THIRD MOLAR SURGERY

What are wisdom teeth?

 

Wisdom teeth, also known as third molars are teeth furthest to the back and last to erupt into the mouth and are more than often non-functioning  teeth. There are many theories as to why we have these teeth but none of these are proven. We do not need wisdom teeth to function properly. 

 

Figure: Impacted third molars which are impossible to clean

Why remove wisdom teeth? 

Often these teeth are impacted against the adjacent tooth leading to difficulty with cleaning. Gum disease, decay and infection can arise if these teeth are left alone and in some circumstances, these infections can be life threatening.

How are wisdom teeth removed?

More than often, removal of third molars necessitates a surgical procedure.  Under a local anaesthetic (you are awake but the area is numb), IV sedation or general anaesthetic (mild disorientation or completely asleep) your surgeon will raise a "flap" to access the underlying bone and tooth.

Bone removal and the tooth division are often needed for safe extraction. Once the tooth is removed, stitches are placed to maintain the integrity of the soft tissues inside your mouth. These are often self-resorbing and eventually fall out several weeks later once the incision has healed. The details will be discussed with you at the time of your consultation.

Figure: Diagramatic explanation of a possible third molar extraction

What are the main risks of the procedure?

Post-Operative  Pain

All patients will invariably have a degree of pain after the procedure. However, with good anaesthetic techniques and medications, post operative pain can be minimized and you can achieve excellent comfort levels after your surgery.

Standard medications will include a combination of Paracetamol and Ibuprofen in most instances with substitution of these when necessary. Further analgesia can be achieved with opioids such as Codeine only if required. The side effects of these medications must always be considered when prescribing. Your surgeon will discuss this with you at the consultation and on the day of surgery.

Pre-operative analgesics are also prescribed for added benefit.

Nerve Injury

A small number of patients will have injury to the dental nerves leading to numbness of the tongue, chin or lip during lower wisdom teeth extraction. These numbers range from 1% to 5% depending on many factors. Some of these include the tooth location, degree of difficulty, age of the patient and surgeons skill level.

Most injuries are transient and are due to slight “bruising” of the nerve. In very rare circumstances these injuries can be permanent. However, these injuries will not affect functionality such as chewing or smiling. Your surgeon will discuss this at your consultation.

Bleeding

Post-operative bleeding can occur and in most instances, only a trickle of fresh blood will be seen. This is rarely life threatening. Potential causes of post-operative bleeding can be due to poor surgical technique, an increase in blood pressure or an undiagnosed bleeding disorder. Significant post-operative bleeding in large volumes is a rare event. However, if this occurs, seek immediate advice from your surgeon or present to your nearest hospital emergency department.

Swelling

Swelling is a normal reaction of trauma to the body. This often occurs in the cheeks after wisdom teeth removal. We can minimize this with cold packs and anti-inflammatory medications. Swelling will last for 2 to 5 days in most instances and will naturally resolve with time. During this period you may have a “chipmunk look”. In most instances, this is normal and does not imply an infection is present. If you are concerned, please discuss this with your surgeon during the post-operative period.

Infection

Unfortunately, a low rate of infection does occur with wisdom teeth removal . This is in the realms of less than 5% of cases. Treatment is with antibiotics, surgical drainage or a combination of both depending on severity. Some signs can be feverextreme pain, significant swelling and severe limitation of mouth opening. If there are any issues, please discuss this with your surgeon before and after your procedure. Other rare  complications can include:

  • osteomyelitis  (bone infection),
  • jaw fracture,
  • damage to  adjacent teeth
  • Jaw joint injury

 

We will endevour to do our best to avoid all these complications with meticulous attention to detail before, during and after your surgery.