Wisdom tooth removal – causes, pain, procedure and recovery

‘Wisdom’ – wisdom is the use of knowledge. It is believed that third molar were given the name ‘wisdom teeth’ because they erupt in mouth when child learn to use knowledge – become more wiser as they enter adulthood. Wisdom teeth are believed to be in evolutionary phase. Due to changes in diet and dietary habits (food become soft, easily chewable as compared to raw food used by our ancestors), we don’t need large and big jaws like our ancestors to chew food. This is the reason why our jaws becoming smaller and smaller in phases of evolution. So sometimes these smaller jaws fails to hold more than 28 teeth out of 32 teeth, these extra four teeth being third molars i.e. wisdom teeth. So wisdom teeth often remain impacted in bone, they can’t get sufficient space to erupt in mouth. There are a lot of myths and misconceptions about tooth extraction especially about wisdom tooth extraction that is why it becomes necessary to know about wisdom tooth and its removal.

# So, what are wisdom teeth ??

Wisdom teeth are third set of molars which are last permanent teeth to erupt in mouth between ages of 17 to 25 years or eruption may also get delayed to few more years. An average person will develop four wisdom teeth but this is not applicable to all, some people may not develop one or more wisdom teeth while in others all wisdom teeth are absent or extra (fifth) i.e. supernumerary wisdom tooth can be seen.
If there is lack of space for eruption of these third molar teeth, they get stuck or say ‘impacted’ in bone or they may erupt partially, making some odd angles or they may erupt in another location. All four wisdom teeth may show eruption differently. Due to poor positioning of these third molars, the area becomes difficult to clean and due to accumulation of food particles and bacterial process food particles may rot there, this can lead to pain and infection and it could infect nearby teeth. Sometime the area and gums covering wisdom tooth become inflamed and it may swell due to accumulation of pus (abscess), this type of condition is called pericoronitis. In such condition patient may experience a lot of pain and trismus (unable to open mouth).
Wisdom tooth may exert force on adjacent teeth which may lead to crowding and malalignment of teeth.

# Causes for wisdom tooth removal -

- Due to improper positioning i.e. malalignment of wisdom tooth, surrounding area may become difficult to clean and it could rot leading pain and infection.
- Many times wisdom tooth erupts in abnormal location or direction, may be seen as tilted sideways or twisted. In some cases wisdom teeth comes in bite and may harm soft tissues i.e. cheek bite
-  When wisdom tooth get impacted in its bony socket below gum line, due to lack of space.
- Decayed wisdom teeth.

# Wisdom tooth removal -

During check-up, your dental surgeon may take intraoral x-ray or orthopentomogram, and after clinical and radiographic examination, your dentist (or oral and maxillofacial surgeon) will inform you whether extraction of wisdom tooth is necessary or not and if necessary what type of preparation you need and how it is going to be done.

#  Procedure of wisdom tooth removal -

- First of all your dentist will give you a local anaesthetic to numb the area where tooth will be removed. Dentist may also opt for general anaesthetic (rarely used) especially if more than one (or all) wisdom teeth will be pulled out at the same time. Your dentist may advise you not to eat or drink after midnight, a night before wisdom teeth removal surgery, so as to prepare for general anaesthesia. General anaesthesia induces sleep and makes your whole body unconscious.
- When anaesthesia started working, your dentist will open up the gum tissues and will remove some bone covering the tooth; this is done for good visibility of tooth and easy removal.
- Extraction instruments are used to loosen tooth from connective tissue which hold tooth firmly in bony socket. Sometimes it is necessary to cut (split) tooth into smaller pieces for easy removal.
- After removal of wisdom tooth, you may need stitches (sutures). If sutures placed are non-dissolving (non resorbable) sutures then you need to visit your dentist after few days for suture removal.
- A thick gauze pack is placed over the extracted socket to control bleeding, and your dentist will give you some important instructions before you leave dental office. All the instructions given are same as we have mentioned in our article – Tooth Removal – Causes, Procedure and Post Extraction Care , which are as follows –

# Immediately after extraction -

* Bite on the cotton gauze pack placed over extraction site for 45 minutes to 1 hour, after that remove it gently.
* Maintain constant pressure or gauze (No talking or chewing).
* Do not spit or suck through a straw. If bleeding persists at home, place a clean gauze pad over the socket & bite it firmly for 30 minutes.
* You can also bite on a moistened tea bag for thirty minutes. (Tannic acid in the tea bag helps to from a clot by contracting bleeding vessels).
* Some blood will ooze from the area of surgery for several hours which is normal.
* Avoid vigorous mouth rinsing or touching the wound with tongue etc. following extraction.
* To minimize any swelling, you can place ice packs to the side of face over extraction area.
* Take prescribed pain medication as soon as possible.
* Get plenty of rest at least 8-10 hours of sleep 7 avoid vigorous exorcize during first 24 hours after tooth removal.
* Do not smoke under any circumstances (at least for 48 hours after surgery).

– > Diet

* Use soft or liquid diet high in protein.
* Drink large amount of water & fruit juices (Do not use straw).
* Avoid hot food for a whole day after tooth removal.

#  Some important points to be taken into consideration–>

* Some pain or discomfort is normal after tooth removal surgery which can be controlled by taking pain medication prescribed by your dentist / oral surgeon.
* Don’t drive an automobile or work around heavy machinery under pain medication.
* Do not mix alcohol & pain medication.
* Swelling after surgery is normal body reaction, applying ice packs over the area for the first 24 hours and not longer than 20 minutes at a time, helps to control swelling.
Do not use hot fermentation (do not apply heat).

* Low grade temperature (99-100F) for 7-10 days following tooth removal is normal.

* You may experience some mild bruising in the area of surgery, which is also normal and will disappear in 7-14 days.

* If sutures/stitches were placed in the area of tooth extracted then your dentist/oral surgeon will tell when sutures/stitches need to be removed (usually in about a week and if sutures are self-dissolving they don’t require removal).

* Contact your dentist for any doubt or severe discomfort.

# Recovery after wisdom tooth removal -

After Wisdom tooth removal you may experience some pain, swelling (inflammation) by following some measures it can be minimized. Swelling could be worse for the first few days but will gradually reduce; applying gently ice packs or a cold cloth to the area will help reduce the swelling. You may also experience trismus i.e. difficulty in opening the mouth: by regular gentle mouth opening exercise it will get improve.  Rarely some patient may experience numbness or tingling in the area, you need to contact your dentist in such cases.

After any swelling and bruising has disappeared, your mouth and face should return to normal.

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