Wisdom Teeth Removal

Oral Examination

With an oral examination and x-rays of the mouth, Dr. Bowler can evaluate the position of the wisdom teeth and predict if there are present or future potential problems. Studies have shown that early evaluation and treatment result in a superior outcome for the patient. Patients are generally first evaluated in the mid-teenage years by their dentist, orthodontist, or by an oral and maxillofacial surgeon. Third molar surgery, when required, is performed under appropriate anesthesia, often a general anaesthetic in hospital as a Day surgery to maximize patient comfort.

Why Should I Have My Wisdom Teeth Removed?

If you do not have enough room in your mouth for your third molars to fully erupt, a number of problems can happen. Impacted wisdom teeth should be ideally removed before their root structure is fully developed. In some patients this can be is as early as 12 or 13, and in others it may not be until the early twenties. Problems tend to occur with increasing frequency after the age of 30. Some of the possible problems related to not removing your wisdom teeth include:

A representation of a pericoronitis infection on a wisdom tooth

Infection:

The most frequent clinical problem we see is pericoronitis, (a localized gum infection). Without enough room for total eruption, the gum tissue around the wisdom tooth can become irritated and infected, resulting in recurrent pain, swelling, and problems with chewing and/or swallowing.

An example of a cyst formation on a wisdom tooth

Cyst Formation:

Non-infectious diseases such as cyst formation may also arise in association with an impacted wisdom tooth. Cysts are fluid-filled “balloons” inside the jaw bone that develop as a result of impacted teeth. Cysts slowly expand destroying adjacent jaw bone and occasionally teeth. They can be very difficult to treat if your wisdom teeth are not removed in your teenage years. Although rare, tumors can be associated with cysts forming around wisdom teeth.

An illustration of teeth crowding causes by a wisdom tooth

Possible Crowding:

Impacted wisdom teeth may contribute to crowding of your teeth. This is most noticeable with the front teeth, primarily the lower front teeth and is most commonly seen after a patient has had braces. There are a number of factors that cause teeth to crowd after braces or in early adulthood. Retained, impacted wisdom teeth may be a contributing factor. Unless you have an active problem when you see the oral surgeon, the reason for removal is primarily to prevent long-term damage to your teeth, gums and jaw bone.

A visual of a wisdom tooth damaging an adjacent tooth

Damage to Adjacent Teeth:

If there is inadequate room to clean around the wisdom tooth, the tooth directly in front, the second molar, can be adversely affected resulting in gum disease, bone loss around the tooth, decay and possible resorption (erosion).

What If I Don’t Have My Wisdom Teeth Removed As A Teenager Or Young Adult?

As wisdom teeth develop, the roots become longer and the jaw bone more dense. When it is necessary to remove impacted wisdom teeth in your thirties, forties or beyond, the post-operative course can be prolonged and there is a higher complication rate. Treating these complications is often more difficult and less predictable than with a younger patient. Healing may be slower and the chance of infection can be increased.

If your impacted wisdom teeth are not removed in your teenage years or early in your twenties and they are completely impacted in bone, it may be advisable to wait until a localized problem (such as cyst formation or localized gum disease and bone loss) develops. In general, you will heal faster, more predictably and have fewer complications if treated in your teens or early twenties.

What Happens On The Day Wisdom Teeth Are Removed?

Most people prefer to be unaware of the experience when they have their wisdom teeth removed and often decide to have surgery performed as a Day Surgery procedure in hospital. You will be provided with appropriate anaesthesia options at your consultation. Most wisdom tooth surgery is performed under general anaesthesia in hospital to maximize your comfort. In some cases you may be suitable for treatment in the rooms; our staff has the training and experience to provide the various types of treatment under local anaesthesia sometimes with sedation. These services are provided in an environment of optimum safety utilizing modern monitoring equipment and a well trained, experienced staff.

Surgery in the Office:

On the day of your procedure we ask that a parent or responsible adult accompanies you to the office and plans to stay with you the rest of the day. You should wear casual comfortable clothing. You may have a very light breakfast (tea & toast) the morning of surgery The procedure will generally take about 30 to 60 minutes and you will probably be in the office for approximately 1-2 hours. Recent advances in medicine and technology allow patients to undergo wisdom tooth removal in a manner which promotes rapid healing and minimal post-operative discomfort. State-of-the art sterilization and infection control techniques are used at all times.

If you are going to be sedated, we usually will provide you with a tablet to take about an hour before the procedure and ask you to wait in the waiting room for this to take effect; you may be sleepy for a significant portion of the day and must not drive for 48 hrs after sedation. When you are seated in the surgical room our friendly nursing staff will make every effort to make you as comfortable as possible. Local anesthesia is given to you prior to the procedure in the rooms and Dr Bowler may attend to other patients whist waiting for the local anaesthesia to take effect.

Day Surgery in Hospital:

On the morning or afternoon of your surgery, it is essential that you have nothing to eat or drink (excluding prescription medications with a sip of water) for at least 6 hours (preferably longer). This does not mean you should try to fit in one “last meal” exactly six hours before your surgery. Having anything in your stomach can increase the risk for serious anesthetic complications, including nausea and vomiting. Your procedure will be rescheduled if you have not heeded these guidelines.

We will provide you with a prescription for pain medication and antibiotics and you will receive this together with suitable postoperative instructions on discharge from hospital. You will stay in the hospital for about 4 hours after surgery and you should allow adequate time to travel home and rest. You must not drive a motor vehicle for at least 24 hrs after having general anaesthesia and possibly longer if you feel drowsy. All patients undergoing surgery under general anaesthesia also receive local anaesthesic to ensure they are pain free once they are awake.

If your surgery requires stitches, these are usually not the type that dissolve as these can cause oral hygeine issues and they do require removal at your one week post op visit. Suture removal is very quick and painless. Following surgery you may notice a sensation of your gums feeling swollen and pulling away from your teeth. This occurs with post op swelling and is all part of the normal recovery; it will subside in several days.

Once the local anesthesia wears off, you may require prescription pain medication. Commonly non-narcotic anti-inflammatory medications such as ibuprofen (Nurofen) are adequate often in combination  with parcetamol but please contact the office or hospital if you need stronger medication. The local anesthesia may last until the following day, and should not be confused with an injury to your nerve – this is very rare. We recommend starting your post-operative diet with clear liquids such as jelly and broths, gradually increasing in substance as your body permits.

We do not recommend using dairy products such as yoghurt, ice cream or milkshakes on the day of surgery, as nausea and vomiting may develop in conjunction with the anaesthetic and pain medication. If you are given antibiotics and you take birth control pills, please be aware that the birth control pills might become ineffective and take appropriate precautions. You must take the entire course of antibiotics. Failure to do this encourages the development of resistant strains of micro organisms

WHAT DOES WISDOM TOOTH REMOVAL COST AND IS IT COVERED BY INSURANCE?

The fee for your treatment is determined by a number of factors. These may include the difficulty involved in removing your teeth and which type of anaesthesia is best for you. During your consultation appointment the surgeon will need to review your x-rays, complete an examination and determine the best option for anaesthesia, before an accurate estimate can be provided. Every insurance company has a different policy regarding the extent of coverage for a given surgical procedure. The oral surgeon’s office staff will help you obtain maximum insurance coverage for your treatment.

WHAT IF I HAVE QUESTIONS BEFORE SURGERY?

At the time of your consultation, your specific situation will be discussed in greater detail. We encourage you to ask any questions you may have. If new questions arise after your consultation, please call our office to speak to one of our staff.

A smiling woman

The Day of Treatment

Please do not eat or drink anything prior to your surgery. Having anything in your stomach can increase the risk for serious anaesthetic complications.