Wisdom Tooth Surgery by Dr Chan Joon Yee Wisdom Tooth Surgery is Medisave claimable at our Medisave Accredited Day Sugery Centre The wisdom tooth is the third molar. Most people have one in each quadrant of the mouth. However, it is not uncommon to find individuals with less than 4 wisdom teeth. Because this tooth usually erupts when the person is about 21 years of age, it is called the wisdom tooth. In reality, the tooth is often non-functional or even problematic. When there is insufficient space in the jaw for the tooth to emerge fully, the wisdom tooth may get trapped under the gum and bone. Partial eruption makes the tooth susceptible to gum infection which may result in recurrent bouts of pain and swelling. Left alone for long periods, chronic gum infection can lead to fibrous growths or cyst formation. view In certain cases, the tooth may be slanted against the next tooth - the second molar. The resulting gap between the two teeth traps food and promotes bad breath as well as decay. view Wisdom tooth surgery is usually carried out to save the second molar or stop the recurrence of gum swelling. In some individuals, the eruption of their wisdom teeth coincides with the appearance of their front teeth being pushed together. Wisdom tooth surgery is also performed to allay fears of crowding/overlapping front teeth, though there is no strong evidence to prove that the crowding front teeth is the direct result of pressure from erupting wisdom teeth. There are various categories of wisdom tooth impaction. Below are some of the most common positions that impacted lower wisdom teeth may end up. From left to right: 1. vertical impaction, 2. mesio-angular impaction 3. horizontal impaction 4. disto-angular impaction The depth of the impaction will affect the degree of difficulty in removing the tooth, but angulation also plays a part. Generally, vertical impactions are easy to deal with while horizontal and disto-angular impactions are challenging. I have successfully removed wisdom teeth in all the above categories. Most wisdom teeth in the upper jaw can be extracted without surgery. Wisdom teeth in the lower jaw are usually more troublesome. Most dental practices are only equipped to provide local anaesthetic. For relatively simple cases, local anaesthesia, delivered by injection, is usually sufficient. For the more difficult cases or for patients who are really nervous, I strongly recommend intravenous sedation. An intravenous line is first set up on a vein in the hand. Then, the sedative is pumped continuously to maintain a state of deep sedation. You may be able to hear things and respond to commands during the surgery, but you won't remember a thing when you wake up. For more info on IV sedation, check this out. What about the surgery? Suffice to say that the tooth may need to be sectioned before removal, after which the socket is thoroughly washed. Once the wound is medicated and haemostatic sponge is placed, it is closed with sutures. You will be given antibiotics and painkillers. Expect some pain, swelling and difficulty opening your mouth for the next few days. You will be given 5 days' medical leave, so be sure to arrange with your office/school before coming for the surgery. An appointment will be given for you to return to the clinic after 5 days, at which time the sutures will be removed. If you're a foreigner and will be leaving Singapore before the 5 days, we can put in some absorbable sutures which do not require physical removal. Risk Factors The most common risk factor I encounter in private practice is wound infection. Almost all those who are affected are smokers or patients with poor oral hygiene. It is very important to note that antibiotics do not offer 100% protection againist wound infection. Postoperative hygiene is very important. Other less common risk factors include nerve damage. As you can see from the diagrams above, the wisdom tooth, if deeply buried, lies close to a nerve running along the body of the lower jaw. The chances of that happening is very low. Removal of the wisdom tooth can cause damage to this nerve and result in numbness of the jaw and lip. Another nerve lying close by is the lingual nerve that supplies the tongue. Damage to this nerve will cause the tongue to be numb. I have not encountered any case of lingual nerve damage in my practice. The lower jaw can also fracture when too much force is used to remove the wisdom tooth. When that happens, the jaws will need to be wired together till the fracture heals. Again, I have not encountered any case of jaw fracture in my practice. Almost all our simple cases have patients eating normally after the 3rd day. Even the difficult cases show little swelling on the 5th day. Before & After Tips: 1. Have a good meal before the operation. 2. Swelling and difficulty opening your mouth are normal. Do not panic. Research has shown that women taking contraceptives will generally experience more pain and swelling than usual after the surgery. Consider stopping the medication temporarily. 3. Relax and co-operate with your dentist during the procedure. 4. After the operation, bite firmly on the gauze provided for at least half an hour. Take your painkillers before the numbness wears out. 5. Do not keep spitting or rinsing your mouth. Swallow your saliva. 6. Ice/cold packs are very effective in controlling swelling when applied immediately after surgery. Remember to apply it outside your cheek. Never put ice inside your mouth or apply for more than 20 mins at one time. Allow 10 min intervals between ice applications. 7. Do not smoke, drink very hot drinks or alcohol. 8. Do not exert yourself. Rest at home. 9. Take care not to bite your lip when it is numb. 10. When bleeding has stopped, eat soft food and keep the wound clean. 11. Remember to see your dentist for the followup. Please call us at 62358316 for an appointment or email us. Or Be Our Facebook Fan