Gum Disease
Wisdom Teeth Removal
Read our second part of the Wisdom Teeth series of blogs and find out when to remove or not to remove wisdom teeth, and learn about the treatment and recovery process.
When to treat, when not to?
Generally, wisdom tooth ‘treatment’ implies the removal of the tooth. In America, it is common for dentists to advise the removal of all four wisdom teeth in many cases, in adolescence. In London and the UK, the ‘official’ recommendations are that wisdom teeth only be removed if there is existing ‘pathology’, i.e. there is already some infection.
My approach is simply this ( and this ‘lies’ between the American and British approach):
Wisdom Tooth diagnosis
I would recommend removal of the wisdom tooth if:
- If there are any symptoms of pain, discomfort , swelling etc. associated with a wisdom tooth, the cause of which cannot ‘relatively’ easily be treated successfully and in such a way that the problem is very unlikely to recur .
- If part of the tooth is exposed through the oral cavity, and that tooth will never come through straight and fully functional, even if there is no pathology present at that time, should I evaluate such a tooth as likely to experience problems in the future?
- If the tooth is functionless, almost impossible to ‘keep clean’ and prevents adequate cleaning of the back of the 2nd molar in front of it. This is more often the case with upper wisdom teeth.
Wisdom tooth treatment – removal
Not all wisdom teeth are ‘difficult’ to remove . It all depends on their position in the jaw bone, their root shape and formation, access to them ( i.e. small or large jaws/opening) and last but not least the patient’s tolerance and attitude. Generally, lower wisdom teeth are the ‘tougher’ to remove than the upper ones .
Usually it takes between 15 minutes and an hour and a half to remove (particularly) a lower wisdom tooth. In some cases, the whole tooth is removed quite easily; in others, one may have to cut the tooth into segments and take each one out separately. There are times , one may decide to leave part of the tooth root in the bone (where it can harmlessly remain ’for life’).
Sometimes it is appropriate to refer to a specialist Oral and Maxillofacial Surgeon , who may or may not remove the tooth/ teeth under local anaesthetic with or without sedation or even, under general anaesthetic. The surgery is sometimes done in a private clinic; sometimes in hospital (particularly if general anaesthetic is needed or required). More often than not sutures ( stitches) are placed over the tooth socket wound , which if not self-resolvable, are removed after about a week. Painkillers are prescribed and antibiotics may or may not be .
Post-operative recovery
Recovery from wisdom tooth removal can sometimes be a bit ‘unpredictable’ . This generally depends on a number of factors:
- The degree of ‘difficulty’ in removal of the tooth.
- The amount of ‘trauma’ experienced during tooth removal.
- The presence or absence of existing underlying infection around the tooth (at time of removal).
- The expertise of the surgeon.
- And very significantly, the health and resilience of the patient .
Any possible post-operative ‘complications’ should obviously be explained to the patient, although in the relatively rare event one of these does occur , it is resolved within a week or two.
