Wisdom
tooth surgery and impacted
wisdom tooth are common occurences but what do you mean by
them?
When someone
tells you he has
an impacted wisdom tooth or if your dentist tells
you that
you have an impacted wisdom tooth, it generally means that your wisdom tooth
is erupted in an unnatural position. An
impacted wisdom tooth more often than not requires wisdom tooth surgery to remove
it and x-rays may be necessary to determine the degree of impaction before
removal.
What is the wisdom
tooth?
The wisdom tooth actually refers to your third molars.
Everyone has a natural complement of 32 adult teeth in their lifetime. Some has
more, a condition called hyperdontia whereas those who has less than the natural
complement of 32 teeth has a condition called hypodontia. The third molar will
be the last adult tooth to erupt and it normally surfaces around 18-21 years of
age.
Why does the wisdom tooth give
problems?
Due to its late eruption and the lack of space that the jaw may
have, to accommodate it, the wisdom tooth may not be
able to erupt properly or may even remain buried. Hence if it is not erupted
properly, it is called an impacted wisdom tooth. An impacted wisdom tooth can cause
food to be easily trapped and cause gum inflammation and swelling leading to pain and
infection. Even if an impacted wisdom tooth is buried and can't be seen, it may just be
under soft tissue e.g your gums which makes it easy for the bacteria and food to
track under the gums via the pockets and cause swelling, infection and pain.
When do I have to remove the
wisdom tooth? If I have an impacted wisdom
tooth is it a must to remove it?
Removal of the wisdom tooth depends on a case to case basis. If the wisdom tooth is erupted properly and there is no problems associated with it then it can be and is normally left alone. If however there is difficulty in keeping it clean and there is a high chance that it might give problems in the future then it becomes an option for removal.
In an impacted wisdom tooth where there is pain or infection associated with it, it is normally indicated for removal via wisdom tooth surgery.
Sometimes the orthodontist (specialist dealing with braces) may also recommend removal of an impacted wisdom tooth or teeth early.
How is
the wisdom tooth removed?
The wisdom tooth can be removed either via simple wisdom tooth
extraction
or in the case of an impacted wisdom tooth it can
be removed via a wisdom tooth surgery. In the first instance, the wisdom tooth
is extracted without any need for surgery and the procedure is normally done
under local anaesthesia.
In
an impacted
wisdom tooth or in a difficult wisdom tooth extraction, wisdom tooth surgery
needs to be performed in order to remove the wisdom tooth.
Wisdom tooth surgery can be
done under local anaesthesia or general anaesthesia. In local anaesthesia, the
surgeon will administer local anaesthetic and proceed with the surgery once the
surgical site is numb. An incision will be made at the surgical site and bone
and tooth exposed. Bone may need to be removed in some cases to enable the
wisdom tooth to be elevated and the wisdom tooth may also need to be sectioned
or cut to facilitate the removal.
Once the impacted wisdom tooth is successfully delivered,
the surgical site will be irrigated and cleansed. A resorbable or non-resorbable
suture will be used to close up the surgical site. In some cases, closure with
sutures may not be necessary.
In
general anaesthesia, the wisdom tooth surgical procedure still remains the same.
However, the additional step will be the administration of general anaesthesia
by a trained anaesthesiologist before the surgical procedure is
initiated.
What
are the risks and complications of wisdom tooth surgery?
Wisdom tooth surgery as with all other surgical procedures does not
come without its own set of risks and complications. The most important risk of
wisdom tooth surgery that must be noted is the risk of paraesthesia ( altered sensation
) or even anaesthesia ( total numbness) of the lips,chin and tongue on
the damaged side. Tooth sensation on damaged side may also be affected. The incidence
of nerve injury as cited in the literatures ranges from roughly
1- 5 %. It is not a hard and fast figure and the chances of a nerve injury might
go higher depending on the anatomy of the patient involved. The degree of
impaction of the impacted wisdom tooth also contributes to this as a more severely
impacted wisdom tooth will increase the difficulty of the wisdom tooth
surgery.
Other complications are dislodgement of the tooth or part
of it into body spaces such as the lingual pouch for the lower wisdom tooth and
the maxillary sinus or the infratemporal space for the upper wisdom
tooth.
Fractured roots or part of the wisdom tooth may also be
left in situ either on purpose or accidentally but if the pieces are small they
normally cause minimal problems. In fact some surgeons leave behind small pieces
of the wisdom tooth behind if its too risky to go after them as it is basically
a risk to benefit surgical call.
Post operative bleeding, TMJ ( jaw joint) pain and damage to adjacent tooth are other complications that might occur.
Due to the increasing number
of patients taking bisphosphonate drugs for osteoporosis, it may be
prudent to include osteonecrosis related to bisphosphonate use as a
complication of wisdom tooth surgery and in such cases the impacted wisdom tooth
can just be symptomatically treated.
This article is written and
contributed by an oral surgeon and any duplication, reproduction or plagiarism
in any form is strictly prohibited without the author’s permission.
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Wisdom Tooth Surgery and Impacted Wisdom Tooth - What you should know
