Be sure to thoroughly read the following important information about the wisdom teeth removal – a tooth extraction procedure offered by Denver oral surgeon, Randolph C. Robinson, MD, DDS, FAACS:
Wisdom teeth, your third molars, are the last teeth to come in — and the ones least needed for good oral health. They may not erupt, or emerge from your gums, until your late teens or early twenties — if they erupt at all.
Often, they are impacted, or trapped in the jawbone and gums, usually because there is not enough room for them in your mouth. In fact, wisdom teeth often do more harm than good, and your surgeon may recommend removing them.
Most people have four wisdom teeth, one in each back corner of the mouth, but each tooth can be at a different stage of eruption and position of impaction. Since wisdom teeth develop over a period of many years, harmful changes in your mouth may be gradual, but these changes could result in sudden and severe pain.
By your late teens, your jawbone has nearly reached its adult size. But sometimes it is not big enough to hold developing wisdom teeth. When this happens, your teeth become trapped in the jaw and grow wherever they can.
The crown (chewing surface of the tooth) may only partially break through the gum. In other cases, it may remain completely in the bone. The roots, which hold the tooth in place, may become misshapen or grow dangerously close to a sinus cavity or the nerve located in your lower jaw.
Wisdom teeth may grow at a mesoangular position, or an angle toward your other teeth. They may also grow at a distoangular position, or away from your other teeth. They can grow into a horizontal or vertical position as well.
Like all teeth, wisdom teeth develop inside a socket (an opening) in your jaw, protected by bone and gum tissue until they erupt. Over time, the wisdom teeth roots lengthen and the jawbone becomes denser. So, the older you are, the more difficult it is to remove your wisdom teeth.
With time, the roots become solidly anchored in the jawbone. Therefore, early removal is sometimes the best treatment to help prevent problems.
Whether wisdom teeth cause your mouth harm depends on several factors, including the size of your jaw and how your wisdom teeth erupt. Sometimes problem wisdom teeth cause symptoms like pain and swelling. Or you may have no symptoms at all, but the other teeth in your mouth could be at risk for damage.
- Gum disease — When a wisdom tooth partially breaks through the gum’s surface, bacteria can get under the flap, causing an infection in the gum.
- Crowding — An impacted or erupting wisdom tooth can push on adjacent teeth, causing them to become crooked or even damaging them structurally.
- Decay — A wisdom tooth that is hard to clean because of its position or because it is partially-covered by gum tissue may fall victim to cavity-causing bacteria.
- Poor position — A wisdom tooth that grows toward the cheek can irritate nearby tissue. If an erupted tooth is crooked, it may be hard to clean and can even make it hard to bite down.
- Cysts — If the sac that holds the crown remains in the bone, it can fill with fluid, forming a cyst that can destroy surrounding bone.
Wisdom tooth surgery may be done in an outpatient surgery setting or, occasionally, in the hospital.
The surgical method depends on whether your wisdom teeth are erupted or impacted and how deep the roots are.
After you are asleep, your jaw will be numbed with a local anesthetic that lasts up to 12 hours. The incisions are made and the overlying bone is removed. It may also be necessary to cut the teeth into pieces to remove them.
All four wisdom teeth are usually removed at the same time. The surgery takes 30 to 60 minutes.
The incisions are closed with dissolving stitches and a gauze pack is placed over the site to help stop the bleeding. The stitches dissolve in 5 to 7 days.
Teenagers have a faster recovery than older patients. Most patients have swelling that is largest on the third day. The bleeding may last for 24 hours. It is best controlled by biting on the gauze packs. If an IV sedation or general anesthetic was used you may be sleepy the rest of the day.
Some patients recover quickly, but some require a week of recovery. Each person is different but you should plan for at least two days off before returning to work or school.
You will be given a prescription for a strong pain relief medicine, antibiotics to prevent infection, and steroids which help reduce the amount of swelling.
Nausea can occur after surgery, sometimes caused by the anesthetics and strong pain relief medicines and may be reduced by preceding each pain pill with a small amount of food (e.g. soda crackers or foods that you can see through; initially avoid dairy products).
On the first post-operative day, if you don’t feel like eating, don’t force yourself to eat. Take the pain pill with repeated sips of clear liquids that you can tolerate, e.g. ‘flat’ 7-Up, ginger ale, water, apple juice, etc. Call our office if you do not feel better, or if repeated vomiting is a problem.
Minor complications include asymmetry (unevenness), contour irregularity, discoloration, numbness, and prolonged soreness. More serious but rare complications include: infection, bleeding, and collection of fluid under the skin. Though complications usually do not occur, you should be aware that they are possible.
- You may need to schedule two to four days off from work or school to give yourself enough time to recover.
- If the surgery is going to include anesthesia or intravenous (IV) sedation, do not eat or drink after midnight, or as your surgeon directs. If you are likely to be nauseated, consult with your surgeon about medications you can take before surgery.
- Arrange to have a responsible adult come along and to drive you home.
- Wear comfortable clothes. Button-closure shirts with sleeves that roll up easily (for IV access) are preferred.
- Make sure we have a recent x-ray show the wisdom teeth or we can take one the day of surgery.
- To control excessive bleeding, bite down gently but firmly on the gauze packs that have been placed over the surgical areas. This pressure helps form a blood clot in the socket(s).
If active bleeding persists after one hour, place enough new gauze to obtain pressure over the surgical site for another 30-60 minutes. Change gauze as necessary, and dampen or fluff for more comfortable positioning.
If bleeding persists or becomes heavy, you may substitute a tea bag (soaked in hot water, squeezed damp-dry and wrapped in moist gauze) for 20-30 minutes. Oozing may persist for up to 24 hours.
- Your gums and jaw may feel tender and sore. Take the first pain pill before the anesthetic completely wears off to manage discomfort better. Some people may even require two of the pain pills at one time during early stages, but that may add to the risk of nausea.
Remember that the most severe discomfort is usually within the first 12 hours after the anesthetic wears off. Then your need for medicine should lessen.
- Normally, your cheeks will swell, but you can keep swelling to a minimum by firmly applying ice packs to your cheeks for 20 minutes on, and 20 minutes off, during the first 24 hours after surgery.
- Nausea can occur from the anesthetic, pain medications, drainage of blood into your stomach, or anxiety. Nausea resulting from the pain pills may be reduced by preceding each pain pill with a small amount of soft food and taking the pill with repeated sips of clear liquids that you can tolerate, e.g. ‘flat’ 7-Up, ginger ale, water, apple juice, etc.
Notify your surgeon if this condition persists, so an anti-nausea medication or a change in your post-operative care regimen can be prescribed.
- Eat soft foods, such as soups and meals puréed in a blender for the first day after the bleeding has stopped. The temperature of the food doesn’t matter, but avoid extremely hot foods. Do not skip meals, and over the next several days, you can progress to solid foods at your own pace. Avoid hard, crunchy foods such as carrots and popcorn for six to eight weeks after surgery.
If you are diabetic, maintain your normal eating habits as much as possible, and follow instructions from us or your primary care physician regarding your insulin or medication schedule.
- Drink a lot of fluid after the surgery.
- Take antibiotics and/or pain reduction medication, if prescribed.
- Keep your head elevated slightly, perhaps with two pillows, while in bed. You may prefer to use an old, clean pillow case or towel on your pillow to catch any drainage that flows from your mouth after surgery.
- Do not disturb the surgical area the first day. Do not probe the area with any objects or your fingers. Keep your mouth clean, but don’t rinse your mouth or spit. Brush your teeth gently and carefully.
- Beginning the day after surgery, rinse your mouth four times each day with salt water for seven days. (Dilution: ½ teaspoon salt in 1 cup of lukewarm water.)
- Using the large syringe provided by your surgeon, irrigate the hole or socket with lukewarm water after the first week of surgery. This rinsing keeps food out and helps reduce infections.
- Don’t smoke after surgery. The smoke is an irritant to healing that can loosen the blood clot and expose the bone to air, causing a higher incidence of dry sockets and a more painful recovery course.
- Please call your surgeon if you experience:
- Excessive, uncontrollable bleeding
- Excessive and persistent swelling
- Persistent and severe pain or nausea, unrelieved by prescribed medications
- Temperature of more than 101.0° F, by mouth
- Reaction to medications, such as itching, hives, or nausea
- Questions about any other aspect of your recovery
Set an Appointment for Wisdom Teeth Removal Today
If live in the Denver, CO area, and you have concerns or questions about wisdom teeth extraction, or any other form of oral surgery, please contact our office to schedule an appointment with Randolph C. Robinson, MD, DDS, FAACS.