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Wisdom teeth surgery How is it done and what to do after

Wisdom teeth surgery How is it done and what to do after

Your wisdom teeth are a set of four adult teeth located in the back corners of your mouth. Wisdom teeth grow in usually between the ages of 17 and 24. Hence why they are called wisdom teeth in the first place: for the wise young adults who produce them.

Most anthropologists believe wisdom teeth were necessary for our caveman ancestors, who lived on a diet of raw roots, leaves, meat, and nuts. But since then, we evolved to cook our food and use utensils that otherwise cut, crush, and mash it into manageable pieces. In other words, modern humans just don’t need wisdom teeth anymore.

An oral and maxillofacial surgeon or your dentist can remove (extract) a wisdom tooth. The procedure often can be done in the dentist's or surgeon's office. You may have the surgery in the hospital, especially if you are having all your wisdom teeth pulled at one time or if you are at high risk for complications.

How do you know if your wisdom teeth should be removed?


How do you know if your wisdom teeth should be removed

When our modern diets evolved, so too did our jawlines. Unfortunately for many of us, our wisdom teeth never got the memo. Our downsized mandibles no longer have room to comfortably fit wisdom teeth, but the majority of people still develop them. And it is this one step in our human development that causes many of us to seek wisdom tooth pain relief.

For some people, wisdom teeth coming in turns out to be no big deal; they experience no wisdom tooth pain or other problems because their teeth erupt fully and without issue. In other cases, wisdom teeth don’t have enough room to come in normally, if at all. Make an appointment with your dentist if you notice any of the following symptoms:

  • Red or swollen gums
  • Tender or bleeding gums
  • Jaw pain
  • Swelling around the jaw
  • Difficulty opening your mouth

Impacted and partially impacted wisdom teeth


When a wisdom tooth forms in the mouth but never breaks through the gums, it is referred to as impacted. One that emerges only part way is called a partially impacted wisdom tooth. In both cases, the tooth often grows at an angle because of lack of space in the mouth. This becomes the source of many potential problems, including:

  • Wisdom tooth pain
  • Trapped food leading to decay
  • Damage to nearby teeth or the surrounding jaw bone
  • Bacterial growth along the opening in the gumline of a partially impacted tooth
  • Development of a cyst around wisdom teeth

Removing Wisdom Teeth


Removing Wisdom Teeth

Removing a tooth that's fully visible in the mouth is a fairly simple procedure; it involves numbing with a local anesthetic, and after a bit of work around the gum, the tooth is out. However, this is usually not the case with wisdom teeth. Located in the back of your mouth, most wisdom teeth don't have enough room to come in properly and are referred to as impacted. In fact, nine out of 10 people have at least one impacted tooth.

Extracting impacted teeth usually requires the removal of some bone and gum tissue, making the procedure more involved than removing teeth that are positioned normally. And because all four teeth are usually removed at once, most offices recommend some type of sedation during the procedure.

Sedatives and Anesthetics


Sedatives and Anesthetics

Before deciding on the best option of anesthesia for your extractions, you and your dentist will need to discuss your anxiety level and the procedure's complexity. Consider the most common types of sedation used in dental offices today:

  • Local anesthesia is the numbing medication injected into the area of the mouth to be treated. This type of anesthesia blocks the sensation of pain during the procedure.
  • Conscious sedation is typically achieved by taking an oral medication, along with an anti-anxiety pill, shortly before the procedure. The medication will make you drowsy and, if given in larger doses, may cause you to fall asleep during the procedure. You'll need a ride to and from the dental office when taking this type of medication.
  • Nitrous oxide or "laughing gas" is a controlled mix of nitrous oxide and oxygen that you breathe through a mask placed over your nose. This allows you to feel relaxed and less nervous about the treatment. The effects of the gas wear off quickly, allowing you to safely drive home after the procedure. Oral medication and the nitrous oxide are frequently used together, in which case you will not be able to drive yourself.
  • Intravenous (IV) sedation, is administered by taking medication orally or through a vein. IV sedation works quickly, and although you are conscious and capable of responding to your dentist's visual signals, you won't remember much about your appointment. Because Intravenous sedation does not provide pain relief, it is used in combination with local anesthesia. You'll be groggy and need a ride home after the appointment.
  • General anesthesia is a combination of oral and IV medications that sedate you to a level where you are placed in a level of unconsciousness. Those who are heavily sedated may reach stages of complete unconsciousness. The best part is, once you're fully awake, you won't remember anything about the procedure.

How Well It Works


Wisdom tooth removal usually is effective in preventing:

  • Crowding of the back teeth.
  • A wisdom tooth becoming stuck in the jaw (impacted) and never breaking through the gums.
  • Red, swollen, and painful gums caused by a flap of skin around a wisdom tooth that has only partially come in.
  • Gum disease and tooth decay in the wisdom tooth, which may be harder to clean than other teeth, or in the teeth and jaw in the area of the wisdom tooth.

What To Expect After Surgery


In most cases, the recovery period lasts only a few days. Take painkillers as prescribed by your dentist or oral surgeon. The following tips will help speed your recovery.

  • Bite gently on the gauze pad periodically, and change pads as they become soaked with blood. Call your dentist or oral surgeon if you still have bleeding 24 hours after your surgery.
  • While your mouth is numb, be careful not to bite the inside of your cheek or lip, or your tongue.
  • Do not lie flat. This may prolong bleeding. Prop up your head with pillows.
  • Try using an ice pack on the outside of your cheek. Apply for 15 to 20 minutes at a time for the first 24 hours. You can use moist heat—such as a face cloth soaked in warm water and wrung out—for the following 2 or 3 days.
  • Relax after surgery. Physical activity may increase bleeding.
  • Eat soft foods, such as gelatin, pudding, or a thin soup. Gradually add solid foods to your diet as healing progresses.
  • Do not use a straw for the first few days. Sucking on a straw can loosen the blood clot and delay healing.
  • After 24 hours, gently rinse your mouth with warm salt water several times a day to reduce swelling and relieve pain. You can make your own salt water by mixing 1 tsp (5 g) of salt in a medium-sized glass (8 fl oz (250 mL)) of warm water. Do not rinse hard. This can loosen the blood clot and delay healing.
  • Do not smoke for at least 24 hours after your surgery. The sucking motion can loosen the clot and delay healing. Also, smoking decreases the blood supply and can bring germs and contaminants to the surgery area.
  • Avoid rubbing the area with your tongue or touching it with your fingers.
  • Continue to brush your teeth and tongue carefully.

Your dentist will remove the stitches after a few days, if needed.

Avoiding dry socket wisdom teeth

Avoiding dry socket wisdom teeth

You might be surprised to hear that the hole takes several months to fully close after tooth extraction. Your dentist will also advise you to avoid certain activities for a period of time because of the risk of dry socket. The name makes it sound pretty innocuous, but it is actually very painful and potentially dangerous.

After wisdom tooth surgery, a blood clot forms in the hole in the bone where the tooth was removed — otherwise known as the socket. This blood clot protects the exposed bone and nerves, but if it dislodges or dissolves in the days following surgery, your bone and nerves are left exposed to food, fluids, and bacterial infections.

To help prevent dry socket after wisdom tooth removal, avoid these activities for about two weeks post surgery:

  • Drinking from a straw
  • Smoking
  • Spitting
  • Strenuous exercise

Tips for home care

It is essential to keep the wound clean while it is healing. Because people still need to eat and drink, food can easily get stuck in the area where the tooth was removed. This can make keeping the wound area clean a bit challenging.

Try the following to help keep the wound clean:

  • using an antiseptic mouth rinse to prevent infection.
  • rinsing with warm water and salt to reduce swelling and soothe sore gums
  • raising the head when sleeping to feel more comfortable

As well as pain, some people will feel tired after having their wisdom teeth out and might choose to avoid exercise for a few days after the surgery.

What can you eat?

Eating soft or liquid foods can help to prevent damage to wounds. Some examples are:

  • soup
  • jello
  • soft noodles
  • eggs
  • mashed banana

For the first few days after surgery, avoid foods that need chewing, such as sticky candy or chewing gum as these may get stuck and can cause pain and damage to the healing wounds. Also avoid hard, crunchy food, such as chips, pretzels, nuts, and seeds, as well as hot or spicy foods.

If one or two wisdom teeth have been removed from the same side of the mouth, it may be possible to chew on the opposite side of the mouth after 24 hours.

How long does it take to recover from a wisdom teeth removal?


Recovery from wisdom teeth removal usually takes a couple of weeks. Some people might need stitches to help close the wound. The dental surgeon will usually remove the stitches after about 1 week. Sometimes, the surgery causes bruising, swelling, and pain, which will also require time to heal. The healing process can be broken down into the following stages:

  • First 24 hours: Blood clots will form.
  • 2 to 3 days: Swelling of the mouth and cheeks should improve.
  • 7 days: A dentist can remove any stitches that remain.
  • 7 to 10 days: Jaw stiffness and soreness should go away.
  • 2 weeks: Any mild bruising on the face should heal.

Recovery time will be different for everyone. If blood clots become dislodged from the wound, or the wound becomes infected, recovery may take longer.

Risks


Though this surgery is a common procedure and usually goes well, wisdom teeth removal complications can occur. Anywhere from 2.6% to 30.9% of patients experience complications from wisdom tooth removal. Being prepared for these possibilities is key to appropriately handling or even preventing them. Here are five of the most common complications to help you jump-start a discussion with your dentist.

Pain and Swelling

Pain and Swelling

Pain and swelling are expected after an extraction, though the extent varies by person. In a study, men reported less pain than women. Though pain is subjective, the study cited that, in the first day following surgery, 53% of patients had mild pain and 47% had severe pain. Only 15.2% had severe pain within one week after surgery. The amount of pain and swelling may be connected to how long the surgery takes. Your dentist may advise taking over-the-counter pain medications, eating a soft diet and avoiding strenuous physical activity to relieve your symptoms.

Lip Numbness

The wisdom teeth are close to the inferior alveolar nerve running through the jaw. If the nerve becomes damaged during an extraction, it can lead to lip numbness. This complication can spontaneously resolve, and does within two months in about 96% of patients. Your surgeon will minimize the possibility of nerve damage while removing the tooth or teeth and will inform you of your risks for this complication prior to surgery.

Other complications

You may also experience:

  • Bleeding that won't stop for about 24 hours.
  • Difficulty with or pain from opening your jaw (trismus).
  • Slow-healing gums.
  • Damage to existing dental work, such as crowns or bridges, or to roots of a nearby tooth.
  • A painful inflammation called dry socket, which happens if the protective blood clot is lost too soon.

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