Wisdom teeth aren’t the most engaging topic in health care, but commonly require treatment in many individuals. This will be the conclusion of a two-part column discussing 3rd molars or wisdom teeth. In this final installment I will discuss the risks, expectations, and possible complications associated with the surgery to remove wisdom teeth, and the postoperative course and care following surgery.
The optimal timing of 3rd molar surgery depends on the development and position of the third molars. Specifically, the development of the third molar root is of prime consideration. The ideal time to extract the third molar is when the third molar root is ½ to 2/3 developed. The vertical position of the third molar is another area of consideration as it relates to the depth of impaction of the tooth, the deeper the impaction, the more difficult the procedure and severe postoperative symptoms.
There are various techniques that can be used to administer anesthesia for the extraction of wisdom teeth, however, the most widely used methods are IV sedation and forms of general anesthesia in the office setting. This involves administration of medications through an IV to induce sedation, which may be augmented by inhalational gaseous agents in some cases. The goal is to induce a state of amnesia, anesthesia, and analgesia (relief of pain) for the duration of the surgery.
There are some risks involved with extraction of wisdom teeth, albeit minor. Risks associated with any surgical procedure include some level of postoperative pain and swelling, bleeding, and potential for infection. Infection and bleeding are often minimized in healthy individuals with no history of diabetes or routine use of anticoagulants such as Coumadin, Plavix, or aspirin. Damage to adjacent nerves and tissues is another area of risk, most notably the inferior alveolar nerve which courses through the lower jaw, usually inferior to the third molar roots and the lingual nerve. Damage to this nerve may result in temporary or potentially some degree of permanent sensory loss in the area of the lower lip and chin. Damage to the lingual nerve may result in some sensation loss of the tongue. Lastly another common risk is that of alveolar osteitis or commonly known as a “dry socket”, which is a significantly painful side effect caused by loss of the blood clot in the surgical site and exposure of alveolar bone, which is normally easily treatable by your surgeon with a topical dressing.
In the immediate postoperative phase, patients should expect some degree of pain, swelling, and stiffness of their jaw, for anywhere from 3 to 10 days. Your surgeon will almost certainly prescribe pain medication to mitigate the postoperative symptoms. Some surgeons also prefer to prescribe a postoperative course of antibiotics to prevent infection, however the need and use of postoperative antibiotics is somewhat controversial. Some patients may also experience nausea and vomiting, which can be secondary to the anesthetic agents used or the prescription pain medication. Besides pain control, it is critical for the patient to perform proper oral hygeine; ultimately the surgical sites heal much more predictably if kept clean. Other details regarding wisdom teeth and their treatment will be discussed at greater length during consultation with your oral surgeon.