Extraction of wisdom teeth

Retain or extract wisdom teeth?

The wisdom tooth or third molar is a tooth that usually grows in adolescence. Occasionally, the tooth lacks space to erupt normally and remains embedded or semi-included in the jaw. In such a situation, it is recommended to consider whether it is advisable to keep the tooth or to extract it.

A visual and X-ray evaluation is necessary to assess your situation.

Wisdom teeth can be removed at any age. However, extraction is often recommended when the root is not fully formed. Extraction at this time is usually easier and the risk of complication is lower.

 The formation of their roots is usually completed by the average age of 21 years. Positioned at the very bottom of the dental arches, these 3rd molars (commonly known as wisdom teeth) require special attention and treatment.

Why extract wisdom teeth?

From a historical point of view, several hypotheses have been put forward concerning the problem of wisdom teeth.

• Some agree that it is simply due to the evolution of Man The jaw bones are shorter than before.
• Others agree that the use made of the teeth and the improvement of dental health means that the teeth remain in the mouth longer than before, so it is results in a deficient place for the wisdom teeth.

In any case, given its location and the current shape of our jaws, there is little space left for these teeth to come out and be in the right position.

But, what’s so terrible about this lack of space?

If, according to the your dentist, the position of your wisdom teeth (erupted or not) does not seem to indicate any risk, he may recommend that you keep them in your mouth.

This recommendation is conditional on regular monitoring and impeccable dental hygiene being maintained. But depending on the high risk potential of keeping them in place, monitoring and often intervention will be necessary.

Wisdom teeth, a major source of pain

What you need to know about wisdom teeth is that they are, due to their position, a great source of problems such as infections and cysts.

A tooth that grows into the roots of the adjacent tooth instead of coming out straight will cause pressure, possibly an abscess, deterioration or even loss of the neighboring tooth, while remaining buried in the jaw.

In this case, we call it an impacted tooth. This is a sneaky damage and pain potential since nothing looks like it to the naked eye.

An impacted tooth that impedes and displaces the second molars

In addition, over the years, even after the roots have finished forming, depending on various factors (such as the loss of another tooth, for example), this impacted tooth could move and interfere with the second molars. It is not impossible, although less likely, that a person in his or her forties suddenly experiences pain and complications from wisdom teeth still in the mouth.

During the long eruption phase of the wisdom teeth (from the age of 14 to about 21-22 years), periods of severe pain, headache and throat pain, inflammation and swelling of the gums very often accompany the 3rd molar teeth.

Although the wisdom tooth pierces the gum, the problem remains

A wisdom tooth that nonetheless manages to break through the gum, but despite being in a good position, fails to emerge completely is also problematic. When the crown section of the tooth remains partially hidden under the gum, it is said to be a partially covered or semi-included tooth: the ideal place for food debris to accumulate and caries to form. Even with good and rigorous hygiene measures, infections on these sites can cause discomfort and pain, harming your health

Panoramic radiography

The evaluation of wisdom teeth begins with a dental examination using a panoramic x-ray (the one that allows a full view of the jaws). With this tool, the dentist will be able to determine the presence and current position of the wisdom teeth and to detect various procedural risks.

Pre-examination for wisdom teeth extraction

Therefore, depending on your age and condition, an evaluation of your wisdom teeth is necessary. This evaluation can be done during your follow-up examination, but often a separate appointment is necessary (if your dentist performs this type of surgery himself) because he will need enough time to explain the procedure and the costs involved.

Your dentist will examine the position and formation of your 3rd molar, The dentist will examine your joints and jaws and will detect the presence of cysts with the help of panoramic radiography. After studying your case, he will recommend the extraction of your wisdom teeth. Since these teeth are rarely in the proper position and completely erupted, the simple extraction of these four teeth is unlikely and they require surgery instead.

To call a specialist or not?

Depending on your specific situation, your dentist may decide to perform the surgery himself or herself or refer you to one of his or her specialist colleagues: a maxillofacial surgeon. After graduating from dental school, maxillofacial surgeons specialize in complex surgery of the mouth and face for an additional four years. Therefore, the complexity of the procedure (the position of your teeth, the proximity of the lower nerve, the shape of the roots) or simply the practice habits of your dentist may influence his or her decision to proceed or not with the procedure.

In any case, if  your dentist If you choose to refer yourself to a maxillofacial specialist, be aware that the cost of the procedure will be discussed with the specialist and that he or she will also request an evaluation in order to make his or her own diagnosis and establish the procedure to be followed. 

When possible, the loan or transmission of the panoramic radiograph taken by your dentist could reduce the cost of the examination and overexposure to radiation.

During the evaluation, the maxillofacial surgeon or your dentist :

• will ask you about your general health
• will provide you with a written cost estimate
• Explain the procedures, risks and duration of the surgery and assess your anxiety level

Estimate costs to prepare for insurance reimbursement

The cost estimate as well as the procedures will be given to you in writing in order to proceed with a predetermination with your insurer. This predetermination is often necessary and therefore highly recommended to facilitate the reimbursement of your benefits according to your dental care coverage.

Send the documents to your insurer

Some clinics do the correspondence themselves and inform you of the answers while others leave this step in your hands. If this is the case, do not delay in sending the documentation to your insurer because it may take a few weeks before you have an idea of what the final cost of the surgery will be depending on your situation.

Duration of the surgery for wisdom teeth removal

Logically, the length of the surgery will be influenced by the number and type of extractions. If your mouth has two single extractions and two semi-included teeth, the time required for surgery will not be the same as planning for four included teeth.

The ideal time to do your surgery

Ideally, a surgery of this type should be performed at the beginning of the week in order to allow the surgeon to be available in the following days in case of complications. However, you should know that your surgeon will provide you with the necessary contact information for a person or a resource location that can be reached outside of regular business hours or days during the first few days following the surgery.

In addition, the cost of post-surgical treatment (including examination) for appointments given for post-surgical concerns, complications or follow-ups are included in the cost of your surgery if provided by the attending surgeon.

However, since a recovery time of 3 to 7 days can be expected, many people schedule their surgery towards the end of the week in order to take advantage of the weekend off to recover without missing class or work.

The course of the surgery

The day of the surgery

• If your surgery is performed under general anesthesia or intravenous sedation, your surgeon will will recommend a certain diet to be respected before the surgery.
• If the procedure is done under local anesthesia at your clinic, just make sure avoid overloading your stomach, Avoid overly acidic products by eating a light meal up to a few hours before the surgery. This will reduce the risk of nausea and/or vomiting due to stress and anesthesia.
• If possible, dress comfortably for surgery so that you can enjoy a good period of rest or relaxation upon your return.
• Confirm the presence of a companion, or at least have the telephone number of a person who can drive you home. Ideally, this contact information should be on paper and given to the receptionist who will make sure to contact the designated person when the surgery is completed.

Also have on hand your insurance forms if necessary, prescriptions or medication.

During the surgery

These four steps will be the same whether your procedure takes place at your dental clinic or at the Maxillofacial, only the mode of anesthesia differs.

Step 1. Anesthesia

Assisted by his staff, the surgeon will first administer the anesthesia. Don’t worry, it will be effective before the beginning of the operation. The surgery will begin some time after the anesthesia. Even if the surgery is planned for all four wisdom teeth, the surgeon will start work on one site at a time, usually the first two located on the same side of the mouth (top and bottom) for efficiency and duration of anesthesia.

Step 2. Clearance

Depending on the tissue surrounding and/or covering the tooth to be extracted, the dentist will first excise (cut) the gum to allow him to reach the bone more easily. Using a variety of instruments, including a dental drill (turbine), he or she will remove some of the surrounding bone to make it easier to free the tooth. Sometimes the surgeon will have to cut the tooth to facilitate extraction in smaller sections. During this surgery, the surgeon will also use elevators to free the tooth from the ligament fibers that hold it to the surrounding tissue.

Being very well anesthetized, you will not feel any pain during the surgery, the sound being essentially the biggest inconvenience you will face: the sound of the devices but also the internal sound when the tooth is released.

Step 3. Cleaning of the cell

Throughout the surgery, the assistant will make sure to preserve the site by suctioning out blood and other material obstructing the tooth socket (the cavity where the tooth was located). The surgeon will remove any apparent roughness to avoid any discomfort after healing. Eventually, the socket will fill with bone over time, but for now, the blood will accumulate and to prevent further bleeding, the surgeon will maintain some compression with absorbent cotton directly on the site.

Step 4. Closing the socket

Once the tooth is removed, the site will be well sanitized to avoid infection and complication. A blood clot will be formed to promote proper healing. In order to allow the gums to close up, the surgeon will proceed with some stitches. The stitches can be melting, which means that they will disappear by themselves after a period of more or less two weeks, while the other forms of stitches can be removed during the post-operative follow-up examination or during another subsequent appointment.

Complications

Although it is never desired, some complications can occur after wisdom tooth surgery. The most common ones are

Alveolitis

Also called “Dry Socket”, alveolitis is a postoperative complication of the tooth socket. Once the tooth is extracted, the cavity where the tooth was lodged will fill with bone after a few months. But shortly after the extraction, as soon as the bleeding is controlled, the body will form a blood clot that will cover the cavity to form a protective barrier.

The loss of this clot will expose the bone and may cause severe pain radiating to the ear. Any sucking effort can expel the clot so it is very important for the first 24 hours to avoid drinking through a straw, rinsing/spitting and smoking.

If you lose the clot that has formed and experience pain like this, contact your dentist so that he or she can clean the socket and make sure it is covered.

Paresthesia

Because of their position, the roots of wisdom teeth are located very close to the dental nerve. When extracting them, there is a real risk of touching and injuring this nerve.

To prevent it, the surgeon will assess this risk with the help of panoramic radiography, but since this science is not as precise as the real thing (2D), the possibility of an injury is still to be considered.

If the nerve is affected, partial or total paralysis of the lower lip and/or tongue may result. In most cases, this loss of sensitivity will be temporary, but in a small percentage of cases, it may be permanent. Inform your dentist of your condition to ensure follow-up.

Hemorrhage

It is normal to have blood-tinged saliva in the first 24 hours after surgery. However, if more bleeding occurs, make sure to stop the bleeding by simply biting on a gauze or cotton ball that you will place on the surgical site where the bleeding originated, for 30 minutes.

Repeat until the cotton or gauze is almost free of blood. Your surgeon may have given you sterile gauze for this purpose after your surgery.

The application of a moistened tea bag may be appropriate if necessary. If after a few attempts it does not seem to diminish, do not delay and contact your dentist which will give you the steps to follow to solve this complication.