthetists feel it is safe to drink plain water until two hours before the anaesthetic. Brush your teeth and gums very thoroughly. Attend the Hospital at the time booked for you. After a short wait at the reception you will be taken to your room. You will initially be seen by the nursing staff and later by the anaesthetist .I will ask you to sign a consent form. Please read what is on the form and tell me to explain anything which is not clear About an hour before your operation, if you are anxious you can be given some tablets to relax you. Some times we give you other medicines by mouth to reduce subsequent pain. Others medication are occasionally given to minimize any tendency to nausea. EMLA numbing cream may be applied to the back of your hand and front of the elbow to reduce the sensation in those regions. This will make giving the medication through the vein more comfortable.
Common consequences of removal of wisdom
teeth Swelling and restriction of jaw opening . The body brings into the site of surgery various substances and cells to start healing and fighting infection. This is seen as swelling which starts following the operation The swelling
increases for the first day or two and then becomes less over the next week.
These changes are more marked in the younger patients. Reduced movement of the jaw is also beneficial. This is achieved by natural tensing-up of the jaw muscles. Stiffness of the mouth usually starts the day after the surgery and may last for a week or two and is perfectly normal.. Taste of blood This may persist for a few days. If more severe bleeding starts, it is usually controlled by placing a rolled up clean handkerchief or a tea bag directly on the socket and biting on it for 15 minutes. If bleeding continues contact me. Altered sensation There are two nerves near
wisdom teeth. These nerves can be compressed or
otherwise injured during the operation resulting in numbness or changed
sensation of the lip, the chin or the side of the tongue. Many patients have
some numbness the day after surgery, but this is usually temporary. Every
effort is made to reduce the chances of long-term numbness. Pain
The mouth is very
sensitive and jaw surgery can be moderately painful. This is why I often
give you two varieties of pain relief tablets. In difficult cases, and in
patients over 25 years old, the pain can persist for over one week. Sometimes
even stronger medication is needed to control the pain.
Tiredness This is nature's
way of slowing you down and making you rest. It is associated with loss of
appetite, and occasionally depression. Please take a week
off work (or school). Avoid strenuous activities. Risk
of Infection Two
types of infections can take place after extraction of teeth. The more common
variety is called a "dry socket”. In this the blood clot in the socket
breaks down instead of forming the foundation for bone replacement. It is very
painful. The
other type of infection involves the flesh. Both varieties are more common in
patients who smoke and who have poor oral hygiene. If you are a smoker, it is,
therefore, important to give up smoking before and after the surgery. In all
patients an excellent oral hygiene is highly desirable. If you
believe you have an infection increase the frequency of your mouthwash. If
there is still no improvement then please contact me. Summary If you have bad taste and pain at the back of your mouth, you should contact your Dentist for assessment to see if it is the wisdom teeth which are responsible.
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