Wisdom Teeth

Wisdom teeth ( third molars) are the last 4 teeth to emerge from the jaw bone at the age between 17-21 years.  They are prone to complications throughout their eruption when jaw bone is too small to compensate them.  The widespread of orthodontic treatment don't leave much room in the dental arch for the wisdom teeth to emerge.

The historical study found that a diet of earlier human beings resulted in a lot of worn teeth created space between each tooth. Normal shifting of the teeth to close the space help make sure that space was available for wisdom teeth to erupt by adolescence.  The current diet is much more delicate and soft; less space occurs between the tooth.

Wisdom teeth may emerge sideways, partly, or entirely trapped (impacted) inside jaw bone.  Resulting in:

• Discomfort
• Decay of an adjacent tooth
• Infection
• Gum disease
• Formation of a cyst

Sometimes immediate extraction after they erupt is necessary to avoid more complications.

Other complications from wisdom tooth

• Cyst - when sac around the impacted tooth is filled up with fluid and grows larger to form a cyst. The growing cyst replaces part of the jaw bone causing hollowed bone. Occasionally this cyst becomes large and may cause damage to adjacent roots, tooth, bone, and nerves. Surgical removal of a cyst is recommended.
 
• Pericoronitis - an inflammation of gum tissue over partially erupted tooth or partially impacted wisdom tooth. The most common site for pericoronitis is the mandibular third molar regions. The thick flap of gingival tissues covering portions of the crown of the wisdom tooth makes an ideal pocket for food particles accumulation and bacterial incubation, resulting in inflammation and infection. In the acute stage, pain and swelling in the area are prominent features, follow by a sore throat, trismus (difficulty in opening the mouth and swallowing).
  
  
  Treatment involves:
  
  
  • Gentle cleaning underneath the flap and irrigation with salt water (1/2 teaspoon salt to 6 oz. of water).  Water should be as hot as one can tolerate. 
  • Rinse vigorously for about 2 minutes at least every 2-3 hours with hot saline to relieve pain and hasten drainage of pus. Some people find it helpful to wash with Gengigel Hyaluronan Mouthrinse (150ml)
  • Massage with Gengigel Gel - 20ml to the affected gums. Gengigel enhances the healing process and reduces the number of recurrent episodes
  • Use of antibiotics in the advanced case is very practical.  Recurrence often occurs until the extraction of the wisdom tooth.
    
  • In some cases, the dentist may incise the gingival flap to provide access for cleaning to remove infected material.
  
  
• Decay (dental caries). The location of wisdom teeth makes them hard to brush; often decay develops between the wisdom tooth and adjacent tooth. 

A current research provided through the American Association of Oral and Maxillofacial Surgeons and the Oral and Maxillofacial Surgery Foundation (AAOMS/OMSF) on healthy erupted wisdom teeth.  The researchers discover the third molars that have emerged from gum tissue and erupted into the oral cavity in a normal, vertical position might be as vulnerable to disease as those third molars that continue being impacted.

When to remove the Wisdom Teeth

Wisdom tooth in a younger patient

Wisdom teeth are less complicated to extract when the patient is at a younger age. The roots of the wisdom teeth are at the incomplete development stage, results in fewer complications.

Removing wisdom teeth at a later age has more complications. Their roots become fully developed. The size of the roots are longer and larger, and the supporting bone is denser in the adult.  The extraction becomes difficult, and injury to the nerves and surrounded structures may occur.

Wisdom tooth in an older patient

One must weigh the risk of wisdom teeth being presence and the potential benefits of wisdom tooth removal. It is not recommended to wait until wisdom teeth begin to create problems before having them extracted. Usually, removing wisdom teeth earlier helps minimize complication during extraction and improve the healing process.

The AAOMS/OMSF study strongly supports the removing of wisdom teeth in young age to prevent complications and to have optimal healing. The researchers also found that older age may be at greater risk of periodontal disease around wisdom teeth and adjacent teeth.

The Oral and Maxillofacial Surgeon perform extraction in most wisdom tooth either under local anesthesia, intravenous sedation or general anesthesia.

Locate an Oral and Maxillofacial Surgeon at American Association of Oral and Maxillofacial Surgeons.

Different stage of wisdom tooth development

Erupted wisdom teeth should be removed if the tooth is non-functional, severely decayed, at risk for periodontal disease.

Precaution: Do not take any drugs that interfere with coagulation (blood clot) prior to dental extraction, e.g., anticoagulants, aspirin, alcohol, broad spectrum antibiotics and chemotherapeutic agents. Consult with your physician before attempting to stop using the above drugs.

Symptom of wisdom tooth erupting:

1. Pain at the area behind the second molar
2. Facial swelling
3. Tender gums at the third molar area
4. Swelling of the gums adjacent to the second molar

Instruction After Surgery

1. Do not brush or rinse your mouth for the first 24 hours as that will disturb the wound.  After 24 hours; gently rinse with warm salt water.
2. Apply pressure to gauze by biting to allow the blood clot for 30-60 minutes or longer if necessary.  Change to new gauze when it soaked up with saliva and blood.
3. Do not smoke or use tobacco products for the first 72 hours after extraction because they can promote bleeding, delayed healing and infection.
4. Do not use a straw because this will promote bleeding and slow down the healing process.
5. During the first 24 hours; Apply ice pack or cold towel alternately 15-20 minutes on and 15-20 minutes off to the outside of your face in the area of extraction for 6 hours or bedtime will prevent swelling. 
6. Diet; soup or soft foods, e.g., mashed potatoes, cream of wheat, etc.  No crunchy or hard to chew food. 
7. No alcohol drinks for the first 48 hours after surgery.
8. Resting - no activity for the first 24 hours to prevent more bleeding.
9. Read "How to prevent dry socket" from here.

What to do if there are complications after surgery:

1. Bleeding at home after leaving the dental office that may cause by removing the gauze too soon, smoke cigarettes, use of straw, rinse your mouth too soon or accidentally brushed the wound. 

What to do:  Put a wet tea bag on the bleeding site and bite down firmly, hold in place for 10-15 minutes. Tea has tannin, a component that helps blood coagulation. Repeat if needed. If the bleeding continue, make an appointment to see your dentist. The dentist may clean the wound and place a hemostatic agent in the socket and suture to control bleeding. Some of the hemostatic agents used in dentistry by the dentist are:

• Ge-lfoam with topical thrombin 
• Surgicel
• Avitene Davol
• Sulzer
• Helistat

2. Dry socket (alveolar osteitis)

Symptom: The pain at the socket that is improving during the first three to four days after extraction abruptly reversing to moderate to severe localized dull aching pain. If the extracted tooth is in the lower jaw, a dull aching, throbbing sensation pain can radiate to the ear and neck.

Dry socket exposed bone surfaces, with a partially or wholly lost blood clot.  A bad odor and taste may or may not be present.  Find more information about dry socket here.

What to do: Use of clove oil from over the counter, soaks in cotton pellet or a small piece of gauze before carefully apply to the wound, has been successfully alleviating the pain in most cases.  Care must be taken to apply only to the socket area and not to contact other soft tissues.

Use the syringe given by your dentist, with warm salt water to clean the socket after each meal. If the pain still present, contact your dentist immediately.

3. Pain

It is normal for the area to be tender for the first few days, and in most cases simple over-the-counter pain relievers are enough to ease any pain. If you are taking daily medicine for your systemic condition, check with the dentist or pharmacist for drug interaction before taking any pain relievers.  Do not use aspirin as its ability to thin the blood can create more bleeding at the wound.

What to do: If pain persisted, and you don't have access to the dental office
1. Application to the wound:

• Use Clove Oil from over the counter, dip a cotton pellet or cotton swab in clove oil and apply to the affected area. Care must be taken to apply only to the socket area and not to other soft tissues as it will have a burning sensation.  Test for allergies with a small amount of clove oil.
  
  Clove oil is approximately 80% eugenol, which has antiseptic, analgesic, anti-bacteria, and antifungal properties. Do not use Clove oil in a nursing mother, a pregnant woman, a child under the age of 2, or those who are taking a blood thinner.
  
  For people over 65 or older children, it is better to start with lower-strength preparations before increasing the strength.  Clove oil may be diluted by adding 3 drops of clove oil to 1 teaspoon of extra virgin olive oil, coconut oil, jojoba oil, or almond oil.  Swish the diluted solution helps to relieve pain. 
• Red Cross Complete Medication Kit, Toothache; contains85% Eugenol.  Apply to the wound as in clove oil.

2. For temporary pain reliever using over-the-counter pain medicines:
For every 4 hours, alternating between 2 extra-strength Tylenol and 2 tabs of Advil. 

Note:

• Do not use this regimen if you have a history of peptic ulcer, liver disease, hypertension.  
• Do not take this regimen more than few days. 
• Do not exceed 4,000 mg or 8 extra strength Tylenol in one day 
• May substitute Tylenol with other Acetaminophen (Paracetamol) 1000m and Advil with other Ibuprofen 400mg

4. Swelling

For swelling 24 hours after surgery;
Apply an ice pack or cold towel to the outside of your face in the area of extraction alternately 15-20 minutes on and 15-20 minutes off for 6 hours or till bedtime.

For swelling more than 24 hours after surgery;

1. Apply moist heated towel to the outside of your face in the area of extraction alternately 10-15 minutes on and 10-15 minutes off.

Note:
To get a moist heated towel, either:

• Wet towel put in the microwave for 10-20 seconds or 
• Dip a towel in hot water

2. Apply Gengigel Gel to the wound 3-4 times a day or rinse with Gengigel with Hyaluronan mouth rinse. The main ingredient in Gengigel is Hyaluronic acid or commonly referred to as Hyaluronan.   Hyaluronan enhances a healing process of the wound.

Hyaluronic acid (Hyaluronan) is a mucopolysaccharide found naturally in most cells in the body. Hyaluronic acid also acts as a ground substance for the connective tissue and helps provide tensile strength to the periodontal ligaments and keeps the gums healthy.

Usage of extracted wisdom teeth:

Transplantation

Transplantation is an implant of an extracted wisdom tooth to another site of missing molar tooth of the same person. Tooth transplant surgery is usually successful if the extracted wisdom tooth is implanted in the mouth of the same person and not successful if the tooth to be implanted comes from the other person.

Stem cells:

In August 2008, scientists in Japan revealed that they were able to harvest stem cells from wisdom teeth successfully. This clinical discovery is important to patients who have their wisdom teeth extracted.  The scientists can have stem cells saved for future use, from extracted wisdom tooth.


Surgical Removal of Wisdom Tooth