THIRD MOLAR EXTRACTIONS

About The Molar Extractions

Wisdom teeth, your third molars, are the last teeth to come in—and the ones least needed for good oral health. They may not emerge from your gums until your late teens or early twenties—if at all. Often, they are impacted, or trapped in the jawbone and gums, usually because there is not enough room for them in your mouth. In fact, wisdom teeth often do more harm than good, and most often, we recommend removing them. Most people have 4 wisdom teeth, 1 in each corner of the mouth, but each tooth can be at a different stage of eruption and position of impaction. Since wisdom teeth develop over a period of many years, harmful changes in your mouth may be gradual, but these changes could result in sudden and severe pain.

Over time, the wisdom teeth roots lengthen and the jawbone becomes more dense. So, the older you are, the more difficult it is to remove your wisdom teeth. With time, the roots become solidly anchored in the jawbone. Therefore, early removal is sometimes the best treatment to help prevent problems. Whether wisdom teeth cause your mouth harm depends on several factors, including the size of your jaw and how your wisdom teeth erupt. Sometimes problem wisdom teeth cause symptoms like pain and swelling. Or you may have no symptoms at all, but the other teeth in your mouth could be at risk for damage.

Gum disease - When a wisdom tooth partially breaks through the gum’s surface, bacteria can get under the flap, causing an infection in the gum.

Crowding - An impacted or erupting wisdom tooth can push on adjacent teeth, causing them to become crooked or even damaging them structurally.

Decay - A wisdom tooth that is hard to clean because of its position or because it is partially-covered by gum tissue may fall victim to cavity-causing bacteria.

Poor position - A wisdom tooth that grows toward the cheek can irritate nearby tissue. If an erupted tooth is crooked, it may be hard to clean and can even make it hard to bite down.

Cysts - If the sac that holds the crown remains in the bone, it can fill with fluid, forming a cyst that can destroy surrounding bone.

The Operation

Extraction of your 3rd Molars will be performed at our state-of-the-art facility, Park Meadows Outpatient Surgery.  The surgical method depends on whether your wisdom teeth are erupted or impacted and how deep the roots are. After you are asleep, your jaw will be numbed with a local anesthetic that lasts up to 12 hours. The incisions are made and the overlying bone is removed. All 4 wisdom teeth are usually removed at the same time. The surgery takes 30 to 60 minutes. The incisions are closed with dissolving stitches and a gauze pack is placed over the site to help stop the bleeding. The stitches dissolve in 5 to 7 days.

Recovery

Teenagers have a faster recovery than older patients. Most have swelling that is largest on the third day. The bleeding may last for 24 hours and is best controlled by biting on the gauze packs.

If an IV sedation or general anesthetic was used you may be sleepy the rest of the day. Some patients recover quickly, but some require a week of recovery. Each person is different but you should plan for at least 2 days off before returning to work or school. You will be given a prescription for a strong pain relief medicine, antibiotics to prevent infection and steroids which help reduce the amount of swelling.

Complications

Removal of wisdom teeth is a common procedure, but as with any surgery, there are risks, such as:

Infection - Infection is a less common complication. It can usually be treated by draining the infection or with antibiotics.

Dry Sockets - Healing can be delayed if the blood clots covering the socket dissolve or are washed away. This exposure of the bone to air may lead to constant, deep, throbbing pain which can be treated with a dressing.

Numbness - Resulting numbness may occur if teeth are close to or in actual contact with the nerves that supply sensation to the teeth, gums, tongue, chin, cheeks, and lips. Sometimes these nerves are injured when the tooth is removed, causing numbness and tingling. If this injury happens, the nerve usually repairs and regenerates itself within 2 years, but it can be permanent.

Sinus problems - Because the upper wisdom teeth are near a sinus cavity, the removal of these teeth can open the sinus cavity. The sinus usually heals, but if a problem persists, further treatment may be needed.

Weakening of the jaw - In rare cases, removal of an impacted tooth can weaken the jaw, making it more susceptible to fracture.

TMJ - It is possible that the joint can be stressed so that there is limited opening and/or pain.

Damage to teeth - damage to adjacent teeth may occur causing a need for dental treatment.

Pre-operative Instructions

1. You may need to schedule 2 to 4 days off from work or school to give yourself enough time to recover.
   
2. If the surgery is going to include anesthesia or intravenous (IV) sedation, do not eat or drink after midnight, or as your surgeon directs. If you are likely to be nauseated, consult with your surgeon about medications you can take before surgery.
3. Arrange to have a responsible adult come along and to drive you home.
4. Wear comfortable clothes. Button-closure shirts with sleeves that roll up easily (for IV access) are preferred.
5. Make sure we have a recent x-ray show the wisdom teeth or we can take one the day of surgery.

Post-operative Instructions

1. To control excessive bleeding, bite down gently but firmly on the gauze packs that have been placed over the surgical areas. This pressure helps form a blood clot in the socket(s). If active bleeding persists after one hour, place enough new gauze to obtain pressure over the surgical site for another 30-60 minutes. Change gauze as necessary, and dampen or fluff for more comfortable positioning. If bleeding persists or becomes heavy, you may substitute a tea bag (soaked in hot water, squeezed damp-dry and wrapped in a moist gauze) for 20-30 minutes. Oozing may persist for up to 24 hours.
2. Your gums and jaw may feel tender and sore. Take the first pain pill before the anesthetic completely wears off to manage discomfort better. Some people may even require 2 of the pain pills at one time during early stages, but that may add to the risk of nausea. Remember that the most severe discomfort is usually within the first 12 hours after the anesthetic wears off; then your need for medicine should lessen.
3. Normally, your cheeks will swell, but you can keep swelling to a minimum by firmly applying ice packs to your cheeks for 20 minutes on and 20 minutes off during the first 24 hours after surgery.
4. Nausea can occur from the anesthetic, pain medications, drainage of blood into your stomach, or anxiety. Nausea resulting from the pain pills may be reduced by preceding each pain pill with a small amount of soft food and taking the pill with repeated sips of clear liquids that you can tolerate. Notify your surgeon if this condition persists, so an anti-nausea medication or a change in your post-operative care regimen can be prescribed.
5. Eat soft foods, such as soups and meals puréed in a blender for the first day after the bleeding has stopped. The temperature of the food doesn’t matter, but avoid extremely hot foods. Do not skip meals, and over the next several days, you can progress to solid foods at your own pace. Avoid hard, crunchy foods such as carrots and popcorn for 6 to 8 weeks after surgery. If you are diabetic, maintain your normal eating habits as much as possible, and follow instructions from us or your primary care physician regarding your insulin schedule.
6. Drink a lot of fluid after the surgery.
7. Take antibiotics and/or pain reduction medication, if prescribed.
8. Keep your head elevated slightly, perhaps with two pillows, while in bed. You may prefer to use an old, clean pillow case or towel on your pillow to catch any drainage that flows from your mouth after surgery.
9. Do not disturb the surgical area the first day. Do not probe the area with any objects or your fingers. Keep your mouth clean, but don’t rinse your mouth or spit. Brush your teeth gently and carefully.
10. Beginning the day after surgery, rinse your mouth 4 times each day with salt water for seven days. (Dilution: ½ teaspoon salt in 1 cup of lukewarm water.)
11. Using the large syringe provided by your surgeon, irrigate the hole or socket with lukewarm water after the first week of surgery. This rinsing keeps food out and helps reduce infections.
12. Don’t smoke after surgery. The smoke is an irritant to healing that can loosen the blood clot and expose the bone to air, causing a higher incidence of dry sockets and a more painful recovery course.
13. Please call your surgeon if you experience any of the following: Excessive bleeding that cannot be controlled, excessive and persistent swelling, persistent and severe pain or nausea, unrelieved by prescribed medications, temperature of more than 101.0° F, by mouth, reaction to medications, such as itching, hives, or nausea, or any questions about any other aspect of your recovery.