Oral Surgery

Many people have their wisdom teeth (third molars) removed, and as with all surgical procedures the operation carries risks. Your dentist will discuss these with you and explain how the procedure works, before you decide to go ahead with oral surgery.

Is it essential to remove the wisdom teeth?

When there is enough room for the wisdom teeth to develop fully and the teeth are strong and healthy, they can actually be a valuable asset. However, in most cases, there is not enough room for the teeth to erupt and grow properly, and this can cause the teeth to become impacted. Impacted teeth start to grow sideways, becoming stuck on the adjacent teeth, and sometimes they are only able to erupt partially.

Extraction is generally recommended in the following instances:

  • When wisdom teeth erupt partially
  • Where there is risk of damage to the neighbouring teeth as a result of poor alignment
  • When a cyst develops and harms surrounding structures

The main reason for extraction is a lack of space in the jaw. This prevents the wisdom teeth from developing as normal and can cause the following problems:

  • Complete bony impaction - this occurs when the wisdom tooth is entirely covered in bone. The tooth is covered in a developmental sac and this can eventually develop into a cyst. These should be removed to prevent damage to the jaw.
  • Partial bony impaction - this occurs if the tooth is only able to erupt partially. In most cases only the crown portion of the tooth pushes through the gum and the tooth points forward. Partial impactions can increase the risk of decay and gum problems in the second molar in front of the wisdom tooth. The main complication of a partial impaction is pericoronitis, which occurs when the flap of tissue covering the partially erupted tooth forms a pocket and becomes infected. The treatment process for pericoronitis is extraction.

Some dentists think that the wisdom teeth shove the other teeth forward when they erupt. However, there is some debate among dentists on this issue.

Potential complications of wisdom tooth extraction

Pain - extraction commonly causes short-term pain, but this can usually be eased with pain-relief.

Infection - infection is a risk that follows all oral surgical procedures owing to the amount of bacteria in the mouth. Patients are normally given prophylactic antibiotics to prevent infection.

Swelling - patients may develop bruising and swelling after treatment, but symptoms will vary according to the individual.

Bleeding - it is normal for the tooth socket to bleed immediately after extraction. Your dentist will stem the bleeding using a small sheet of gauze.

It is possible to remove the wisdom teeth under local anaesthetic, but many patients prefer to be sedated during the procedure. Sedation is particularly beneficial for patients with dental anxiety or dental phobia.

Risks and complications of wisdom tooth removal

There are roots in the upper wisdom teeth and these are divided from the maxillary sinuses with a thin sheet of bone. There is occasional contact between the mouth and the sinus after a tooth is removed, in which case the area will be stitched and the patient prescribed medication (usually decongestants and antibiotics). The dentist will also advise against actions such as blowing the nose and a follow-up appointment will be needed.

The lower wisdom tooth roots are close to the inferior alveolar nerve, which is a nerve that carries messages and brings about sensation in the lips, tongue and teeth. Occasionally, when the lower wisdom teeth are removed, the nerve is bruised or bumped and a slight alteration in sensation on the affected side of the mouth can occur. Movement in the mouth will not be affected, as the nerve is a sensory nerve. The nerve normally mends itself, but this can take time as nerves mend slowly. In very rare cases, harm to the nerve may be permanent.

Your dentist will explain all the risks and possible complications of the procedure before you have the operation.

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