Wisdom Teeth

Wisdom teeth are a pain. Most of us don’t have room for them and end up having them removed. The long and the short of it is, “If you have impacted wisdom teeth, unless they are deeply buried under the bone, you should have them removed, and the sooner you do this, the better.”

We can help you determine whether or not you should be worried about your wisdom teeth, what treatment might be required in your individual circumstances, and what the costs might be.

Chances are, we will be able to carry out any necessary procedure in our pleasant, comfortable offices at a time that suits you. With the benefits of a little sedation and some local anaesthetic, you will find the experience a lot less dramatic than your friends would have you believe.

If you really want to know more, you should find the answers to your questions below. Better still, call us for an appointment to discuss.

F.A.Q.

Q. What are wisdom teeth?
A. Wisdom teeth (also known as third molars) are teeth that appear at the very back of the mouth usually between the ages of 18 and 25 years. They are the last of the adult permanent teeth to develop.

Q. Are all wisdom teeth problematic?
A. No. If wisdom teeth come fully through, they can be useful teeth. If they are kept healthy by careful cleaning, they will last a lifetime.

Q. What are ‘impacted’ wisdom teeth?
A. Because they are the last teeth to develop, there is usually not enough room for wisdom teeth, so they only come through part-way or not at all. These cases are called ‘impacted’ wisdom teeth.

Q. Why are impacted wisdom teeth a problem?
A. There are a number of reasons:

• Decay. Wisdom teeth can be very difficult to clean, and therefore often get decayed. It is usually not possible to repair such teeth simply because they are so inaccessible.
• Infection. Impacted wisdom teeth very often have a flap of gum over the back. This area is always chronically infected and will undergo occasional acute flare-ups. When there is an acute flare-up, the gum around the tooth can get quite swollen and tender. There is often a discharge of pus from such areas, and a foul taste or odour. Swelling can spread to the cheek and to the area and glands under the jaw. Before the days of antibiotics, infections in this area were considered life-threatening, because of the risk of airway obstruction.
• Damage to neighbouring teeth. Another common way that impacted wisdom teeth can be a problem is the risk they pose to adjacent teeth. It is common for an impacted lower wisdom tooth to affect the second molar immediately in front. Impacted wisdom teeth can rapidly damage this second molar too, and result in the loss of the second molar tooth in addition to the wisdom tooth.
• Tooth crowding. Some authorities believe third molars can also affect the teeth further forward, and some orthodontists ask that third molars be removed to reduce the risk of unwanted tooth movement or crowding.
• Cysts. Impacted third molars can form cysts, and this can produce significant deformity and require extensive surgery.
• Tumours. Tumour formation around impacted third molars is uncommon, but does occur. Some of these tumours are very nasty (malignant).
• Jaw fracture. Individuals who play contact sports have a greater risk of jaw fracture if they have impacted wisdom teeth.

Q. Do I need to have my impacted wisdom teeth removed?
A. It depends. If you are 25 years old or younger and have impacted wisdom teeth, you are almost certainly better off having them removed. If you are over thirty, the situation is a little more complicated. For ‘over-thirtys’, if the wisdom teeth are completely covered with bone on an X-ray, they can probably be left (such teeth should be periodically reviewed by your dentist). If the wisdom teeth are partially through into the mouth, however, they should probably removed in most cases. As with any surgical procedure, a risk analysis should be undertaken by an experienced dental or oral surgeon, to determine the risks profile of surgery as opposed to the risk profile of leaving the teeth in place. This will require a clinical examination, history taking and a special X-ray.

Q. Why should I have my impacted wisdom teeth removed if they have not given any trouble?
A. As mentioned above, unless impacted wisdom teeth are well covered by bone they are almost certain to cause problems if left in place. This is particularly true of the lower wisdom teeth. Such problems can occur suddenly, and often at the most inconvenient times.

Q. When should I have my impacted wisdom teeth removed?
A. Immediately after any acute infection has been controlled. It is now recommended by most specialists that impacted wisdom teeth should be removed between the ages of 14 and 25 years, whether they are causing problems or not. Surgery is technically easier and patients recover much more quickly when they are younger. What is a relatively minor operation at 20 years of age can become quite difficult in patients over 40. Also, the risk of complications increases with age, and the healing process is slower.

As a rule, removal of wisdom teeth is regarded as an elective procedure, but should be carried out at the earliest convenient time. Don’t wait until you have pain, swelling or infection.

Athletes who have impacted wisdom teeth should have their surgery carried out in the ‘off-season’, if possible.

Q. How are wisdom teeth removed?
A. There are three options here:

• Local anaesthesia alone. This is just like when a dentist numbs your mouth for a filling. This technique is adequate for single tooth extractions where the surgical difficulty is assessed as routine.
• Intravenous sedation and local anaesthesia. With this technique, a sedative agent is administered intravenously (by injection into a vein in your arm or the back of your hand). Local anaesthesia always follows. The advantages of this technique are that it makes you feel very relaxed, time passes quickly and you experience no pain. Although you are actually awake throughout the procedure, you will have little or no memory of the procedure afterwards. Intravenous sedation does not carry the risks associated with general anaesthesia and is the best option for the removal of most wisdom teeth.
• General anaesthesia. This is where an anaesthetist administers a full (general) anaesthetic, so that you are completely ‘asleep’ throughout the procedure. This option is only available at facilities such as public and private hospitals and other places where fully equipped operating theatre facilities are present. This option is the most appropriate for complicated procedures or where there are specific risk factors which are better managed under general anaesthesia.

Q. If my wisdom teeth need to be removed, who will do it?
A. Straightforward removal of wisdom teeth may be done by your regular dentist. More complex extractions will often require referral by your dentist for treatment. We receive referrals from a large number of dentists for wisdom tooth surgery on a regular basis. Dr Neil Piccione is experienced at the surgical management of impacted wisdom teeth, and he is certified to administer intravenous sedation. It is very likely that he will be able to help you.

If your are assessed as requiring a general anaesthetic, we can assist you to find a surgeon and facility that will be able to help you.

Q. How does it all work?

A. Make an appointment for a consultation with your dentist or call our office. If your dentist is not prepared to undertake the treatment themselves, they will refer you to someone else.

If you are referred to us (or come to us on your own), our office procedure is as follows:

You will need to have a special X-ray done (often called an OPG or Panex) and this should be available to us at your consultation appointment (we can arrange this for you).

We will then need a consultation appointment to meet you and discuss treatment with you before scheduling an appointment for surgery. At this initial consultation appointment, your specific treatment needs will be assessed and discussed. Your general health and medical history will be reviewed. Any risk factors will be identified, explained and discussed. The procedure will be explained to you and you will have an opportunity to ask any questions. An estimate will be prepared and a consent form presented to you for your signature. You will then be able to make an appointment for surgery.

Q. What do I have to do to prepare for surgery?
A. Please take note of the following if you are having surgery under intravenous sedation:

You should not have anything to eat or drink (‘nil per mouth’) for four hours before surgery (insulin dependent diabetics may require special attention – please discuss with Dr Piccione).

• Ensure you have arranged for a responsible adult friend or relative to drive you home and look after your for 2-3 hours after surgery.
• Wear comfortable, loose-fitting clothing.
• Remove contact lenses and any lip, tongue or nose ‘jewellery’ before coming in.
• Disclose all medications and health conditions to Dr Piccione.

Q. Will it hurt?
A. You will not feel any pain during the procedure.

Q. How much does it cost?
A. This varies depending on the number of teeth involved, the need for special tests or X-rays, the time required and the complexity of the surgery. As a guide, our recent fees for wisdom tooth surgery under intravenous sedation have varied between NZ$800 and NZ$2100. A written estimate will be given to you after your consultation appointment (before you make your surgery appointment). We do require payment in full on the day of surgery.

Q. How long will it take?
A. You should plan on being at the surgery about an hour, sometimes a little longer. Please instruct your escort/driver to arrive 45 minutes after your appointment begins, so that we can go over your care instructions with them and answer any questions they may have.

Q. What can I expect after wisdom tooth surgery?
A. Surgical removal of wisdom teeth does cause more discomfort than routine extractions. After the local anaesthetic wears off, usually several hours after you get home, you may experience:

• Some pain or discomfort. Prescribed medication will help you cope with this.
• Some swelling. This will usually peak at 24-48 yours and then resolve. There may be some associated bruising which becomes obvious with time, then fades.
• Some bleeding. This should not be a feature after the first 24 hours and should be readily controlled with pressure dressings. Blood stained saliva is to be expected for 2-3 days.
• Difficulty in opening your mouth and chewing. This will gradually improve as swelling reduces and healing occurs.
• A change in feeling (tingling or numbness) of your tongue, lip and/or chin.

All these symptoms are temporary , and in most cases your mouth will be feeling normal within a few weeks.

You should be seen a week after surgery to check healing and remove any sutures (stitches). This is usually a short appointment of 5-10 minutes duration.

Q. What is a ‘dry socket’?
A. This is a painful condition that usually begins 3-4 days after tooth extraction. It most commonly occurs after the removal of lower wisdom teeth, and is seen much more often in smokers. It is characterised by an empty tooth socket (no blood clot), and increasing pain. Treatment usually consists of placing a dressing in the wound to disinfect the area and make it more comfortable while healing occurs. Antibiotics are sometimes also prescribed.

Q. Is it normal to still have tingling or a numb feeling in my lip, chin or tongue several days after having wisdom teeth out?
A. No, but this is a well-known complication of wisdom tooth surgery that is explained during the initial consultation and consent procedure. It is generally due to injury to one of the nerves that lies close to the wisdom tooth that was removed. The tingling/numbness usually returns to normal with time, although it may be permanent. This complication is said to occur in up to 10% of people, but is much less common in younger patients (under the age of 20 years). You should contact us if you experience this complication.

Q. Will the antibiotics prescribed make my oral contraceptive less effective?
A. Yes, this is a distinct possibility. While you are taking the antibiotics and for the next seven ‘real’ pill days, you should use additional contraceptive measures.

Q. What should I do after surgery?
A. You will be given specific written instructions. In general:

• Have a responsible adult friend or relative drive you home.
• Do not drive a motor vehicle or operate any sort of machinery for 24 hours.
• Do not undertake any responsible decision-making for 24 hours.
• Do not drink alcohol for 24 hours.
• Do not take any medication unless it has been prescribed by your doctor or dentist.
• Rest, preferably in a seated position. Do not undertake any physical activity for 24 hours.

Q. What about post-operative care of my mouth?
A. You will be given specific written instructions. In general:

• Do not disturb the wound. In doing so you may invite irritation, infection and/or bleeding. Chew on the opposite side for the first 24 hours.
• Do not smoke for 36 hours. Smoking will promote bleeding and interfere with healing.
• Do not spit, suck on the wound(s) or suck through a straw. These activities will promote bleeding and may dislodge the blood clot, which could result in a ‘dry socket’.
• Control of bleeding. A pack made from a damp folded sterile gauze pad (which we will supply) should be placed over the bleeding wound, under firm biting pressure. It is important that this pack stay in place, under pressure, to control bleeding and to encourage clot formation for 15 minutes by the clock. If the bleeding has not stopped when the original pack is removed, place a new gauze pad over the extraction site and exert pressure by biting for another 15 minutes. If you run out of gauze packs, tea bags are good. Report persistent bleeding to us.
• Pain control. Pain relief medication will usually be prescribed by Dr Piccione after wisdom tooth surgery. You should not take medication that contains aspirin if you are experiencing any post-operative bleeding. Inform us immediately if you experience any undesirable side effects from prescribed medication.
• Diet and nutrition. There are no specific restrictions, but a soft diet may be more comfortable for a few days following surgery. Food may have to be cut up into smaller pieces for a few days. It is most important to keep fluid intake up in the days following surgery.
• Encouraging healing. After the first 24 hours, it is advisable to rinse gently with very warm salty water every few hours (one level teaspoon of salt to a small glass of very warm water). Do this for up to 7 days.
• General. Following the removal of your wisdom teeth, you should call us if any unusual bleeding, swelling or pain occurs. The first 24 hours after a surgical extraction are typically the worst, but are manageable with prescription medication. You should plan to see us approximately one week after surgery to ensure everything is healing well, and to have any sutures (stitches) removed.

Q. How long before I can go back to work?
A. Different people recover from wisdom tooth surgery at different rates. Depending on the nature of the surgery, your age and your individual recovery capacity, you should expect to get back to regular work in 2-4 days. In our practice, most people choose to have their surgery on a Thursday or Friday and almost all are fine to return to work by the following Monday.

Please Note: If you are uncertain whether or not to proceed with any suggested treatment, it is a good idea to get a second opinion. The decision to proceed with treatment (or not) is yours, and should be made only after you are fully informed.