South FloridaOMS Oral & Maxillofacial Surgery

Wisdom Teeth

The average adult has thirty-two teeth by age eighteen: sixteen teeth on the top and sixteen teeth on the bottom. Each tooth in the mouth has a specific name and function. The teeth in the front of the mouth (incisors, canine and bicuspid teeth) are ideal for grasping and biting food into smaller pieces while the back teeth, or molar teeth, are used to grind food up into a consistency suitable for swallowing.

However, the average mouth is made to hold only 28 teeth. It can be painful when 32 teeth try to fit in a mouth that holds only 28 teeth. These four other teeth are your Third Molars, also known as "wisdom teeth."

Why Should I Remove My Wisdom Teeth?

Wisdom teeth are the last teeth to erupt within the mouth. When they align properly, and gum tissue is healthy, wisdom teeth do not have to be removed. Unfortunately, this does not generally happen. The extraction of wisdom teeth is necessary when they are prevented from properly erupting within the mouth. They may grow sideways, partially emerge from the gum, and even remain trapped beneath the gum and bone. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to erupt successfully.

These poorly positioned impacted teeth can cause many problems. When they are partially erupted, the opening around the tooth allows bacteria to grow and will eventually cause an infection. The result: swelling, stiffness, pain and illness. The pressure from the erupting wisdom tooth may move other teeth and disrupt the orthodontic or natural alignment of teeth. The most serious problem occurs when tumors or cysts form around the impacted wisdom tooth, resulting in the destruction of the jawbone and healthy teeth. Removal of the offending impacted tooth or teeth usually resolves these problems. Early removal is recommended to avoid such future problems and to decrease the surgical risk involved with the procedure.

Oral Examination

With an oral examination and x-rays of the mouth, Drs. Holmes and Sclar can evaluate the position of the wisdom teeth and predict if there may be present or future 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.

The Surgical Procedure

The removal of wisdom teeth can now be performed with minimal discomfort. All outpatient surgery is performed under appropriate anesthesia to maximize patient comfort. Drs. Holmes and Sclar have the training, license and experience to provide various types of anesthesia to allow patients to select the best alternative. These services are provided in an environment of optimum safety, utilizing modern monitoring equipment and staff experienced in anesthesia techniques.

Surgical Risks

Done correctly the removal of impacted teeth is very safe. However. Often there are some anatomical variations that may put some patients at risk.

The upper teeth are often close to the sinus and may be displaced into it or root tips may fall in it. Also, there is a risk for an opening between the mouth and the sinus that may need to be closed later.

The lower teeth are close to the nerves that give sensation to the lip and tongue and may cause numbness of these areas.

Any extraction has the risk of damage to adjacent teeth, bleeding, swelling, and infection.

Each patient is different and these risks will be specifically discussed with you.

The Post-Operative Period

The removal of impacted wisdom teeth and the surgical removal of teeth is quite different from the extraction of erupted teeth. The following conditions may occur, all of which are considered normal:

1. The surgical site may hurt for a few days
2. The surgical area will swell.
3. Swelling peaks on the 2nd or 3rd post -operative day
4. Trismus (stiffness) of the muscles may cause difficulty in opening your mouth for a period of days.
5. You may have a slight earache.
6. A sore throat may develop.
7. Your other teeth may ache temporarily. This is referred pain and is a temporary condition.
8. If the corners of the mouth are stretched out they may dry and crack. Your lips should be kept moist with cream or ointment.
9. There will be a space where the tooth was removed. After 24 hours this area should be rinsed following meals with warm salt water until it is healed. This cavity will gradually fill in with new tissue over the next few months
10. There may be a slight elevation of temperature for 24 to 48 hours. If temperature continues, notify us.
11. It is not unusual to develop bruising in the area of an extraction.

Please take all prescriptions as directed and take pain medications if you are experiencing pain. Pain medications can cause side effects and nausea and should not be taken if there is no pain.

Women please note: Some antibiotics may interfere with the effectiveness of your birth control pills. Please check with your pharmacist.

Care of Mouth After Oral Surgery

1. Do not rinse or spit for 24 hours after surgery.
2. Keep fingers and tongue away from socket or surgical area.
3. Use ice packs on surgical area (side of face) for first 48 hours, apply ice 20 minutes on - 10 minutes off. Bags of frozen peas work well.
4. For mild discomfort take Tylenol or Ibuprofen every four to six hours as instructed.
5. For severe pain use the prescription given to you.
6. Drink plenty of fluids. (Do not use a straw)
7. If the muscles of the jaw become stiff, chewing gum at intervals will help relax the muscles. The use of warm, moist heat to the outside of your face beginning on the third day will further help with relaxation of the muscles.
8. After the first post-operative day, use a warm salt-water rinse following meals for the first week to flush out particles of food and debris which may lodge in the surgical area. (1/2 teaspoon of salt in a glass of warm water. Mouthwash can be added for better taste.)
9. Diet may consist of soft foods which can be easily chewed and swallowed. No seeds, nuts, rice, popcorn, etc.
10. A certain amount of bleeding is to be expected following surgery. Bleeding is controlled by applying pressure to the surgical area using small rolled gauze for 90 minutes. After that time remove the gauze and then you may eat or drink. If bleeding persists, a moist tea bag should be placed in the area of bleeding and bite firmly for one hour straight. This will aid in clotting blood. Repeat if necessary. If bleeding still persists call our office.
11. We suggest that you do not smoke for at least 5 days after surgery. Nicotine may break down the blood clot and cause a "Dry-Socket".
12. Numbness of lip/tongue may be experienced for a variable period of time.
Feel free to contact us if any doubt arises as to your progress and recovery.

Post-Op Instructions

What you should do following oral and maxillofacial surgery procedures

A certain amount of bleeding, pain, and swelling is normal. Reduce your activity as much as possible for several hours. Avoid eating, drinking, and unnecessary talking. These activities may hinder proper healing in the first few hours.

Do not be alarmed if your vision is blurred for a time following anesthesia or if a "black and blue" bruise should appear at the site of an injection. The arm also may be "black and blue", swollen and tender to touch due to the IV.

Follow the simple instructions below to minimize complications and help ensure prompt recovery.

To control bleeding

Immediately following procedure. . .keep a steady pressure over the surgical site. Pressure helps reduce bleeding and permits formation of a clot. Gently remove the compress after one hour. If bleeding persists, place another compress and again keep steady pressure on the area for one hour.

After 24 hours... some oozing of blood may persist. If necessary, use a moist tea bag instead of the gauze. After bleeding has stopped, cautiously resume oral hygiene.

Immediately following procedure... begin taking medication as directed by your doctor to minimize discomfort when the anesthesia wears off and feeling is back to normal. Application of an ice bag can also help relieve discomfort.

To minimize swelling and discomfort

Immediately following procedure. . .apply an ice bag over the affected area. Use 20 minutes on and 10 minutes off for 24 hours to help prevent development of excessive swelling and discomfort. If an ice bag is unavailable, simply fill a heavy plastic bag with crushed ice. Tie end securely and cover with a soft cloth to avoid skin irritation. Frozen bags of peas make wonderful ice packs and can be refrozen and used repeatedly.

After 24 hours. . . it should not be necessary to continue with cold applications. You may expect swelling for 7-10 days and a fever of 99 degrees F to 100 degrees F.

If anti-inflammatory medication was prescribed by your doctor, begin taking the medication with food immediately after the procedure and continue as directed. Take the prescribed narcotic medication only if you experience significant pain. If you were not prescribed any anti-inflammatory medication and you do not have a known allergy to Aspirin or Ibuprofen (Motrin), you can take 600 mg of Ibuprofen (Motrin) every six hours to control mild to moderate pain.

Special considerations following removal of impacted teeth:

Removal of impacted teeth is a surgical procedure. Postoperative problems are not unusual, and extra care must be taken to avoid complications.
Severity of postoperative pain will depend on the procedure and your physical condition. Take medication for pain precisely as directed.
Healing of the surgical site is variable.
Swelling can be expected. Be certain to apply ice bags as directed above.
Difficulty in opening your mouth widely and discomfort upon swallowing should be anticipated.
Numbness of lips and/or tongue on the affected side may be experienced for a variable period of time.

Oral hygiene is important

Oral hygiene is important

24 hours after surgery, rinse mouth gently with a solution of one-half teaspoonful of salt dissolved in a large glass of water. Repeat after every meal or snack for seven days. Rinsing is important because it removes food particles and debris and thus helps promote healing. Brush tongue with a dry toothbrush to keep bacteria growth down, but be careful not to touch the surgical site.

Resume your regular tooth brushing, but avoid disturbing the surgical site.

Maintain a proper diet

Have your meals at the usual time. Eat soft, nutritious foods and drink plenty of liquids - with meals and in between. Have what you wish, but be careful not to disturb the blood clot. Add solid foods to your diet after 4+5 days after they are comfortable to chew.

In case of problems

If you should have any problems such as excessive bleeding, pain, or difficulty in opening your mouth, call our office immediately for further instructions or additional treatment.

Remember your follow-up visit

It is often advisable to return for a postoperative visit to make certain healing is progressing satisfactorily. In the meantime, maintain a healthful diet, observe rules for proper oral hygiene, and call our office if you have any questions