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Wisdom Tooth Extractions
Wisdom Tooth Extractions Rating 5 out of 5 based on 1 reviews

Wisdom Tooth Extractions

Wisdom teeth are the last of the adult teeth to come through the gum, usually between the ages of 18-25. Some people never develop any wisdom teeth whilst others develop one wisdom tooth in each of their four dental arches.

Wisdom Tooth Extractions

Wisdom Tooth Extraction

An impacted Wisdom tooth.
Some bone is removed to gain access.
The tooth is split.
The roots are removed separately.
The gum is replaced and heals naturally

 

 

Dry Socket

After a damaged tooth is removed, the ‘socket’ naturally produces a blood clot.
Over time the gum will heal over the clot, and gum tissue is restored.
However, after the tooth is removed if the clot is lost by premature rinsing for example the bone can be exposed to the air.
This can be very painful.
An anti-bacterial swab can be inserted and slowly the gum will heal from below until the gum tissue is restored.

The impacted wisdom tooth

Through evolution and dietary changes in humans over thousands of years, the human jaw has gradually become smaller, resulting in insufficient space being available in the jaws for the last tooth to erupt (i.e. the wisdom tooth).

When there is not enough space available in the jaws for the wisdom teeth to erupt in a straight fashion, they become impacted.

Impacted wisdom teeth can cause food and bacteria to stagnate around the gum overlying them (called operculum) and this leads to the gum (operculum) becoming swollen. Pain, gum infection, Bad breath and soreness of the jaw can then begin as the problem worsens.

Types of impacted wisdom tooth

If you suffer from an impacted wisdom tooth, its likely to be one of the following four types. 

  • Mesial impaction – the most common type seen, This type occurs where the wisdom tooth grows at a roughly 45 degrees angle towards the tooth in front. 
  • Vertical impaction – This occurs when the wisdom tooth grows straight down but gets stuck against the tooth next to it 
  • Horizontal impaction – the wisdom tooth grows at a 180 degrees angle and horizontally pushes against the tooth in front 
  • Distal Impaction – the wisdom tooth grows backwards and impacts against the jaw bone behind itself. 

When do we extract a wisdom tooth?

  1. Repeated episodes of Pericoronitis – This is where there is repeated infection of the gum (operculum) overlying the wisdom tooth caused by plaque and bacteria stagnating between the operculum and the wisdom tooth below it causing severe toothache at times. 
  2. Cavities – Decay can form on the wisdom tooth itself and also form on the tooth in front due to the patient having difficulty in cleaning their teeth through poor access. 
  3. Gum disease – Poor cleaning due to difficulties of access can lead to gum inflammation at first which can be followed by gum disease. Gum disease bacteria can spread to the teeth in front and lead to them losing bone and becoming loose. 
  4. Cysts – The bone tissue surrounding the impacted wisdom tooth can become infected, leading to the formation of a fluid/gas/solid sac also known as a cyst. Cyst formation damages the neighbouring bone and if a large cyst forms, it will need cyst enucleation as well as wisdom tooth removal. 

Treatment options for an impacted wisdom tooth

  • No treatment – for impacted teeth causing no problems this is the best option. 
  • Antibiotics – for situations where pus has formed, antibiotics provide temporary relief. 
  • The surgical removal or tooth extraction of the impacted wisdom tooth – Where the wisdom tooth has caused infection, cyst formation, tooth decay or gum disease around itself, then tooth extraction is the best choice.
  • Cutting back the surrounding gum (operculum) tissue – If pain is caused as a result of the impacted teeth pressing into the overlying gum, an operation to cut back the operculum gum is sufficient. However this gum may re grow and may not be a definitive solution. 
  • Coronectomy – This is a technique that involves removing the crown of the wisdom tooth but leaving its roots inside the jaw. This technique is useful when there is a risk of nerve damage if the roots are removed. However this technique can not be used in all cases. 

What are the NICE guidelines regarding removal of wisdom tooth?

The National Institute for clinical excellence (NICE) is an organisation consisting of experts that make recommendations to the health professional on best clinical practice. They investigated wisdom tooth management and made recommendations that we at Pearl Dental Clinic follow. 

NICE recommendations on wisdom teeth state

  • Impacted wisdom teeth that are free from disease (healthy) should not be operated on. There are two reasons for this: 
  • There is no reliable research to suggest that this practice benefits patients 
  • Patients who do have healthy wisdom teeth removed are being exposed to the risks of surgery. These can include, nerve damage, damage to other teeth, infection, bleeding, and, rarely, death. Also, after surgery to remove wisdom teeth, patients may have swelling, pain and be unable to open their mouth fully. 
  • Patients who have impacted wisdom teeth that are not causing problems should visit their dentist for their usual check-ups.
  • Only patients who have diseased or Infected wisdom teeth, or other problems with their mouth, should have their wisdom teeth 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. 

So what we can do for you if you need your wisdom tooth removed

We first do an examination of your wisdom tooth and usually take a panoramic X-ray of the jaws to show the wisdom tooth and its proximity to Inferior Dental (ID) nerve. The ID nerve is the nerve that supplies sensation to the lower lip and chin and can sometimes be very close to the roots of the lower wisdom teeth.

We will then advise you on the type of your wisdom tooth impaction and the procedure for removing it as well as any risks and complications involved. 

Wisdom tooth Surgery

  1. Wisdom Tooth SurgeryWe usually do all our wisdom teeth extractions under Local anaesthesia with or without Intra Venous Sedation depending on patients choice. 
  2. Once the area is very numb, we push the gum back so that we can access the wisdom tooth. If the tooth is easily accessible, then we simply elevate the tooth out.
  3. Sometimes, we shave a little bone around the wisdom tooth and split the wisdom tooth into bits in order to remove it.
  4. Finally we close the gum back to where it should be with self dissolving sutures. The whole procedure is carried out inside of the mouth so that there are no scars left on the outside skin.

What can be expected after wisdom tooth surgery?

There may well be some pain, swelling, bleeding, and soreness of the jaws and muscles of the mouth following wisdom tooth removal.

If necessary, we may prescribe Corsodyl disinfectant mouthwash and antibiotics and pain killers to combat these problems. 

Do’s and Don’ts after wisdom tooth removal

  • There may be bleeding from the socket, apply a clean gauze or a clean handkerchief to the top of the extraction site and apply pressure by biting on it. The pressure usually stops the bleeding. 
  • If there is profuse bleeding form the socket you will need to come back to see us. Putting an extra pillow underneath your head at night encourages the blood to go to your lower limbs rather than the extraction site. 
  • There can be some pain afterwards from the surgical site. The extent of the pain can depend on the complexity of the surgery and the inflammation that it creates. Make sure you have some Neurofen plus and paracetamol at home (subject to no allergies) to relive the pain that you may have.
  • There may be tingling sensation in the lips and tongue which in most cases eventually disappears. If this sensation persists, please come back to see us
  • Avoid exercise for a few days and avoid hot drinks for 24 hours. Eat a soft diet for a few days. 
  • After 24 hours has passed, gently rinse your mouth with salt water or mouthwash. Avoid rinsing in the first 24 hours as this can break the fragile blood clot and cause further bleeding.
  • Avoid smoking for 1 week post surgery. Smoking after surgery increases the risk of dry socket which can be very painful. 
  • If restorable sutures have been uses, they usually resorb after 2-3 weeks by themselves. Otherwise, you will have to come back to see us for the suture removal. 

Risks and Complications of surgery

  1. Common complications of bleeding, infection, allergic reaction to anaesthetic or antibiotics can occur with any oral surgical procedure. We will be able to manage these easily should they arise.
  2. Dry socket can occur after any extraction and this is when a blood clot lying inside the socket is lost too early and so the bone underneath is exposed to saliva and air. Dry socket is a very painful occurrence that usually starts around 3 days after extractions and can last for 7 days or so. Dry socket delays healing and makes the healing procedure a more painful affair. Should dry socket pain arise, you need to get in touch with an emergency dentist for them to place a sedative dressing over the socket every day or two until the socket forms its own lining. 

Please reduce the risk of dry socket by not smoking for 1 week post extractions. 

Complications more specific to wisdom teeth removal:

Temporary or Permanent Paresthesia – The Inferior Dental Nerve and the lingual nerve that lie very close to the lower wisdom tooth roots can be damaged during wisdom tooth extractions.

We will always warn you if the risk of nerve damage is high at your initial consultation visit. Damage to this nerve can result in temporary numbness or “pins and needles” in the tongue, lower lip or lower jaw.  

There is also risk of the pins and needles sensation becoming permanent in certain rare cases. Repair surgery can be carried out to repair the nerve damage but the success rate is limited. 

Accidental damage to other teeth during the extraction of the wisdom tooth is rare but can occur in some cases. 

Our dentists have the skills and experience in performing complex wisdom teeth extractions and our Specialist Oral Surgeons (Dr. Dejan Dragisic and Dr. Hassan Taqvi) are both on the General Dental Council’s specialist list for Oral Surgery.

How To Find us

The practice is open Seven days a week from 8am to 11pm for routine dentistry and we offer a 24 hour emergency dental service 365 days a year. You can book a consultation at any time by calling our reception team 24 hours a day on 0208 547 9997 or contact us during our working hours by email.

Latest Patient Reviews

  • Pearl Dental Clinic

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    16/01/2014
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    opening hours ! professional, friendly, reassurring staff

    29/12/2013
  • Pearl Dental Clinic

    friendly and comfortable. For anyone who is nervous, has fear of the dentist this practice will alleviate any fears. I am so impressed that I travel 2 hours each way to attend my appointments.

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    The skill and expertise of Dr. Vahid Motahar and his calm, friendly, confident and relaxed manner. The Reception staff are also very pleasant, efficient and attentive.

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  • Pearl Dental Clinic

    Once more I am so grateful for my treatment today (10th August) The two front teeth you so painlessly removed, replacing with a small temporary plate, have given me absolutely no pain or discomfort whatsoever. My mouth feels completely normal with no pain killers needed at all.
    No one believes that I have had anything done. You provide such a kind, caring and excellent service for us "whimps", I dread the day that you move on or need a change of venue. Thank you so very, very much.

    August 2010
  • Dear All,

    Nick

    I would just like to message you to thank everyone for everything they did for me. I traveled down to London from Leicestershire yesterday to have a tooth extraction. The dentist noticed how severe this tooth was and knew straight away that it needed to come out, this was done straight away and I left the dentist having had the extraction done which i was desperate to have done. It now means I can forget that awful toothache that I have been having daily, and not have to wait until 16th September to have my tooth extracted in Nottingham. It's people like yourselves that keep people going. Without your 24 hour surgery I would of had to wait until 16th September to have an extraction which is crazy. Once again many thanks for being so kind and helpful, I will certainly be back if I have any problems in the future.

    Kind Regards

    Aug 2008