Procedures

• Dental Implants
• Bone Grafting
• Wisdom Teeth
• Impacted Canines
• Facial Trauma
• Jaw Surgery
• Oral Pathology

Wisdom Teeth

By the age of 18, the average adult has 32 teeth; 16 teeth on the top and 16 teeth on the bottom. Each tooth in the mouth has a specific name and function. The teeth in the front of the mouth (incisors, canine, and bicuspid teeth) are ideal for grasping and biting food into smaller pieces. The back teeth (molar teeth) are used to grind food up into a consistency suitable for swallowing.

The average mouth is made to hold only 28 teeth. It can be painful when 32 teeth try to fit in a mouth that holds only 28 teeth. These four other teeth are your third molars, also known as "wisdom teeth."

Why Should I Have My Wisdom Teeth Removed?

Not everyone needs his or her wisdom teeth removed. Removal may not be recommended for patients who have adequate space in their mouth for the teeth to erupt properly and allow access for cleaning. In general, surgical risks increase with age. Your oral surgeon may recommend scheduled periodic clinical and radiographic exams if the risks of removing the wisdom teeth outweigh the risks of monitoring them.

The majority of the time, wisdom teeth become impacted due to lack of space in the jaws. Wisdom teeth that do not erupt properly can cause numerous problems. Occasionally the patient may notice symptoms caused from pathologic wisdom teeth, however often the onset of these problems may be gradual and unnoticed.

These problems include:

Gum disease:

A wisdom tooth that partially erupts through the gum tissue can harbor problem-causing bacteria in the space between the second and third molar causing bone loss and damage to the second molar.

Crowding:

A wisdom tooth can push on adjacent teeth causing them to become crooked.

Cavities:

A wisdom tooth may be hard to clean due to partial gum tissue coverage or lack of space causing it or the second molar to become decayed.

Poor position:

A poorly positioned wisdom tooth may rub on the cheeks causing irritation and pain.

Infection:

A wisdom tooth that partially erupts through the gum tissue can accumulate food or bacteria under the flap of gum tissue causing pain and swelling. These infections can in rare instances become very serious.

Cyst development:

Cysts and tumors can develop from the follicle that wisdom teeth form in. These cysts and tumors can destroy jawbone and teeth.

When Should I Be Evaluated For Wisdom Teeth Removal?

Most dentists will evaluate your wisdom teeth radiographically around age 16. Depending on the development of these teeth and the anticipated lack of space, he/she will refer you to an Oral and Maxillofacial Surgeon for consult and removal between 16 and 21 years of age. Around this time the roots are not completely developed and the jawbone isn’t as dense, facilitating easier removal with less risks. As a person gets older the teeth become more anchored in the denser jawbone making extraction more difficult.

What Are The Risks Of Wisdom Tooth Removal?

As with any surgery there are risks to wisdom tooth removal. Infection after routine wisdom tooth removal is less than 5%. These infections usually respond to treatment with antibiotics. There is also a risk of damage to teeth adjacent to the wisdom teeth. A tooth may be chipped or a filling loosened in rare cases. Small pieces of the tooth or root may be left behind if the doctor feels it would cause more trouble to remove the piece than to leave it.

In the upper jaw, wisdom teeth form close to the sinus. Removal of some wisdom teeth can leave a small opening between the sinus and the mouth. This opening will usually heal when assisted with careful postoperative care but in rare cases gum tissue may need to be repositioned to close the opening.

The most common postoperative complication in the lower jaw is the development of a "dry socket". A dry socket occurs when the tooth socket either fails to form a blood clot or the clot disintegrates which can result in delayed healing. The specific cause of dry socket is not known. Dry sockets usually occur on the third to fifth postoperative day and will be associated with distinct persistent throbbing pain in the jaw that often radiates toward the ear and forward along the jaw.

This may cause adjacent teeth to hurt or feel like an earache. Symptoms may get worse at night and pain medications seem to offer limited relief. If this were to occur, treatment is usually placement of a medicated dressing into the tooth socket. This dressing would need to be changed every few days until the discomfort is gone.

Also in the lower jaw there is a small risk of numbness to your lip, chin, or tongue. The nerve, which supplies feeling to your lip and chin, runs within the lower jaw and can be located close to the roots of the tooth. Removal of lower wisdom teeth can cause a tingling or numbness of the lip or chin in about 1 in 200 people. This condition will usually resolve over a few weeks to a few months. In very rare cases the condition could be permanent. In any case, please ask your doctor any questions that you might have.

What Anesthetic Options Do I Have?

All outpatient surgery is performed under appropriate anesthesia to maximize patient comfort. Your Oral and Maxillofacial Surgeon has the training, license and experience to provide various types of anesthesia to allow patients to select the best alternative. These services are provided in an environment of optimum safety, utilizing modem monitoring equipment and staff experienced in anesthesia techniques.

Depending on the difficulty of your teeth and your medical health, there are numerous ways to have your wisdom teeth removed. The majority of healthy patients receive IV sedation or a general anesthetic. With these options, intravenous medications are given to deeply sedate and induce sleep, making you comfortable and unaware of the procedure. Recovery after an intravenous anesthetic may leave a patient drowsy for the majority of the day and patients are not allowed to drive a vehicle for 24 hours. Local anesthetic is also administered to keep you comfortable during and after the procedure.

Nitrous oxide (laughing gas) may be a recommended anesthetic option for patients who are less medically healthy, patients with wisdom teeth that are less difficult to remove, or for patients who prefer not to have an intravenous anesthetic.

This gas relaxes you and takes your mind off the procedure but does not put you asleep. Local anesthetic will also be given to keep you comfortable during and after the procedure.

The option of receiving local anesthesia ("novocaine") only may also be considered and effective in appropriate situations.

In any case feel free to discuss these options with your Oral and Maxillofacial Surgeon.

How Should I Prepare For Wisdom Tooth Removal?

• If you are planning on IV anesthesia, you should have nothing to eat or drink (including water) 6 hours before the procedure.
• Patients who are under age 18 need their parent or guardian to be present for the informed consent.
• A responsible adult needs to come with you and stay in the lobby for the entire procedure and then drive you home.
• Wear loose fitting clothing so your sleeves can easily be pulled up.
• If you wear contacts please wear your glasses the day of the appointment.

What Should I Expect After Wisdom Tooth Removal?

The following conditions are considered normal if they occur:

• The surgical area will swell.
• Swelling peaks on the second or third day post op.
• Stiffness of the muscles may cause difficulty in opening your mouth for up to a week.
• Your other teeth may ache temporarily.
• Your lips may become dry and crack. Your lips should be kept moist with cream or ointment.
• There may be a slight rise in temperature for 24-48 hours. If the temperature continues or is greater than l0l .5 F please call our office.
• It is not unusual to develop bruising in the area of extraction.
• Minor bleeding or oozing is not uncommon for the first 24 hours.

How Should I Care For My Mouth After Surgery?

Bleeding

The gauze, which is placed immediately after surgery, should be kept in for the first hour. Biting down on the gauze will cause pressure over the extraction sites controlling the bleeding.. If active bleeding persists after the first hour, fold new gauze into a tight roll and place it so biting applies pressure directly over the surgical site. Continuous bleeding can occur because the gauze is positioned and clenched between the teeth rather than directly applying pressure over the surgical site. Try repositioning the gauze and rest with the head elevated. If these measures fail, use a tea bag (soaked in hot water, squeezed damp dry and wrapped in gauze) for 30-60 minutes. If bleeding remains uncontrolled, please call the clinic.

Diet

Eat any nourishing food that can be taken with comfort. Avoid hard or hot foods in the first 24 hours. It is sometimes advisable to confine the first day’s diet to soft, cold foods. Over the next several days you can progress to solid foods at your own pace. Avoid things such as nuts, seeds or popcorn that may get lodged in the wounds. Do not use a straw for 5 days following surgery. Straw use may cause bleeding or a dry socket.

Swelling

Swelling will vary depending on the patient’s tendency to swell and the complexity of the procedure. Some swelling should be expected. Rest with the head elevated. Apply ice bags to the sides of the face for the first 24 hours (20 minutes on - 10 minutes off) to help minimize swelling. Ice should be discontinued after the first 24 hours. The greatest swelling should be expected 36-72 hours after the procedure. Swelling does not mean that infection has set in especially if it starts to subside after the third day.

Oral hygiene: Keeping your mouth clean after surgery is essential. Use the rinse directed by your doctor or 1/2 teaspoon of salt in 8 ounces of water and rinse 6 times daily starting the day AFTER surgery. Brush all the remaining teeth with a soft toothbrush starting the day after surgery. This will reduce the risk of post op infection.

Nausea

Nausea is most often caused by the stronger narcotic pain medications. Preceding these medications with food can reduce nausea. Try taking small sips of carbonated beverages and minimize the narcotic pain medications.

Pain

Unfortunately most oral surgery is accompanied by some degree of discomfort. If a prescription has been given take them as directed on the bottle. You may find better pain control if you take your first pain pill before the local anesthetic wears off. Do not combine the prescription pain medicine with other pain medicines unless directed to do so by your Oral and Maxillofacial Surgeon. Do not combine the pain medicine with alcohol. Many prescription pain pills can cause drowsiness and must not be taken if you are driving a car, operating machinery, or performing skills that require concentration.

Dry Sockets:

Avoid drinking through straws or spitting for 5 days after surgery. In addition NO smoking is permitted for three days after the procedure.