What are Wisdom Teeth?
Wisdom teeth are the last teeth to erupt at the back of your mouth. By the time they do erupt into your mouth most of the space available in your mouth has already been taken by your other teeth.
This means the wisdom teeth are unable to come into your mouth fully and often get shoved about and erupt into your mouth at unusual angles.
This makes it difficult to clean your wisdom teeth.
- Food and bacteria builds up between the wisdom tooth and the tooth in front causing the tooth in front of the wisdom tooth to rot or
- food and bacteria build up under the gum around the wisdom tooth causing infection which results in pain and swelling.
The links below show 2 videos which contain some basic information about wisdom teeth
Wisdom Teeth Symptoms
Wisdom teeth commonly become infected. They usually produce localised symptoms of pain and swelling in your mouth in the area of the wisdom tooth. The gum around the wisdom tooth may bleed and your breath may smell.
As the infection becomes worse you may find it difficult to open or close your jaw, it becomes stiff (this is called Trismus) as the infection spreads into the local muscles.
As the infection spreads further you may experience swelling and redness on your face. You will eventually develop a temperature and start to feel unwell ( clammy/ hot and sweaty).
If the infection was left untreated it could spread further into your neck and or brain. In historical times it was possible for a wisdom tooth infection to kill you. This is extremely rare in modern society.
Pain due to an infection is generally a dull throbbing pain. It can become intense at times but tends not to remain intense and decomes dull and throbbing after some time.
Pain in wisdom teeth due to dental decay can vary from mild sensitivity to hot and cold or tenderness on chewing to severe pain which will keep you awake at night.
Wisdom tooth pain may be localised to the wisdom tooth or it may present as a pain in your eye, ear, neck temple or other teeth ( referred Pain) . As the pain worsens it will eventually localise to your wisdom tooth but the referred pain may continue and become worse.
Swelling around a wisdom tooth normally indicates infection. It is usually localised to the wisdom tooth but may spread to your face, jaw, temple and neck.
Bacteria smell. If you have an infected wisdom tooth there will be a build up of bacteria at the back of your mouth and you will develop bad or four smelling breath (halitosis).
If infection around a wisdom tooth spreads to the muscles on your jaw, the muscles will go into a cramp. They will become rock solid and refuse to work. It will be extremely difficult to open or close your mouth. Your jaw will feel stiff.
The treatment options are very simple.
- Keep your wisdom teeth very clean and they will cause few if any problems.
- If this is not possible then take out the wisdom teeth.
Treatment is available on the day of your consultation. You should be in and out of Dr Murnane’s clinic, in Nenagh (close to Limerick ) within 90 minutes.
Wisdom Tooth Extraction–an Explanation
Many wisdom teeth are close to the surface, they nearly made it fully into your mouth however there is still some gum covering them making the wisdom teeth impossible to clean. These wisdom teeth can be removed by “ELEVATION”.Elevating a wisdom tooth involves pressing down firmly beside the wisdom tooth and the wisdom tooth is forced to the surface. It normally takes between 20 seconds and one minute. The benefit of this procedure is that there is very little damage or trauma caused during the wisdom tooth extraction. The benefits of this are:
- Very little pain after the wisdom tooth extraction.
- No swelling on your face.
- No stitches in your mouth.
- The procedure will usually take less than a minute.
- You should be able to resume normal activity once the numb feeling has left your face.
- Due to the simplicity of this procedure you should be able to return to work the following day with little difficulty.
- Surgical Removal
If a tooth cannot be elevated, it must be cut out of your jaw or “SURGICALLY REMOVED”.Surgical removal of a wisdom tooth will take between 7 to 8 minutes under normal circumstances. It will sometimes take longer if the tooth is difficult to reach or other factors slow the procedure. If you are awake you will feel as if you are having a filling at the back of your mouth. The procedure is not painful. Several dissolving sutures are placed in the gum once the wisdom tooth has been removed.The down side of a surgical extraction is that you should expect to have a sore and swollen face for 7 to 10 days. The swelling on your cheek will be golf ball in size and will take about one week to resolve. Your face and nect may be black and blue with bruising and you will often need several days off work and will need painkillers and antibiotic for several days after the wisdom tooth extraction until the socket has healed.
The surgical removal of a wisdom tooth involves
- Lifting the gum beside the tooth so the surgeon may see the tooth and the surrounding bone.
- Remove a small amount of bone to free up the wisdom tooth.
- Cut the wisdom tooth in several small fragments.
- Remove the individual fragments.
- Several sutures are then placed in the gum to close the hole left after the wisdom toots extraction is complete, these stitches dissolve.
Sedation is often used so you can sleep through the procedure, (please read the section on sedation). If you are awake for the procedure, the procedure will feel like you are having a filling at the back of your mouth. It is uncomfortable but not painful.
Side Effects of removing Wisdom Teeth
This x -ray shows an Impacted Wisdom Tooth with the nerve to lower lip and chin running across the roots. This patient was left with a numb lip after the tooth was removed.
The removal of wisdom teeth from the lower jaw may result in damage to the nerve which gives feeling to your lower lip, cheek and tongue resulting in a numb LIP, CHEEK, TONGUE which may be permanent.
All lower wisdom teeth are close to this nerve however some wisdom teeth , about 1 in every 200 may actually actually be touching this nerve. The removal of these wisdom teeth from the lower jaw will result in damage to the nerve which gives feeling to your lower lip, cheek and tongue.
Damage to this nerve results in a numb, pins and needles or tingling feeling in your lip, chin, cheek or tongue on that side of your mouth.
It does not alter your appearance in any way.
This numb feeling usually lasts between 3 to 6 months before resolving. The numb feeling may last for 18 months in a small number of cases and any numbness which remains after 2 years is permanent and will last for the rest of your life.
The altered feeling may be permanent ! ! ! This is rare but it does happen ! ! !
This is a recognised risk with the removal of all lower wisdom teeth.
For wisdom teeth extraction there is an incidence of one patient in every two hundred ( 1: 200 ) will have some numbness in there lip, cheek or tongue when the procedure is completed.
It is not possible to predict from an x ray or scan who will have a numb lip after wisdom tooth removal and there is no effective treatment possible. However occasionally you will clearly see the nerve crossing the roots of wisdom teeth as in the x-ray opposite.
Does every wisdom tooth extraction carry the same risk?
No! It depends on the type and difficulty of the impaction and other factors. The figure of 1:200 is based on several studies and gives some idea of the frequency.
A dry socket is a recognised complication following any dental extraction. In occurs after approximately 4% of all dental extractions. A Dry Socket is an intense pain which occurs following an extraction. It is a failure or delay in bone healing.
A dry socket is more common after
• having teeth extracted in the lower jaw
• after difficult extractions
• after having wisdom teeth extracted
• in females and in patients taking
• and in patients taking the oral contraceptive.
However a dry socket may occur in anyone, after any extraction.
The cause is unknown, but it is believed to be a failure of the bone to heal related to an inadequate blood clot forming in the socket or premature loss of the blood clot.
The symptoms are PAIN and vary from mild to intense pain which will come on immediately after the dental extraction or approximately 3 days later.
The pain will normally last between 10 and 14 days. But the duration will vary and on rare occasions the symptoms may last much longer.
The pain is poorly or not relieved by painkillers, is constant and may keep you awake at night.
Antibiotics will make no difference.
Painkillers are generally ineffective and there is no effective treatment which a dentist can offer. It is best not to disturb the socket in the search for a cure as this can aggravate the condition.
CLOVE OIL from your chemist placed in the socket will help to alleviate the pain. It is unlikely to rid you of pain completely but the severity of the pain will reduce. This is the most effective treatment for dry socket. It is important that you keep the socket clean with warm salty mouth-wash and CORSODYL or KIN mouth wash.
Some dentist will place dressings in the socket in the hope of relieving the pain. This is effective in a minority of patients but also delays healing and may prolong the length of time with which you will suffer pain.
Once the dry socket has run its course the symptoms will resolve and healing will progress fully and naturally.