Wisdom Teeth Extraction

What are wisdom teeth?

By their late teens or early twenties the majority of people have 32 teeth in their mouth, 16 in each of the upper and lower jaws. The teeth in the front of the mouth, which are called the canine, bicuspid and incisors are used for biting and taking hold of the food, whereas the back teeth or “molars grind the food into smaller bits so that they can be swallowed more easily. Usually, three molars develop at the back of the lower jaw. Each molar has either two or three roots, as compared to most other teeth that have one root.

Wisdom teeth are also called third molars and are the last teeth to break through the gum or “erupt” at the back of your mouth. This usually happens in the late teens or early twenties. Wisdom teeth begin to form at about 9 years of age within a small hollow or “crypt” inside the jaw bone. The crown is usually completely developed by the age of about 14, and is followed by the roots. As the roots grow the tooth moves through the jaw toward the surface of the gum. By the age of 16 when the jaw has reached its adult size, your dentist can take an X-ray to determine the stage of development of your teeth and whether you have enough space in your mouth for them. Usually one wisdom tooth develops in each of the four corners of the mouth, although some people are missing one or more of these teeth. Even if they take the proper position when they erupt, they are the most difficult to clean.

• An impacted tooth is one that is unable to break through the gum. Impacted teeth trying to find space to erupt may eventually grow into a normal healthy position or at an angle. The tooth may also erupt into a more unfavorable position, away or towards the other teeth or parallel to the gum line.
• You may experience pain from the pressure of the wisdom teeth breaking through the gums against other teeth. This pressure may also cause the teeth to be worn down or “eroded”. They may also push the nearby teeth out of alignment and interfere with your bite.
• The teeth may partially break through the gum and then a flap of gum tissue will grow over it. Bacteria, saliva and food can get caught under the flap and lead to bad breath, swelling, redness and pain in the gums. As a result, an infection, referred to as “pericoronitis” can develop which sometimes can spread to the cheek and neck.
• You may be unable to open your mouth completely, a condition called “trismus”.
• Decay can develop in the wisdom tooth or the tooth next to it. This type of decay is very difficult to access and remove.
• Although this is very rare, a cyst can develop from the gum covering the tooth. This condition can destroy some of the bone in your jaw, cause your jaw to expand, damage nearby teeth or move them out of their proper position. If the cyst gets very large, the jaw may fracture due to weakening of the jaw bone and pressure.
• If you are wearing braces to straighten your teeth, your orthodontist may recommend that you have your wisdom teeth extracted. As they try to erupt, the wisdom teeth can cause other teeth to move and compromise the desired result of the orthodontic treatment.

To learn more about wisdom teeth extraction in our Montreal office please view this in-depth multi-media presentation designed to answer many of your questions.

Wisdom Teeth Extraction Presentation

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When should I have my wisdom teeth extracted?

This procedure should be done between the ages of 14 and 22 when the jaw bone is not so dense and the roots are not fully developed. Wisdom teeth become more firmly anchored to the bone and more difficult to extract with advancing age. Complications are also more likely to occur. As well, younger people tend to heal and recover more quickly.

What other options are there?

Your surgeon may not recommend removal of you wisdom teeth if they are in a position that makes the surgery risky or if you have other health problems. You will have regular visits to check for any complications. Medication can be used to control pain or infection. Sometimes a minor surgical procedure called an “operculectomy” in which the gum over the wisdom teeth is removed can be helpful to remove the pressure to the wisdom teeth on the gums. It is possible in some cases for wisdom teeth to develop into a normal position, eliminating the need for their removal.

How should I prepare for the wisdom teeth surgery?

• Plan to take time off from work, as you will need at least a day to rest after the surgery. You should tell your surgeon about all the medications you are taking as he may ask you to make some changes. Patients taking aspirin will sometimes need to discontinue their medication after consulting with their medical doctor.
• Your surgeon will give you instructions on what to eat. He or she may ask you not to eat or drink from midnight before the procedure, in order to be prepared for the anesthetic you will receive before surgery.
• Wear loose-fitting and comfortable clothing so that it will be easier to insert the intravenous.
• You should plan to have a responsible adult take you home after your surgery, as you should not drive for a period of 24 hours after the procedure.

How is the wisdom teeth procedure done?

The surgery usually takes place in the dental office. However, if you are having all 4 teeth extracted at once or are at high risk for complications your surgeon may prefer to do the surgery in the hospital. The removal of wisdom teeth may be done in different ways depending on:

• The tooth’s position
• Whether or not it has broken through the gum
• How deeply beneath the gum it is positioned
• How close the roots of the teeth are to the sinuses or important nerves and blood vessels.

Your surgeon will first give you an injection that will numb the area where the tooth is to be removed. He or she may offer you a sedative medication that will help you relax. This can be given by intravenously, or in pill form. Nitrous oxide or “laughing gas” may also be used. A general anesthetic that will put you to sleep during the procedure may be used particularly if several or all of your wisdom teeth are being removed.

Your surgeon will make a cut in the gum to open up the gum tissue over the tooth being extracted. A flap is thus created which is folded back to expose the bone and tooth. Your surgeon will then separate the tissue that connects the tooth to the bone. In some cases the tooth can be loosened using an instrument called a forceps and removed. In other cases the surgeon will cut the tooth into smaller pieces in order to extract it. Some bone around the tooth may need to be removed as well. The incision in the gum is then stitched together. Some stitches dissolve and others may need to be removed a few days after surgery. You will be asked to bite gently on cotton gauze that will be placed over the extraction site.

What can I expect after the wisdom teeth surgery?

You will need to rest for a while in the office after the general anesthesia or sedation. Once the anesthesia has worn off, most patients can go home. However if you have had general anesthesia you should have someone drive you home and stay with you for a period of 12 hours. Your jaw may feel stiff and sore but you will be given pain medication to make you more comfortable. You can expect some bleeding for 24-48 hours after the surgery. You should call your surgeon if the bleeding continues beyond this period. You may experience some bruising and swelling of your face during the first week. To ensure a quick recovery, you should rest, eat a nutritious diet and follow your surgeon’s instructions for the care of the extraction site. Your surgeon will provide you with an instruction sheet explaining how you should take care of the extraction site after your surgery:

Instructions to follow after wisdom tooth surgery:

• Continue to bite gently on the gauze square folded in four periodically for 20 minutes at a time. Change the gauze as it becomes soaked with blood.
• Take care not to bite the inside of your cheek, lip or tongue while you mouth is still frozen.
• Prop up your head with a pillow, when in bed: lying flat could make you to continue bleed for longer a period of time.
• To reduce the swelling apply an ice pack to the outside of your cheek for 30 minutes, taking a 30 minute break between applications during the first 48 hours.
• Get plenty of rest for the first 24 hours. Avoid any physical activity as it could prolong the bleeding.
• Once you have stopped bleeding begin a light diet for the first two days: e.g. yogurt, soup, milk drink, protein drinks. Avoid hot foods and do not use straws for the first day as this can loosen the clot and promote bleeding. You may return slowly to a normal diet when you feel you are able to.
• You should not smoke or drink alcohol as this can increase bleeding and delay your recovery. Smoking can also reduce the blood supply to the area and bring germs to the extraction site.
• It is critical to keep your mouth clean. Starting the day after surgery you should rinse your mouth with warm salt water (1 tsp in a glass of water) after meals and before bed.
• You may begin brushing your teeth gently the day after the surgery.
• If necessary, your surgeon will prescribe medication to ease your discomfort. Take them according to the instructions on the bottle.
• Dissolving stitches, which fall out after 3-4 days, are used most often.

When should I contact my surgeon and what can go wrong with the procedures?

Most people experience no problems after a wisdom tooth extraction, but contact your surgeon or the hospital immediately if you:

• Experience bleeding that is difficult to control.
• Have severe pain that is not controlled by the medication.
• Have fever or chills.
• Experience new swelling of your cheeks, jaw or face after the original swelling has begun to decrease.
• Develop itching, a rash or other symptoms suggesting you are having an allergic reaction to your medication.
• Experience continuous nausea or vomiting.

  Other complications that can occur include infection and dry socket.

• Infection tends to be uncommon after the removal of wisdom teeth. If you detect any new swelling of your face you should contact you doctor for a follow-up appointment as this may be a sign of infection for which you may need to take antibiotics.
• Dry socket is a painful inflammation that can occur when the clot dislodges too soon. This usually appears within 2 to 3 days AFTER the extraction of a wisdom tooth and is easily treated with a special type of socket dressing or packing.

What is happening during the healing process?

It is quite common for patients to feel that a hole has developed, especially at lower wisdom tooth extraction sites within the first week after surgery. At the time of your follow up appointment, your doctor may provide you with special instructions on how to flush out this healing socket to avoid food entrapment and speed up the healing of the area.

After the tooth is removed, a blood clot forms in the socket. In the first few days, repair tissue begins to fill in the space and from this, new bone begins to develop. When the bone fills the cavity completely you have healed. Healing is usually complete after 2 to 3 months from the time of the extraction.