Wisdom teeth that cannot fully erupt into a normal positon are called impacted. They are problems waiting to happen. Usually at the most inconvenient time. That's why you should consider the removal of these teeth at a time that is convenient for you.
Most people prefer to be asleep for this kind of procedure and while its being done. If you need other treatment such as fillings, I can get that done too for you at the same time because I do a wider range of dental treatments - not just surgery.
Removing Wisdom Teeth
What you need to know
Dr. Peter Copp
Most people get their wisdom teeth (also called third molars) in their
late teens or early twenties. Very often, the jaws are not large enough to accommodate these teeth in a useful position and they remain trapped under the gum
(impacted). Impacted teeth are teeth that have not erupted into a healthy position because they have run into something such as another tooth, bone or gum. Most impacted teeth need to be removed because sooner or later they cause major problems such as serious infection, pain, swelling, sinus problems, ear problems, cysts, eating away of the jaw bone or they can even damage other healthy teeth. Although initially impacted teeth usually cause no pain, sooner or later they cause a great deal of pain, usually at the most inconvenient time. This is one of many reasons why even though your impacted teeth many have never bothered you, it is a good idea to have them removed before they do.
Pathology arising from impacted teeth includes recurring infections which ranges in severity from minor to life-threatening; resorption of adjacent teeth, periodontal problems, decay of neighboring teeth, weakening of the jaw bone, development of numerous cysts and tumors as well as possible crowding of the other teeth. These pathological conditions develop with increasing frequency after 30 years of age.
The National Institutes of Health, the Canadian and American Associations of Oral and Maxillofacial Surgeons agree that scientific evidence shows that impacted teeth are pathological entities and surgical removal is the best treatment. No one can tell you when your impacted molar will cause trouble. We just know that they are a problem waiting to happen and when it does, it is usually painful and makes the treatment more complicated.
The usual result of removing impacted teeth is uncomplicated healing with no significant, lasting problems. This is our experience in almost all of our patients. Postoperative complications can occur in any surgical procedures. The most common complications are delayed healing and infection.
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Generally the younger you are, the easier it is to remove impacted teeth and recover from it. Almost everyone under the age of 20 years does very well with a very low incidence of complications such as delayed healing. Between 21 to 25 years about 30% of patients experience difficulties. About 60% of people aged 26 to 30 have a complication, usually minor, after surgery and about 90% of those over 30 years of age will have problems after their surgery but with proper measures these can be minimized.
Most common complications are things such as bruising, swelling, aching, slow healing, or prolonged bleeding. Other rare complications include infection, cracking and chipping of the bone near the tooth socket, leaving a piece of the tooth in the socket, or very rarely, numbness from the nerve near lower teeth and problems with the sinus near upper teeth.
Avoiding Bruising, Swelling & Discomfort
Patients are usually most concerned about bruising, swelling and pain after surgery. Knowing this I make the following suggestions to help you. These recommendations are based on well proven, conservative scientific evidence: Any alternative healing strategies you would like to try should be in addition to these recommendations.
The most important thing you can do to minimize swelling, bruising and pain is to apply ice packs to the corner of the jaws, just under your ears after your surgery for approximately 48 hours. Icing thoroughly for an extended time is the single most important and effective thing you can do. It is important that the cold compresses conforms to your face closely and that you ice long enough to make the area actually cold to the touch. Do not cover the ice pack with a thick layer of cloth or paper. Ideally the ice should be placed directly on your skin or covered by a thin layer of plastic. I recommend you use a bag of frozen peas and a bag of frozen corn if you have had surgery done on both sides. Place the bag of frozen peas on the right side for about 20 minutes and then put it back in the freezer. Get the bag of frozen corn and place it on the left side for 20 minutes and then go back and use the peas on the right side while the corn re-freezes. Continue icing each side alternately for the rest of the day of your surgery as well as the next two days. You should even go to bed with ice packs with your head elevated by two pillows and a towel over the pillows to protect them. Short of actually freezing your cheeks - which is almost impossible to do -
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you can’t “over-ice”. The more you ice the better you will do. In fact we place ice packs on your face while you are still in the treatment room the minute your surgery is done.
The next most important thing to do to limit swelling, bruising and pain is to take ibuprofen (Advil or Motrin 400mg) about 6 hours before your appointment and then again at 2 hours before your surgery. (You shouldn’t take ibuprofen if you have severe asthma, an active stomach ulcer or have a true allergy to aspirin.) I will usually prescribe another type of medication (flubiprofen) for after your surgery.
To minimize swelling and bruising after your surgery you should not lie flat. Keep your head elevated as much as possible for three days. Use 2 or 3 pillows or rest sitting up.
Rinsing with salt water and keeping your mouth clean is vitally important to ideal healing. As simple as salt-water rinses seem, ongoing research demonstrates that rinsing with salt water promotes wound healing. As difficult as it may be, brushing your teeth and brushing or scraping your tongue at least twice each day is important to avoid infection. Avoid mouthwashes containing alcohol such as Listerine, Scope and most other commonly available mouthwashes.
Dry Socket Complication
The most common complication of wisdom tooth removal is a type of delayed healing called dry socket. This is a condition were the blood clot that forms in the tooth socket a few minutes after I remove the tooth is lost for some reason. We do not know why this happens to some patients but we do know that it happens more frequently in lower sockets than upper ones; more in people who smoke; more in women who are taking birth-control pills; and more often the older you are. The main problem with a dry socket is that there is more pain than usual. Patient developing a dry socket often complain that they get a metallic taste and a foul odor as well as increasing pain. Dry sockets usually start about 5 to 10 days after surgery. The usual treatment is a vigorous routine of washing the socket out with salt water and packing medication into the socket until gum tissue can cover the exposed jaw bone.
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Very rarely other complications can arise from removing wisdom teeth. Generally these complications are more likely to occur the longer removal is delayed in life and can even occur from leaving the teeth alone when they develop infection, cycts or tumors around them. These complications include fracture of the jaw, prolonged bleeding, a hole between your sinus and your mouth, and partial or complete numbness of your lower lip and/or tongue. Of these complications the one that is usually most concerning and potentially the most permanent is numbness of the lower lip. If this occurs it usually is due to swelling and pressure on the nerve that runs through your lower jaw near the root tips of the teeth. It can be compared to the feeling of hitting your funny bone in your arm. In extremely rare cases instead of pressure or bruising of the nerve, it can be actually partially or completely cut or torn depending on the position of the tooth that was removed. This nerve is one of the rare nerves in the body that can actually heal but this takes many, many months or even years. If numbness or tingling is permanent it does not affect muscle function of the lips or face - only sensation. This complication is extremely rare and usually only occurs if the roots of your teeth are entwined with the nerve. I can usually determine if you are at increased risk from viewing the x-ray of your teeth before surgery.
Preparing for Surgery - Vitamins & Nutrition
To speed healing you should have optimum nutrition before your surgery and while you are healing. If you don’t eat a perfectly balanced diet I suggest that you take multiple vitamins that contain vitamin A, B, C, D, E and K as well as calcium and zinc for at least a week before your appointment and for six to eight weeks after. Vitamin A significantly contributes to healing by reducing the inflammatory period of tissue repair. Vitamin C is important for connective tissue and bone repair. Vitamin K is essential for proper blood clotting and most recently it has been found to be important in bone healing and metabolism.
Vitamin A helps maintain healthy epithelial (skin and gum) tissue by discouraging the formation of abnormal cells. It is important for formation of bone and soft tissues. It is called the “anti-infection vitamin”. It enhances the activity of your immune system and will
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actually reduce infection when you are exposed to bacteria. I recommend you have 1,000 mcg/RE per day during your healing time.
Vitamin C is needed to make and maintain collagen, a protein that is the building block and cement in all connective tissues such as bone, teeth, skin and gums. It promotes wound healing, blood clotting and fights infection. I recommend you have 500 - 1000 mg of vitamin C per day during this time.
Vitamin D helps regulate calcium and phosphorous, key components of both bone and teeth. It helps in the formation of new bone needed to repair most dental surgical wounds. Vitamin D receptors are also found in the pancreas on cells that produce insulin needed in higher amounts for healing. It also plays an important role in your immune system. I recommend that you have 400 IU per day during this time.
Vitamin K supplementation is only available by prescription. Vitamin K is important for blood clotting and mineralization of healing bone. In order of highest amounts of Vitamin K the following foods are excellent natural sources: Spinach, kale, broccoli, romaine lettuce, cabbage.
Calcium is also important for bone healing. The Recommended Dietary Allowance (RDA) for adults is 800 mg per day. During this time I recommend you have 1,000 to 2,000 mg per day. One cup of plain yogurt has 415 mg.
Zinc functions in the mineralization of bone; wound healing and normal taste. It also helps maintain normal blood levels of vitamin A. I recommend you have between 15 and 30 mg of zinc per day during this time.
Recent research has shown that fresh pineapple contains a special protein-digesting enzyme called bromelain. It has primarily anti-edema (fluid swelling) and anti-inflammatory effects and may also have anti-tumor effects. Because of these effects I recommend that you eat fresh pineapple the day before your surgery. This enzyme is deactivated by canning or cooking pineapple so you must eat fresh pineapple for it to be helpful. Pineapple is also very high in vitamin C and has some vitamin A that also aids in wound
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healing. By also eating one medium banana, broccoli and a large glass of orange juice you will also get many of the essential vitamins your body will need to heal quickly and well.
During your surgery I will usually give you an intravenous medication that also helps your body limit swelling. It works most effectively if you are following all the other strategies.
If you have asthma, I recommend supplementing your diet with 10 mg of vitamin B6. Some people who consume additional vitamin B6 daily report a reduction in severity and frequency of asthmatic episodes.
Lotz-Winter H On the pharmacology of bromelain: an update with special regard to animal studies on dose-dependent effects. Planta Med 1990 Jun;56(3):249-53
Utley R Nutritional factors associated with wound healing in the elderly. Ostomy Wound Manage 1992 Apr;38(3):22, 24, 26-7
Greenwald D; Mass D; Gottlieb L; Tuel R Biomechanical analysis of intrinsic tendon healing in vitro and the effects of vitamins A and E. Section of Plastic Surgery, University of Chicago Pritzker School of Medicine, Ill. Plast Reconstr Surg 1991 May;87(5):925-30; discussion 931-2
Greenwald DP; Sharzer LA; Padawer J; Levenson SM; Seifter E Zone II flexor tendon repair: effects of vitamins A, E, beta-carotene. Department of Plastic Reconstructive Surgery, University of Chicago, Illinois 60637. J Surg Res 1990 Jul;49(1):98-102
Gottschlich MM; Warden GD. Vitamin supplementation in the patient with burns. Shriners Burns Institute, Cincinnati, OH 45219. J Burn Care Rehabil 1990 May-Jun;11(3):275-9
American Association of Oral and Maxillofacial Surgeons. Position Paper on Impacted Teeth.
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