Wisdom Tooth

Wisdom teeth are the third and final set of molars that most people get in their late teens or early twenties. Sometimes these teeth can be valuable asset to the mouth when healthy and properly aligned, but more often, they are misaligned and require removal

Wisdom teeth present potential problems when they are misaligned - they can position themselves horizontally, be angled toward or away from the second molars or be angled inward or outward. Poor alignment of wisdom teeth can crowd or damage adjacent teeth, the jawbone, or nerves. Wisdom teeth that lean toward the second molars make those teeth more vulnarable to decay by entrapping plaque and debris. In addition, wisdom teeth can be entrapped completely within the soft tissue and/or the jawbone or only partially break through or erupt through the gum. Teeth that remain partially or completely entrapped within the soft tissue and/or the jawbone are termed "impacted". Wisdom teeth that that only partially erupt allows for an opening for bacteria to enter around the tooth and cause an infection, which results in pain, swelling, jaw stiffness, and general illness. Partially erupted teeth are also more prone to tooth decay and gum disease because their hard-to-reach location and awkward positioning makes brushing and flossing difficult.

How Do I Know if I Have Wisdom Teeth ?

Wisdom teeth present potensial problems when they are misaligned-they can position themselves horizontally, be angled toward or away from the second molars or be angled inward or outward. Ask Dr. Muruga about the positioning of your wisdom teeth. He may take an X-ray periodically to evaluate for the presence and alignment of your wisdom teeth.

Dr. Muruga may recommend that your wisdom teeth be exracted even before problems develop. This is done to avoid a more painful or more complicated extraction that might have to be done a few years later. Removal is easier in young people, when the wisdom teeth roots are not yet fully developed and the bone is less dense. In older people, recovery and healing time tend to be longer.

How is Wisdom Tooth Removed ?

Wisdom teeth can be entrapped completely within the soft tissue and/or the jawbone or only partially break through or erupt through the gum. The relative ease at which Dr. Muruga can extract your wisdom teeth depends on the position of the impacted teeth. Your oral health care provider will be able to give you an idea of what to expect during your pre-extraction examination. A wisdom tooth that is fully erupted through the gum can be extracted as easily as any other tooth. However, a wisdom tooth that is underneath the gums and embedded in the jawbone will require an incision into the gums and then removal of the portion of bone that lies over the tooth. Oftentimes for a tooth in this situation, the tooth will be extracted in small sections rather than removed in one piece to minimize the amount of bone that needs to be removed to get the tooth out.

What Happens During the Procedure ?

Before your wisdom tooth is exracted, the tooth and the surrounding tissue will be numbed with a local anesthetic - the same injection with the same medication you would receive to numb a tooth prior to having a cavity filled. In addition to the local anesthetic to numb the pain, you and Dr. Muruga may decide that a sedative is desired to control your anxiety. Sedating medications that could be selected include : nitrous oxide (otherwise known as "laughing gas"), an oral sedative (for example, Valiun), or an intravenous sedative (administered via an injection into your veins). If nitrous oxide is given, you will able to drive yourself home. If any of the other medications is selected, you will need someone to drive you both to and from the appointment in which your tooth will be extracted.

What Does Recovery Involve ?

How quickly you heal depends on the degree of difficulty of the extraction (a simple extraction of a fully erupted tooth versus a tooth impacted into the jawbone). In general, here's what to expect.

During the first 24 hours ?

Bleeding may occur for several hours after tooth extraction. To control it, position a piece af clean moist gauze over the empty tooth socket and bite down firmly. Apply constant pressure for about 45 minutes. A moistened tea bag is an effective alternative. The tannic acic in tea helps healing blood clots to form (blood clots function similarly to a scab on an open wound). Repeat this process if a small degree of bleeding continues, if heavy bleeding continues to occur, you can contact Dr. Muruga directly. Avoid rinsing or spitting for 24 hours after tooth extraction, avoid "sucking" actions (for example, don't drink beverages through straws or smoke) and avoid hot liquids (such as coffee or soup).

Facial swelling in the area where the tooth was extracted typically occurs. To minimize swelling, place a piece of ice, wrapped in a cloth, on that area of your face on a schedule of 10-minutes on, followed by 20-minutes off. Repeat as necessary during this first 24-hour period.

Antibiotics that may have been prescribed prior to tooth extraction (to treat any active infection around the wisdom tooth to be extracted) should continue to be taken until the full prescription is gone.

Foods should be chewed on the side of the mouth opposite the extraction. Avoid hot liquids and alcoholic beverages for at least 24 hours. In the case of difficult extractions, consume a soft or liquid diet for the first 24 hours.

Continue to brush your teeth, but avoid the teeth directly neighboring the extracted tooth during the first 24 hours. On day two, resume the gentle brushing of your teeth. Do not use commercial mouth rinses - these can irrirate the extraction site.

After 24 hours ?

Facial swelling in the area of the tooth extraction should be treated with heat after the first 24 hours of ice. Apply a moist warm towel to the area on a 20-minute on, 20-minute off schedule. Repeat as necessary.

Rinse your mouth with warm salt water (1/2 teaspoon of salt in a cup of warm water) after meals and before bed. Do not use commercial mouth rinses.

Stitches, if used and if not of the self-dissolving type, need to be removed by your oral health care provider in about 1 week. If you do require stitches, ask what type you have have been given.

Watch for signs of dry socket (described below). This condition requires treatment by your oral health care provider.

Complete healing doesn't occur for a few weeks to a few months following the extraction. However, usually within the first week or two, enough healing has taken place for use of your mouth to be reasonably comfortable in the area of the extraction. Dr. Muruga will explain what to expect in your specific case.

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