What are Wisdom Teeth
Wisdom teeth usually start to erupt around 18 years old, sometimes a little sooner and frequently later into your early twenties. It is not uncommon to have one or two missing and some do not develop any at all. There are many myths around wisdom teeth, however, essentially they are just another molar tooth similar to the two that are present in front.
Do all Wisdom Teeth need removing?
Erupting wisdom teeth frequently cause some discomfort, however, this does not mean they need to be removed. Many people will cope well with partially erupted teeth so long as they are kept clean and free from decay. Occasionally they will become infected as they come through, however, this often settles down with good oral hygiene and home care. Some times these symptoms persist, the tooth decays or the tooth damages the adjacent tooth. If this occurs it may be recommended to have one or more removed. If it can be done in the practice we will do so, however, some require specialist care to remove and we will refer you to hospital to have this done.
How are they removed?
If we are removing them in the practice, the procedure will be little different from any other tooth extraction. The procedure will be under local anaesthetic where you will be awake. We will advise you of the risks of removal and the after care needed. Smoking is a risk factor for infection and pain and we will encourage you to resist from this during the healing phase.
If we do have to refer you to hospital, in the worst case scenario for the most difficult teeth the procedure may be carried out under general anaesthetic. You will be asleep during the procedure. However, most times the procedure can still be carried out under local anaesthesia or for more difficult teeth with the help of intravenous sedation. Here you will be given an injection in the back of the hand that will make you feel a little sleepy but you will still be awake. You will be unaware of the time taken for the operation and feel relaxed. With any procedure it may be advisable not to drive or work afterwards, however, with sedation or general anaesthesia this will be a requirement.
We will discuss the difficulty and the possibilities with you and advise you on the best type of procedure for your particular case.
NICE (National Institute of Clinical Excellence) Guidance
As already mentioned, not all wisdom teeth need to be removed. NICE has recommended that impacted wisdom teeth that are healthy should not be removed. The current recommendations are that only diseased wisdom teeth, or where other problems are occurring related to the wisdom tooth, should be removed.
Examples include untreatable tooth decay, abscesses, cysts or tumours, disease of the tissues around the tooth or where the tooth is in the way of other surgery.
Wisdom teeth removal is commonly performed and for the incidence fairly risk free. However, there are some recognised risks and in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.
If the operation is performed under general anaesthesia the risks of this are no different to any other operation.
You may also have some swelling, bruising, pain or jaw stiffness for up to two weeks. These symptoms are usually at their worst for the first two or three days and then gradually improve.
The risks of wisdom tooth extraction are recognised and are largely related to the site of the tooth. There are more significant risks with lower wisdom teeth than upper ones.
These may include:
- Infection of the socket
- Damage to other teeth
- Loss of the blood clot causing pain and delaying healing
- Damage to the jaw joint from opening the mouth wide and the force needed for removal
- Damage to the sinuses with upper teeth
- With lower teeth damage to the nerve running to the lower lip causing numbness or tingling. Damage to the nerve suplying the tongue causing numbness or tingling. This is usually temporary but in some cases can be permanent.