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Wisdom teeth are the third molars and the last teeth in the dental arch. These teeth usually erupt by the age of 21. Sometimes due to the discrepancy in the jaw size and tooth size, wisdom teeth are often trapped in the bone or under the gum. This restricts the tooth to come out of the bone or the gum into the oral cavity. This condition is called as Impaction.
Third molars are the last to erupt and have no enough space to erupt, hence they are frequently impacted.
They don’t have to be extracted all the time. There are some conditions where removal is indicated.
They have to be extracted in the following conditions:
· Recurrent pain and swelling in the third molar.
· Recurrent Pericoronitis – repeated food entrapment can lead to infection causing pain and swelling, sometimes pus discharge can also be seen.
· Tooth is decayed.
· Mal positioned and when it is impinging on the adjacent tooth.
· Gum infection.
· Prophylactic removal is indicated when the tooth is suspected to cause problems in the future.
· When correcting jaw deformities.
· Pain or swelling around the wisdom tooth
· Ulcers on the cheek
· Bad breath
· Swollen glands
· Radiating pain to the ear
· Thorough medical and dental history of the patient.
· Radiographic assessment (IOPA, OPG)- to assess the position and depth of the tooth, its angulation, to know the adjacent structures.
If repeated pericoronitis occurs and left untreated it may be lead to
· Crowding of the Teeth- when wisdom teeth impinge on the adjacent teeth causing crowding.
· Infection can spread to the jaws, face and surrounding structures.
· Cyst formation occurs that can damage the bone and adjacent structures.
It is absolutely painless. It is a minor oral surgical procedure performed under local anesthesia. It may be a bit uncomfortable, but surely not painful if done by an experienced dental surgeon.
Local anesthesia is injected at the site of extraction. An incision is made in the gum to expose the tooth. Bone is also cut by continuous irrigation of saline to expose the bone. Once the tooth is visibly exposed, it is removed using forceps as a whole or sectioned into pieces and then removed. Sectioning and removing depend on the shape and position of the tooth. Once the tooth is removed, the site is thoroughly cleaned using an antiseptic solution. Curettage of the site is done to remove any infected tissue present. Sutures are placed at the site. Pressure packs are applied against the site to control bleeding. Postoperative instructions should be given to the patient.
· Bite firmly on the gauze placed on the socket for a minimum of half an hour. This helps in the stabilization of the clot in the socket.
· Soft diet for two days as biting hard on the site can traumatize the socket and cause bleeding.
· Avoid hot food as it may cause bleeding and burns.
· Don’t rinse the mouth vigorously for two days as it may cause dislodgement of the clot from the socket.
· Don’t suck from a straw as it may cause negative pressure and dislodge the clot from the site.
· Postoperative pain and swelling are present for two to three days. An ice pack may be given to the patient to apply it extra orally at the site. Anti-inflammatory and analgesic drugs are given to the patient.
· Patients should be advised not to engage in strenuous work for at least three days after the extraction.
· The patient should be advised to open the mouth normally after two days of extraction.
· Maintain oral hygiene properly by gentle brushing and warm saline rinses.
· Return for suture removal after one week.
· Smoking and alcohol consumption should be avoided until the wound heals.
· Hematoma formation can occur with the regional block anesthesia causing injury to the blood vessels. This can be treated by repeated application of pressure and ice packs.
· Infection from the local anesthetic injection can occur if the sterile technique is not followed.
· Temporary or permanent nerve damage can occur.
· Soft tissue damage during incision.
· Injury to the adjacent tooth.
· Damage to the bone during cutting of the bone with inadequate cooling. This results in delayed healing.
· Oroantral communication- This is in case of upper third molar extraction. This is communication between the oral cavity and the maxillary sinus. This can be surgically corrected.
· Increased pain and swelling due to prolonged duration of treatment, trauma to the tissues. This can be reduced by using anti-inflammatory and analgesic drugs.
· Prolonged anesthesia of lip and tongue- usually local anesthesia lasts for 30-60 minutes.
Beyond this, ie., anesthesia for 2-3 hours is considered prolonged. This can be treated.
· Prolonged Bleeding- It can be due to damage to soft tissue or other structures.
· Trismus- This is a common complication with lower third molar extraction. It is caused when muscles of mastication are strained. should be advised to practice regular mouth opening and recovers completely in one week.
· Dry socket is seen after a few days of extraction which is characterized by extreme pain and halitosis. It is seen as the absence of clot at the extraction site. Smoking and improper oral hygiene can lead to a dry socket. This condition can be treated by irrigation and obtundent dressing.
Some of the postoperative complications can be avoided by maintaining proper oral hygiene and following postoperative instructions advised by the dentist.
The cost of wisdom tooth extraction depends on the complexity of the procedure. Complexity depends on the position of the tooth, its close proximity to the adjacent structures like nerves, vessels, etc. All these factors decide the cost of the surgery. The cost of the surgery ranges from $70-$200 in India.
Surgical extraction of impacted wisdom tooth is one of the most common minor oral surgeries. It requires good understanding of surgical principles and patient management skills. Careful preoperative examination, surgical planning, atraumatic surgical removal with good postoperative care is essential for a successful procedure.
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