Wisdom teeth are the third and last molars located on each side of the upper and lower jaws. They are the final teeth to erupt and usually appear when a person is in their late teens or early twenties, or your “wisdom years.”
The development of these teeth is not always functional and can crowd the mouth causing problems for you in the future. The roots of the wisdom teeth are not fully formed between the ages of 16 and 21 so it is recommended that they are evaluated during this time. As the wisdom teeth develop, the roots become longer and the jaw bone becomes denser making them more difficult to remove.
Why Should I Have My Wisdom Teeth Removed?
For many patients, wisdom teeth never fully or even partially enter the mouth. Often the jaw is not large enough and the wisdom teeth are tilted under the gums, blocked from coming in by bone or other teeth, causing them to become impacted. The impacted wisdom teeth can take many positions in the bone as they attempt to find a pathway that will allow them to successfully erupt. When they do partially erupt, this can cause a “food trap” where the opening around the teeth allows plaque to accumulate and bacteria to grow. The result: swelling, stiffness, pain, and illness. The pressure from the erupting wisdom teeth 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 teeth, resulting in the destruction of the jawbone and healthy teeth. Removal of the offending impacted teeth usually resolves these problems. Early removal is recommended to avoid future problems and to decrease the surgical risk involved with the procedure.
Oral Examination for Wisdom Tooth Removal
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. With an oral examination and x-rays of the mouth, Drs. Burchfield, Richardson, McLeod, Shea, West, Hamilton, Wicke, Mort and Cone Jr. can evaluate the position of the wisdom teeth and assess if there are current issues or if future problems are likely to arise. An x-ray of your mouth and jaws (Panorex) will be examined during your consultation to help determine if your wisdom teeth are impacted, if there is room for them to erupt, and how difficult the removal may be.
Types of Impacted Wisdom Teeth
Soft Tissue Impaction: The upper portion of the wisdom tooth (the crown) has penetrated through the gum tissue.
Partial Bony Impaction: The wisdom tooth has enough room to allow for partial eruption, however it is still primarily impacted within the jawbone and does not have enough space to function properly.
Complete Bony Impaction: The wisdom tooth remains fully embedded in the jaw bone and may never break through the gums.
Wisdom Teeth Removal Procedure
Wisdom teeth removal is an outpatient procedure, which means you arrive and go home on the same day. All outpatient surgery is performed under the appropriate level of anesthesia to maximize patient comfort. Drs. Burchfield, Richardson, McLeod, Shea, West, Hamilton, Wicke, Mort, and Cone as well as our surgical staff, have the training, credentials and experience to provide various types of anesthesia for patients to select the best alternative. In most cases, the removal of wisdom teeth is performed under general anesthesia. These anesthetic options, as well as the surgical risks (i.e., sensory nerve damage, sinus complications), will be discussed with you before the procedure is performed.
Once the area is completely numb, an incision is made in your gums so the impacted teeth and jawbone can be reached to remove any bone that is overlying the tooth. With clear access, the tooth and roots can then be removed; either intact or in sections. Stitches will be used to close the incision and allow the gums to heal. These stitches usually dissolve in 5 to 7 days and do not require removal. To help control bleeding, bite down on the gauze placed in your mouth. You will recover under our supervision in the office until you are ready to be taken home. Be sure to have a parent, legal guardian or responsible adult with you on the day of your appointment that can remain in the office throughout your procedure, take you home afterwards, and remain with you for the rest of the day.
Upon discharge, your postoperative kit will include postoperative instructions, a prescription for your medications and a follow-up appointment in one week to evaluate your recovery. If you have any questions, please do not hesitate to call us at 615-822-8403 as there is always a doctor available if necessary. Our services are provided in an environment of optimum safety that utilizes modern monitoring equipment and staff who are experienced in anesthesia techniques.
- You may not have anything to eat or drink (including water) for six (6) hours prior to the appointment.
- No smoking at least 12 hours before surgery. Ideally, cut down or stop smoking as soon as possible prior to the day of surgery.
- A responsible adult must accompany the patient to the office, remain in the office during the procedure, and drive the patient home.
- The patient should not drive a vehicle or operate any machinery for 24 hours following the anesthesia experience.
- Please wear loose fitting clothing with sleeves which can be rolled up past the elbow, and low-heeled shoes.
- Contact lenses, jewelry, and dentures must be removed at the time of surgery.
- Do not wear lipstick, excessive makeup, or nail polish on the day of surgery.
- If you have an illness such as a cold, sore throat, stomach or bowel upset, please notify the office.
- If you take routine oral medications, please check with OMSNashville prior to your surgical date for instructions.
The removal of impacted teeth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully.
Immediately Following Surgery
- The gauze pad placed over the surgical area should be kept in place for a half hour. After this time, the gauze pad should be removed and discarded.
- Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
- Take the prescribed pain medications as soon as you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished. Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
- Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.
A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for thirty minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.
The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the body’s normal reaction to surgery and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 36 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Thirty-six hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.
For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours or Ibuprofen, (Motrin or Advil) two-four 200 mg tablets may be taken every 3-4 hours.
For severe pain, take the tablets prescribed as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.
After general anesthetic or I.V. sedation, liquids should be initially taken. Do not use straws until the bleeding has completely stopped. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away form the surgical sites. High calorie, high protein intake is very important. Refer to the section on suggested diet instructions at the end of the brochure. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 5-6 glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat.
Caution: If you suddenly sit up or stand from a lying position you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing.
Keep the mouth clean
No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the night of surgery but rinse gently. The day after surgery you should begin rinsing at least 5-6 times a day especially after eating with a cup of warm water mixed with a teaspoon of salt.
In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.
If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions.
Nausea and Vomiting
In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on coke, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine.
- If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, this is usually temporary in nature. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. So be careful. Call OMSNashville if you have any questions.
- Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.
- You should be careful going from the lying down position to standing. You were not able to eat or drink prior to surgery. It was also difficult to take fluids. Taking pain medications can make you dizzy. You could get light headed when you stand up suddenly. Before standing up, you should sit for one minute then get up.
- Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots, they are the bony walls which supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by Drs. Burchfield, Richardson, McLeod, Shea, West, Hamilton, Wicke, Mort and Cone Jr.
- If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as vaseline.
- Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days.
- Stiffness (Trimus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event which will resolve in time.
Sutures are placed the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture form your mouth and discard it. The sutures will be removed approximately one week after surgery. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is no discomfort associated with this procedure. So it’s really nothing to worry about.
The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur call my our office for instructions.
There will be a cavity where the tooth was removed. The cavity will gradually over the next month fill in with the new tissue. In the mean time, the area should be kept clean especially after meals with salt water rinses or a toothbrush.
Your case is individual, no two mouths are alike. Do not accept well intended advice from friends. Discuss your problem with the persons best able to effectively help you: Drs. Burchfield, Richardson, McLeod, Shea, West, Hamilton, Wicke, Mort and Cone Jr. or your family dentist.
Brushing your teeth is okay – just be gentle at the surgical sites.
If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.