Oral Surgery

Surgical Removal of Impacted Wisdom Tooth

The third molar teeth, more commonly referred to as the wisdom teeth, generally erupt between the ages of 17 and 25, a time of life that has been called the “Age of Wisdom”. In a large proportion of the population, there is insufficient space for a wisdom tooth to erupt into optimum position and the situation is referred to as an impaction. There are many forms of impaction of a tooth. A wisdom tooth can be impacted in the gum tissue overlying it (known as soft tissue impaction). More commonly the wisdom tooth is still encased in some bone and it may be partially erupted or fully unerupted.

The tooth impaction may vary in its angulation relative to the adjacent tooth and the depth of the tooth relative to the occlusal plane.

 

Potential complications associated with impacted wisdom teeth

Not all problems related to third molars are painful or visible. Damage can occur without one being aware of it.

Impacted wisdom teeth that aren’t removed can cause numerous problems. These problems include:

 

1. Caries

Hygiene and care of a third molar is usually a challenge especially if the tooth is not in a correct position relative to the arch. More importantly is the caries on the adjacent second molar. Dental caries may not be detected until pain sets in, by which time, extensive destruction of tooth structure and pulpal necrosis (death of the nerve) has set in which may result in the extraction of both the second and the third molars.

 

2. Periodontal disease

It is a disease of the supporting tissue of a tooth including gum, bone, and the periodontal ligaments around the root of a tooth. The periodontal defects may compromise both the impacted wisdom tooth and the adjacent second molar tooth resulting in their mobility.

 

3. Pericoronitis

It is the infection of the soft tissue that occurs around the crown of a partially erupted tooth.

Food can become trapped and bacteria can grow under the gum that grows over a wisdom tooth, creating infections. This infection is caused by the normal flora of the oral cavity. Trauma from the upper tooth biting on the swollen soft tissue aggravates the situation.

Pericoronitis is associated with swelling of the soft tissue, moderate to severe pain and/or limited mouth opening.

In neglected chronic cases, an abscess can form which can result in a discharging sinus on the face.

 

4. Cyst and other pathology

The crown of a wisdom tooth grows in a sac. If the sac remains in the jawbone, it can fill with fluid, forming a cyst that can damage the jawbone, teeth and nerves. Very rarely a tumour, usually benign, also may develop. The pathological lesion may not be detected until it is large and causes swelling or pain. It is recommended that the tooth and the lesion be removed surgically.

Partially erupted impacted wisdom teeth are more likely to cause problems as patients age. No one can predict when third molar complications will occur, but when they do, the circumstances can be much more painful and the teeth more difficult to treat. It is estimated that about 85% of third molars will eventually need to be removed.

The AAOMS/OMSF recommends that wisdom teeth be removed by the time the patient is a young adult. In general, earlier removal of wisdom teeth results in a less complicated healing process. Older patients are at greater risk of periodontal infections, more complicated surgery and a high rate of complicated healing.

 

Treatment

The surgery is best carried out by an Oral Surgeon or a well trained and skillful dentist. In addition, well trained staffs and surgical facilities equipped for emergencies are necessary to accomplish the surgery safely. Many important factors are taken into consideration including patient’s age, health status, psychology, difficulty of the procedure (based on the type of impaction), surrounding anatomical structures and access to the surgical site.

Post operative care

Recovery period is between 48 to 72 hours. The patient will be reviewed to assess healing and to manage any complications that may occur.

Bleeding is expected for a few hours after the surgery. To control bleeding, pressure is applied at the surgical site. This would be more effective if a suture is place.

Swelling can last for several days. Placement of an ice pack would keep the swelling to a minimum. It may help if patient’s head is elevated during sleep.

Infection following surgery is not common. Anti-inflammatory medication (analgesic / pain killer) will be prescribed to the patient. An Antibiotic is prescribed if the possibility of a wound infection is high.

In some cases, infection in the tooth socket can occur (called a dry socket). This complication is treated with a medicated dressing placed in the infected socket.

The inferior alveolar nerve, which carries sensation from the lower lip, is sometimes very close to the impacted wisdom tooth. The lingual nerve which carries sensation to the tongue is also close to the surgical site. These two nerves may be damaged during surgery to remove the impacted wisdom tooth. The recovery of the sensation is related to the degree of injury. In most instances, complete recovery can be expected within a couple of months.