Wisdom Teeth in honolulu & aiea

the removal of impacted teeth

In this office we specialize in the removal of troublesome third molars (wisdom teeth) and other oral surgical procedures. It is this kind of problem that will most likely bring you to us for what may be your first exposure to surgery. Even though our encounter is usually brief, we try hard to help you understand the nature of this surgery, the risks and complications involved and some of the reasons for it.

Teeth displaced within the jaw are difficult to examine with conventional dental x-rays. For this reason, we use a panoramic radiograph (x-ray) to insure the proper diagnosis and pre-operative evaluation of your surgical needs. This radiograph will provide an overall view of both the upper and lower jaws and the relationship of the teeth to the adjacent nerve and blood vessel canals, as well as to the nasal and sinus cavities.

This information is intended to help you understand your anticipated surgery. You may have anxiety prior to your surgery; however, we hope your understanding of our procedures will help minimize or alleviate it. Please read the following information thoroughly and feel free to ask questions about any aspect of your surgical plan.

Because the removal of impacted teeth is an important matter to both the patient and the oral surgeon, it is extremely important for you to understand the reasons for their removal, the possible consequences of not having these teeth removed and the normal side effects which may follow.

what is an impacted tooth

All teeth are formed deep within the jaw bones. As the roots develop, most teeth travel toward their future place in the dental arch. This movement is called eruption. If a tooth travels in the wrong direction or is blocked by another tooth by dense bone, by gum tissue or by any combination of these impediments, it is said to be impacted. Unerupted teeth are generally considered to be a normal finding during childhood, but are abnormal in adults.

what harm can be caused by impacted teeth?

Since it is not normal for a tooth to remain beneath the surface of the gum tissue beyond the age of eighteen, it is easy to understand why unhealthy conditions may develop.

Whenever saliva can reach the crown or top of the tooth—and this may happen though the impacted tooth cannot be seen in the mouth—decay can occur, just as it can in normal teeth. Because there is no way to fill such cavities, severe toothaches and infections will eventually develop.

Bacteria in the saliva may also cause pericoronitis, which is an infection in the soft tissue and bone that surrounds the crown of the impacted tooth. This infection can spread to the cheek, throat or neck, causing severe pain, stiffness of the jaws, swelling, an inability to open the mouth and more general illness.

As impacted teeth press against normally erupted teeth, they may injure the roots of those teeth or push them out of position. Oral hygiene becomes a serious problem when erupted teeth are pushed from their normal positions.

Sometimes cysts will form around the crowns of impacted teeth. Through its very gradual enlargement, a cyst will cause serious destruction of bone and damage to teeth in the adjacent area. Such cysts should be removed.

Impacted teeth are often a source of what is called referred pain. Earaches, sore throat, sinus pain, headaches, pain in the area of the eyes and in adjacent teeth are examples of distant areas of discomfort due to impacted third molars “wisdom teeth.” Impacted canines “eye teeth” may cause sinus pain and frontal headaches. In most instances, an x-ray must be taken to determine whether or not an impacted tooth is causing referred pain.

why should impacted teeth be removed?

While it is true that not all impacted teeth cause the complications that have been described, no one can be certain from an x-ray which ones are going to cause difficulty or when it might occur. Symptoms usually occur unexpectedly and at inconvenient times. Older persons do not tolerate the operation as well as younger people and the operation becomes more difficult with advancing age. For these reasons, we recommend all adults with impacted teeth have them removed especially if there is any existing pathology (infection, disease, etc), if they are interfering with normally functioning teeth or if they are the source of referred pain.

Sometimes it is advised that unerupted teeth be removed during childhood. This decision is most often made by persons well-trained in Orthodontics or in Pediatric Dentistry. It is also recommended that children who may have extra teeth have them removed to permit the growth of permanent teeth. Extra teeth may be impacted or fully erupted.

When impacted teeth are under a denture, the mild irritation of the denture may cause the teeth to become symptomatic. This may even cause the teeth to begin erupting, making their removal necessary. There are times when it is best not to remove deeply impacted teeth prior to denture construction. This decision is best left to the family dentist and the oral surgeon.

what is it like to have an impacted tooth removed?

Many erupted teeth can be removed with forceps by carefully manipulating the tooth from the socket. This, of course, is not possible with impacted teeth because they are partially or completely beneath the surface of the tissue. In most cases, soft tissue and bone must be incised and/or removed and the tooth sectioned in one or several planes in order to remove it. The actual removal of the tooth is carried out in keeping with accepted principles of surgery, sterile instrumentation and gentle handling of the soft tissue and bone in a well-lighted field.

We will assist the patient in selecting anesthesia best suited to their individual needs. In some cases, local anesthesia will be enough; however, some cases require intravenous anesthesia or a combination of both techniques. Some patients may be pre-medicated before coming to the office.

Post-operative instructions are provided for each patient in order to assist recovery. Certain medications will be prescribed to minimize discomfort, reduce swelling, prevent infection, promote healing and aid in good oral hygiene.

The removal of an impacted tooth is an operation and is not a casual matter. This is not said to frighten you, but to encourage you to understand the surgery, its risk to you, its cost and the need for your careful preparation and good post-operative care.

are there any risks or complications?

Any operation carries with it some risks. The wound, which is created following the removal of an impacted tooth, is large and healing may be delayed because the body is unable to build normal tissue as quickly as with a small wound. In the upper jaw, healing usually proceeds uneventfully. However, in the lower jaw, because the bone is more dense, the blood supply is less well-developed and the food and saliva are in more prolonged contact, about five to ten percent of the wounds will take longer to heal causing more pain and swelling. This may require some type of post-operative dressing. This condition is referred to as alveolar osteitis (dry socket) and is characterized by pain in the jaw or ear. For this reason, it is not wise for patients to travel on a long trip immediately after surgery or to be where they cannot secure satisfactory post-operative care. Alveolar osteitis, if it occurs, usually does not develop until the third or fourth post-operative day.

There is often some mild bleeding and oozing following surgery which will stop by itself after a few hours. Post-operative instructions are provided explaining what to do if bleeding is prolonged or more serious.

Lower impacted teeth often rest on the main nerve to the lower jaw. Sometimes, despite all precautions, this nerve may be touched, bruised, slightly lacerated, or in very rare cases, severed. The result is numbness of the lower lip, chin and all of the teeth on the affected side. This condition may last from a few days to several weeks, improving gradually as the nerve repairs itself and regenerates. Very rarely, it may be permanent. Another nerve which supplies sensation and taste to the front of the tongue can also be bruised during surgery even though this occurrence is even rarer.

Lower impacted third molars occupy one of three “weak” spots in the lower jaw. Rarely, in the case of impacted teeth surrounded by unusually dense bone, the pressure required to remove these teeth equals the pressure to break the jaw. Fortunately, this is a most uncommon complication and one that we make every effort to avoid.

Upper impacted third molars lie against the wall of the maxillary sinus or antrum. The surgeon will exercise great care to see that no unnecessary injury occurs to this structure; occasionally the thin wall of bone separating the sinus from these teeth may crack slightly or is perforated causing blood to seep into the sinus. Should this happen, the patient will notice some blood in their nose. This usually clears up promptly and requires no further treatment. Rarely, a second operation is necessary to close the communication between the sinus and the mouth.

All patients about to have impacted teeth removed should understand that adjacent teeth may have been weakened or otherwise injured by the presence of impacted teeth. This injury may not become apparent until the impacted teeth have been removed. Adjacent teeth must therefore be considered “on probation” for three to six months following the removal of the impacted teeth. Large fillings on adjacent teeth may be disturbed if they are in between impacted teeth.

The operated area will probably swell. Swelling is usually most pronounced on the second and third day and begins to disappear on the fourth day.

Black and blue marks on the face are caused by bleeding into the cheek. This may appear first as swelling, but after the second or third day it may discolor the face yellow, black, or blue. It will gradually disappear in seven to ten days and is nothing to be concerned about.

This information is your guide to a better understanding of impacted teeth or unerupted teeth, their associated removal and the possible side effects associated with this operation. In consenting to have their impacted teeth removed, all patients should clearly understand the possible risks and complications which have been described. If you have any questions regarding your anticipated surgery, please do not hesitate to ask.