people require removal of their third molars also known as wisdom teeth.
As with any surgical procedure, there are some possible risks and complications.
The decision on third morlar removal should be decided by a patient and
Is it necessary to remove wisdom teeth?
Wisdom teeth are a valuable asset to the
mouth when they are healthy and properly positioned. Often, however, problems
develop that require their removal. When the jaw isn't large enough to
accommodate wisdom teeth, they can become impacted (unable to come in or
misaligned) Wisdom teeth may grow sideways, emerge only part way through
the gum or remain trapped beneath the gum and bone.
Extraction of third molars is generally
When wisdom teeth only
When there is a chance
that poorly aligned wisdom teeth will damage adjacent teeth;
When a cyst (fluid-filled
sac) forms, destroying surrounding structures such as bone tooth roots.
The most common reason people choose to
remove their wisdom teeth is that their mouth is t too small for these
teeth to normally erupt behind the second molare into a good position.
This can result in one of the following situations:
1. Complete Bony Impaction
when the wisdom teeth are completely covered in bone. When the tooth
is completly covered with bone it will remain completly covered with its
"developmental sack" in which all teeth develop. Later in life, this sack
may undergo changes and enlarge and develop ionto a cyst. This cyst will
enlarge at the expense of the bone of the jaw. These cysts should be removed
and and examined by a pathologist.
Some dentists believe that wisdom teeth may
push the other teeth in the mouth forward and cause crowding and misalignment
of the lower front teeth. Not all dentists believe that this actually happens.
2. Partial Bony Impaction whenThe
teeth begin to erupt but are not able to erupt completely. In this situation,
the upper third molars usually are poisitoned towards the cheek while the
lower third molars usually lean forward with only part of the crown sticking
through the gum. This situation can to decay and gum disease around the
second molar directly in front of it.
The most common complication of the partial
bony impaction, is that the flap of gum tissue which partially covers the
erupting third molar, creates a pocket where bacteria that are present
in the mouth can grow and and cause an infection known as pericoronitis.
The swelling and infection can become very serious. The treatment for pericoronitis
is extraction of the third molar tooth.
The risks and complications involved in
the removal of third molars are:
Finally there are some
risks/complications that are unique to the removal of third molars.
Surgical removal of the third molars can
lead to some discomfort and pain. This is usually treated with pain medication.
Because of the large number of bacteria
present in the mouth post surgical infection is always possible. Patients
are usually placed on prophylactic antibiotics to prevent infections from
Following surgery patients may experience
swelling and bruising. These symptome vary between patients.
Some post surgical bleeding is considered
normal. This is usually minimal and is easily controlled with the pressure
of biting on gauze.
Most wisdom teeth can be removed with local
anesthesia alone but many people prefer I.V. sedation during surgery.
The upper third molars have roots which
often are separated from the maxillary sinuses by only a very thin layer
of bone. Occasionally, a small communication is established between
the sinus and the oral cavity when one of the upper third molars is removed.
If this is the case, the normal procedure is for the area to be sutured
closed, the patient to be informed of the finding, appropriate antibiotics
and decongestants to be prescribed, the patient to be instructed
to avoid Valsalva maneuvers (tasks which build up pressure in the sinus
like nose blowing and bearing down forcefully) and the patient reappointed
for followup. Most often this results in an uneventful healing period
with no further treatment being required. Occasionally, the area
will heal open rather than closed in which case an additional small
surgical procedure will be required to close the communication.
The lower third molars often have roots
that lie very near or even wrapped around the inferior alveolar nerve.
This is the nerve that supplies feeling to the lip, teeth and tongue on
each side of the mouth. Occasionaly, when a lower third molar is removed,
that nerve will be bumped or bruised and if so a change in sensation
may be noted on that side. It is important to understand that this
is a sensory nerve and does not affect the ability to move the parts
of the oral cavity to which it gives sensation (feeling). In most cases,
the nerve heals itself but, because nerves heal slowly, it may take
six months to one year before return of normal sensation. Very rarely,
the damage to the nerve is permanent.
Finally, the normal precautions, risks and
benefits of extraction of any tooth (which are beyond the scope of
this discussion) also apply here and should be discussed with the
dentist prior to beginning any procedure.