The Wisdom of Wisdom Teeth Removal - Dr. Ruben …...wisdom teeth can have a detrimental effect on...
Transcript of The Wisdom of Wisdom Teeth Removal - Dr. Ruben …...wisdom teeth can have a detrimental effect on...
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TheWisdomofWisdomTeethRemoval
RonaldAchong,M.D.,D.M.D.
RubenCohen,D.D.S.
�LicoPublishing
1541SouthRobertsonBlvdLosAngeles,CA90035
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TheWisdomofWisdomTeethRemovalBy:Dr.RonaldAchong&Dr.RubenCohen
Copyright2014byRonaldAchong.M.D.,D.M.D.&RubenCohen.D.D.S.
ALLRIGHTSRESERVEDunderInternationalandPan-AmericanCopyrightConventions.Exceptforbriefquotationinreviewsorarticles,nopartofthisbook
maybereproducedbyanymeans.
Inquiriesshouldbeaddressesto:LicoPublishing
1541SouthRobertsonBoulevard,LosAngeles,CA90035
FirstEdition2014Coverdesign:ChadCarpenter.
Insidedesign:ChadCarpenterandRoseMaryH.Cohen
Contacttheauthors:
Dr.RonaldAchong:[email protected]
Dr.RubenCohen:[email protected]
ISBN:978-0-9667361-7-5
DISCLAIMER:Theinformationprovidedinthisbookisnotintendedasasubstituteforprofessionalmedicaladvice,diagnosisortreatment.Itisprovidedtohelpyoucommunicateeffectivelywhenyouseektheadviceofyouroralandmaxillofacial
surgeon.
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TableofContents
RemovalofWisdomTeeth:AWiseMove?...............................................................................4
WhyShouldWisdomTeethBeRemoved?................................................................................4
WhenShouldWisdomTeethBeRemoved?.............................................................................5
Cavities,PainandInfection.............................................................................................................7
GumDiseaseandWisdomTeeth...................................................................................................8
WisdomTeethandDentalCrowding...........................................................................................8
Pathology.................................................................................................................................................8
TheHealthoftheSecondMolar....................................................................................................10
AgeandWisdomTeeth.....................................................................................................................10
HowAreWisdomTeethRemoved?.............................................................................................10
X-rays,ImagingandOralSurgery.................................................................................................12
AnesthesiaandOralSurgery..........................................................................................................13
Bene`itsofOf`ice-BasedAnesthesia............................................................................................14
Post-OpInstructions..........................................................................................................................14
You’veMadeItthroughtheFirstDay.NowWhat?...............................................................15
ThingstoAvoidPost-Op....................................................................................................................15
RisksofRemovingWisdomTeeth.................................................................................................16
Conclusion...............................................................................................................................................17
FrequentlyAskedQuestions............................................................................................................17
AbouttheAuthors................................................................................................................................19
References................................................................................................................................................21
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RemovalofWisdomTeeth:AWiseMove?
Yourdentistprobablyhasbeentellingyouforyearstohaveyourwisdomteethremoved,butyoumaybehesitanttohavetheproceduredoneforamultitudeofreasons:youmayhaveheardhorrorstoriesfromfriendsorcolleagues,youmaybeanxiousaboutsurgery,youmaynotknowwhat’sinvolved,oryoumaythinkthatyoucancontinuetowaitsinceyourwisdomteetharenotcausingpain.
Severalfactorsneedtobeconsideredwhenevaluatingwisdomteeth:thehealthofthesecondmolar(whichsitsrightinfrontofthewisdomtooth),thepresenceofgumdisease,theageofthepatient,andtheriskofdentalcrowding.
Yourdentist’srecommendationtohaveyourwisdomteethremovedprobablyiscorrect.Inthisbook,theauthors—bothofwhomhavemanyyearsofexperienceinevaluatingandremovingwisdomteeth—willdescribewhatwisdomteethactuallyare,reasonstohavewisdomteethremoved,howtheyareremoved,andwhattoexpectaftersurgery.Inshort,thisisaguideforpatientsconsideringorplanningtohavetheirwisdomteethremoved.Theprocessisusuallyquickandeasy,andmostpatientsarepleasantlysurprisedbyhowsmooththewholeexperiencereallyis.
Why Should Wisdom Teeth Be Removed?
Onereasonfortheremovalofwisdomteethislackofspaceinthejaws.Often,ourjawsarenotwideenoughtoaccommodateallofthewisdomteeth.Thisresultsinovercrowdingandmisalignedteeth.Patientscanalsoexperienceanunpleasantsmile,ordevelopgumdisease,cavities,infectionsandpain.
Theaveragejawhasroomforonlyfourteenteeth,butmostadultshavesixteenteethonthetopjawandsixteenonthelowerjawforatotalofthirty-twoteeth.Thefouradditionalteeth,whicharethelastteethinthebackofthejaw,arethethirdmolars,commonlyknownas“wisdomteeth.”
Allfourwisdomteethdonotalwaysdevelop.Mostindividualshaveatotaloffourwisdomteethintheirmouth;however,othersmayhavefewerormorethanfour.Someluckypeoplehavenone,andsomeunluckypeoplehavemorethanfour.Lookatthex-raybelowandguesshowmanywisdomteethareinthispatient.Theanswerisseven:twoonthetopright,twoonthetopleft,oneonthelowerleft,andtwoonthelowerright.
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�Figure1:X-rayshowing7wisdomteethinapatient
Eachtoothhasaspeci`icnameandeachtoothhasaspeci`icfunction.Thefrontteeth(incisors,caninesandbicuspids)areusedtobiteintofood,whilethebackteeth,calledmolars,areusedtochewfood.Technically,wisdomteetharecalledthirdmolars;theyareusuallynon-functionalandprovidenocosmeticbene`it.Anumberofstudieshavede`inedthedevelopmentanderuptionpatternofthirdmolars.Thelowerwisdomtoothbudisusuallyvisibleonx-raybytheageofnine.Thecrownofthewisdomtoothisusuallyformedcompletelybyagefourteen,andtherootsareapproximately50percentformedbyagesixteen.
Whenatoothisunabletofullygrowthroughthegumandenterthemouth,itisreferredtoasan“impacted”tooth.Ingeneral,impactedteethareunabletobreakthroughthegumsbecausethereisnotenoughspacepresent.Themostcommonimpactedteetharewisdomteeth.
Mostwisdomteethdonoteruptintothemouthandinsteadbecomeimpacted,orunerupted.Itisimportanttorememberthattheeruptionofwisdomteethisusuallycompletebytheageoftwenty,soiftheyarenotvisiblebythatage,oneormoreoftheteethmaybeimpacted.
WhenShouldWisdomTeethBeRemoved?
Theoptimumtimetoremovewisdomteethisinyourteenageryears.Lookatthex-raysbelowthatshowthegrowthofthewisdomteethatvariousages.Wisdomteethareeasiertoremovewhenpatientsareyounger,sincetherootsarenotcompletelyformed,thesurroundingboneissofter,andthereislesschanceofdamagingnearbynervesorotherstructures.Removalofwisdomteethatalateragebecomesmorecomplicatedbecausetherootsarefullydeveloped,therootsgrowclosertothemandibularnerve,andtheresultingdefect(fromtheremovalofthewisdomtooth)maybesolargethatabonegraftingproceduremaybeneededto`ixthedefect.
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� Figure2:X-rayshowingthedevelopmentofwisdomteethona12year-oldpatient
� Figure3:X-rayshowingthedevelopmentofwisdomteethona15year-oldpatient
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� Figure4:X-rayshowingthedevelopmentofwisdomteethona23year-oldpatient
Cavities,PainandInfection
Itischallengingtomaintaingoodoralhygienenearwisdomteeth.Subsequently,foodbecomestrappedaroundthewisdomteeth.Thefoodwillattractbacteriathatcancausecavitiesinboththewisdomteethandthesecondmolars.Whenwisdomteetheruptthroughthegums,paincanbefeltinthebackofthemouth,makingitdif`iculttochewandspeak.Astheteethtrytoeruptthroughthegums,foodmaygettrappedaroundtheseeruptingteeth.Thisareabecomesamagnetforbacteria,causingthewisdomtoothandthesurroundingareatobecomeinfected.Thischronicinfectioncanleadtoanabscess.Suchanabscesscangrowsigni`icantlywithinhours,causingsevereswellingofthefaceandneck.Thissituationcanbelife-threateningifnottreatedimmediatelyandmayrequirehospitalizationforintravenousantibioticsandsurgicaldrainage.
Figure5:Illustrationshowinganinfection(green)attherootsofthewisdomtooth
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GumDiseaseandWisdomTeeth
Anotherfactortoconsiderintheremovalofwisdomteethisthedepthofthegumpocketbehindthesecondmolars.Agumpocketdepthof`ivemillimetersormorecancompromisethesecondmolars.1Thesepocketdepthshavebeenshowntoincreaseovertimeandattractbacteriathatcausegumdisease.Therefore,impactedwisdomteethcanhaveadetrimentaleffectonthehealthofthegums.2,3Notably,thebacteriacountaroundthemolarshasbeenshowntodecreaseafterremovalofwisdomteeth.4
Afterwisdomteethareremoved,theholesleftbehindinthejawbonecanhaveadetrimentaleffectonthesecondmolar,whichisrightinfrontofit.Somesurgeonsadvocatepackingboneinthatholetoimprovethehealthofthatsecondmolar.Thisprocedure,knownasbonegrafting,preventsadefectfromdevelopingbehindthesecondmolar,especiallyinadultstwenty-sixyearsofageorolderwithpre-existinggumdisease.Bonegraftingwillpreservethehealthandintegrityoftheboneandthesecondmolar.5
Itisalsoimportanttonotetheeffectofwisdomteethongumdiseaseandin`lammation.Evenpregnantwomenwhosewisdomteethshownosignsofdistresstendtoexperiencemoreproblemsthanwomenwhosewisdomteethhavebeenremoved.6Inshort,themerepresenceofwisdomteethtendstocausein`lammation,whichcannegativelyimpactphysicalhealth,includingpregnancyoutcomes.
WisdomTeethandDentalCrowding
Whilepatientsanddentistsarealwaysquicktoblamewisdomteethfordentalcrowding,ade`initiveandclearcorrelationbetweenwisdomteethanddentalcrowdingisdif`iculttodetermine.Dentalcrowdingiscausedbyavarietyofconditions,andwhilewisdomteethmayplayasigni`icantroleinsomepatients,adirecteffectisdif`iculttoestablishconclusively.Itiscommonlybelievedinthedentalcommunitythatpressurefromeruptingwisdomteethwillcauseshiftingoftheremainingteeth,whichmayeventuallydisruptthenaturalalignmentofteeth,andadverselyaffectyoursmile.
Pathology
Cystsortumorsmayformaroundanimpactedwisdomtoothcausingdestructionoftheadjacentjawboneandteeth.Removaloftheoffendingimpactedwisdomtooth
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orteethusuallyremediesthisproblem.Earlyremovalisrecommendedtoavoidfutureproblemsandtodecreasethesurgicalrisk.
Acystcanformaroundawisdomtooth,asshowninFigure6below.Thispatientisinhislate`iftiesandthiscystwasfoundonaroutinepanoramicx-ray.Thecystislargeinsizeandisaffectingthelowerrightsecondmolarandthewisdomtooth.Notealsotheamountofbonethathasbeendestroyedbythecyst,whichisrepresentedbyadarkareaaroundthecrownofthewisdomtooth.Tominimizesuchdamage,itisrecommendedthatpatientswithwisdomteethhaveanx-rayoftheupperandlowerjawstakeneveryfewyears.Thispatienthadthecystremovedalongwiththeinvolvedwisdomtoothandthesecondmolar.Sixmonthslater,theareafromwhichthecystwasremovedhashealedwellandnewbonehasformed.
� Figure6:X-rayshowingacyst(blackshadow)aroundthecrownofthelowerrightwisdomtooth
� Figure7:X-rayofthesamepatient,taken1yearafterremovalofthecystandteeth
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TheHealthoftheSecondMolar
Secondmolarsareimportantfunctioningteethusedtogrindfood.Theyarelocatedimmediatelyinfrontofthewisdomteeth.Whenevaluatingwisdomteeth,itisimportanttoevaluatethehealthofthesecondmolarstodetermineiftheyarecompromisedbythepositionofthewisdomteeth.Wisdomteethcangrowinavarietyofpositions.Sometimestheyeruptstraightupliketherestoftheteeth,butothertimestheywillgrowsidewaysortowardthesecondmolars.Researchhasshownthattheligamentsurroundingthesecondmolarsandtheirrootscanbenegativelyaffectedbywisdomteeth,especiallyasthepatientgetsolder.7
AgeandWisdomTeeth
Numerousstudieshaveshownthatolderadultswhostillhavewisdomteethhaveahigherriskofcomplications.Theyhaveahigherriskofgumdefectsaroundthesecondmolar.8Theincidenceofcavitiesonwisdomteethalsoincreaseswithage.9Theriskofcomplicationsaftersurgeryandtherecoverytimebothincreasewithage,especiallyinpatientstwenty-`iveyearsofageandolder.10
Therefore,earlyremovalofwisdomteeth(whentheteethhavehardlyanyoftherootsformed)hasbeenshowntoresultinverypredictableandsuccessfuloutcomes,withhardlyanygumpockets,drysockets,nerveinjuryorinfectionsdevelopingpost-operatively.11
Alternatively,itiswelldocumentedthatthereisincreaseddifAicultyandanincreasedriskofcomplicationswhenremovingwisdomteethlaterinlife.12
HowAreWisdomTeethRemoved?
Someofyoumaybecuriousabouthowimpactedwisdomteethareremoved.Howdoestheoralsurgeongetdownintotheboneandremoveatooththatisdeepunderthegumsandsurroundedbybone?Thefollowingdiagramswillclearlyexplaintheseprocedures.
Wisdomteethcanbepresentinvariouscon`igurations:tiltedforward,straightup,tiltedbackwards,orsideways.
1. Awisdomtooththatistiltedforward:Whenremovinganimpactedwisdomtooththatistiltedforward,asurgicaldrillisusedtocreateasmalltrougharoundthecrownofthetooth.Thisprovidesspacetoallowremovalofthetooth.Thebackpartofthetoothissectionedoffandthengentlyremoved.Thetoothisloosenedwithaninstrument.Afterwards,thetoothisthenrotatedbackandoutoftheextractionsocket.
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Figure8:Removalofawisdomtoothtiltedforward
2.Awisdomtooththatisinthestraightupposition:Whenremovinganimpactedwisdomtooththatisstraightup,asurgicaldrillisusedtocreateasmalltrougharoundthecrownofthetooth.Thisprovidesspacetoallowfortheremovalofthetooth.Thetoothisthensectionedinhalfandeachhalfisgentlyloosenedwithaninstrument.Next,thebackhalfofthetoothisremovedoutofthesocket.Thisprovidesadequateroomtoallowremovalofthefronthalfofthetooth.
Figure9:Removalofawisdomtooththatisinthestraightupposition
3.Awisdomtooththatistiltedbackwards:Whenremovinganimpactedwisdomtooththatistiltedbackwards,asurgicaldrillisusedtocreateasmalltrougharoundthecrownofthetooth.Thisprovidesspacetoallowremovalofthetooth.Thecrownofthetoothissectionedoffandthengentlyremoved.Therootsofthetoothareloosenedwithaninstrument.Therootsarethenremovedfromtheextractionsocket.
Figure10:Removalofawisdomtooththatistiltedbackwards
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4.Awisdomtooththatislyingsideways:Whenremovinganimpactedwisdomtooththatislyingsideways,asurgicaldrillisusedtocreateasmalltrougharoundthecrownofthetooth.Thisprovidesspacetoallowremovalofthetooth.Thecrownofthetoothissectionedoffandthengentlyremoved.Therootsofthetoothareloosenedwithaninstrumentandremovedoneatatime.
Figure11:Removalofawisdomtooththatislyingsideways
X-rays,ImagingandOralSurgery
Traditionally,wisdomteethhavebeenevaluatedbyobtainingapanoramicx-ray.Suchpicturesgiveanexcellentpreliminaryevaluationofsomeone’sjaws,enablingthesurgeontodetectthepresenceandpositionofwisdomteethandtodiscoveranycystsorotherpathology.However,duetodistortionspresentintheimage,panoramicx-raysdonotprovidetheamountofspeci`icityanddetailneededtoproperlyplanandprepareforanactualsurgery.Someoralandmaxillofacialsurgeonsmayorderaconebeamscan,whichissimilartoamedicalCATscaninthatitrevealsminutedetailsinaviewthatallowsthesurgeontolookathundredsofindividualslicesofthescannedarea,includingthree-dimensionalimages.
Whenplanningtheremovalofwisdomteeth,oneimportantconsiderationisthepositionofthemandibularnerve(themainnervethatispresentinsidethelowerjaw)inrelationtotherootsofthelowerwisdomteeth.Thisnerveoftenrunsincloseproximitytothelowerwisdomteeth,andinjurytoitcancausetemporaryorpermanentnumbnessofthecornerofthemouth,chinand/orlowerlip.Whileresearchsuggeststhattheimmediateriskofnumbnessaftersurgeryisbetween1and5percent,andpersistentnumbnesssixmonthsaftersurgeryislessthan1percent,itisalwaysdesirabletominimizetheriskofanycomplicationsduringsurgery.13,14
Aconebeamscanallowsthesurgeontoviewthepositionofthemandibularnervein`inedetail,evaluatethepositionofthesecondmolar,andcarefullyplanthesurgery.Justassurgeonswhospecializeinlungoperationsusebothachestx-rayandaCATscantoplanprocedures,oralandmaxillofacialsurgeonsusebothx-raysandaconebeamscantominimizetheriskofcomplicationsandtraumatothesurroundinghealthytissue.
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Whilethelevelofradiationexposureisalwaysacauseforconcernanytimesomeonegetsanx-ray,it’simportanttonotethatconebeamscanscandeliveraslittleas0.087mSvofradiation,whichiscomparabletonaturalbackgroundradiationexposureforelevendays.Incontrast,atypicalCATscanoftheheaddeliversabout0.86mSvofradiation,whichiscomparabletonaturalradiationexposureforonehundredandeightdays.15
AnesthesiaandOralSurgery
Beforeremovingawisdomtooth,thesurgeonwilladministeralocalanesthetictonumbthetoothtoberemovedandthesurroundinggum.However,mostpatientspreferfull-bodysedationsothattheyarenotawakeduringtheprocedure.Inthissection,differentlevelsofanesthesiawillbereviewed.
Oralandmaxillofacialsurgeons(OMS)aretrainedinallaspectsofanesthesiaadministration.Followingdentalschool,theycompleteatleastfouryearsoftraininginahospital-basedsurgicalresidencyprogramalongsidemedicalresidentsingeneralsurgery,anesthesiaandotherspecialties.Duringthistime,residentOMSserveonthemedicalanesthesiologyservice,wheretheyevaluatepatientsforanesthesia,delivertheanesthetics,andmonitorpatientsduringandaftersurgery.
Asaresultoftheirextensivetraining,OMSarewellpreparedtoappropriatelyadministernotonlylocalanesthesiabutallformsofsedationandgeneralanesthesiainanoutpatientsetting.Theyareexperiencedinairwaymanagement,endotrachealintubation,establishingandmaintainingintravenouslines,andmanagingcomplicationsandemergenciesthatmayariseduringtheadministrationofanesthesia.
Beforeschedulingyoursurgery,youroralsurgeonwillreviewalltypesofanestheticavailableinordertomeetyourexpectations.Thisisthetimetodiscussanyconcernsyoumayhaveaboutanyfacetoftheprocedure.
Thefollowingarevariousanestheticoptionsthatmaybeusedtocontrolapatient’spainandanxiety.Mostoftheseoptionsareusedinconjunctionwithlocalanesthesia.
LocalAnesthesia:Thepatientremainstotallyawakeandwillbefullyawareofeverythingduringtheprocedure.Alocalanesthetic(e.g.,lidocaine)isadministeredintheareawheretheteetharetoberemoved.
NitrousOxide:Thisisalsoknownaslaughinggas.Amixtureofnitrousoxideandoxygenisadministeredthroughanasalbreathingapparatus.Thepatientisawakebuttypicallyfeelsrelaxed,evengiddy,whichusuallylessenstheuncomfortablesensationsassociatedwiththeprocedure.
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IntravenousAnesthesia:Alsoknownas“twilightsleep,”thisiswhensedationmedicationsareadministeredthroughanintravenousline,causingthepatienttobecomecalmandsleepy.Thepatientislessawareoftheactualprocedureandthuslessabletorememberit.
GeneralAnesthesia:Sedationmedicationsareadministeredthroughanintravenousline.Thepatientiscompletelyasleepfortheprocedureanddoesnotremembertheprocedure.
BeneYitsofOfYice-BasedAnesthesia
Themajorityoforalandmaxillofacialsurgeryproceduresareperformedintheof`iceusingoneoftheanesthesiaoptionslistedabove.Thistreatmentapproachisconvenient,safeandcost-effective.Thecomfortable,personalizedsettingoftheOMSof`iceminimizeswaitingandrecoverytime,ascomparedtohavingthesameprocedureperformedinahospitaloutpatientsurgerycenter.Inaddition,in-of`iceproceduresandanesthesiadeliveryareusuallylessexpensivethansimilarcareinahospitaloroutpatientsurgerycenter.
OMSof`icesareoftenaccreditedbystateagenciesorindependentagencies—sometimesboth—whichalsoaccreditandinspecthospitalsandoutpatientsurgerycenters.Tocon`irmtheaccreditationofyouroralsurgeon’spractice,askthesurgeonorof`icestaffatthetimeofyourappointment.
Post-OpInstructions
Duringthe`irsthouraftertheoperation,bitedowngentlybut`irmlyonthegauzepacksthathavebeenplacedovertheextractionareas,makingsuretheyremaininplace.Donotchangethemduringthistimeunlessthebleedingisnotcontrolled.Thepacksmaybegentlyremovedafteronehour.Ifactivebleedingpersists,placeenoughnewgauzetoobtainpressureovertheextractionsitesforanotherthirtyminutes.
Donotdisturbtheareaswheretheteethwereremoved.Donotrinsevigorouslyorprobetheextractionareaswithanyobjects.Youmaybrushyourteethgently.DONOTSMOKEforatleastoneweek,sincethisisverydetrimentaltohealingandmaycauseadrysocket.
Bleeding:Intermittentbleedingoroozingovernightisnormal.Bleedingmaybecontrolledbyplacingfreshgauzeovertheareasandbitingonthegauzefortwentytothirtyminutesatatime.
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Bleedingshouldneverbesevere.Ifthereispersistentbleeding,itusuallymeansthatthegauzepacksarebeingclenchedbetweenteethonlyandarenotexertingpressureontheextractionareas.Tryrepositioningthepacks.Ifbleedingpersistsorbecomesheavy,substituteateabagthatwassoakedinveryhotwater,squeezeddamp-dry,andwrappedinmoistgauze.Ifbleedingstillremainsuncontrolled,callyouroralsurgeon’sof`iceorproceedtoyourlocalemergencyroom.
Swelling:Swellingoftenaccompaniesoralsurgery.Itcanbeminimizedbyusingacoldpack,icebag,orabagoffrozenpeaswrappedinatowelandapplied`irmlytothecheekadjacenttotheextractionarea.Applycoldcompressestothefaceforthe`irsttwenty-fourtoforty-eighthours.
Pain:Wisdom-toothremovalisnotatrivialundertaking.Mostpatientswillexperiencesomedegreeofdiscomfortaftertheprocedure.Analgesicssuchasaspirinoribuprofenmaybesuf`icienttorelievethisdiscomfort.Sometimesstrongerprescriptionpainmedicationsmaybeneeded.Youroralsurgeonwillusuallyprescribepainmedicationstouseafterthesurgery.
You’veMadeItthroughtheFirstDay.NowWhat?
MouthRinses:Keepingyourmouthcleanisessentialtohealing.Use1/4teaspoonofsaltdissolvedinaneight-ounceglassofwarmwaterandgentlyrinseoutyourmouth.Youcanrepeatthisasoftenasdesired,butdoitatleasttwicedaily.Threetimesisbetter.
Brushing:Afterthe`irstday,resumeyournormaloralhygieneroutineassoonaspossible.
Compresses:Verywarmcompressesappliedtotheskinovertheareasofswellingmaybeappliedafterthe`irstforty-eighthourstosoothetenderareasanddecreaseswellingandstiffness.
ThingstoAvoidPost-Op
Avoidspittingforatleastaweek.Spittingcanrestartbleedingandleadtopainatthesurgicalsite.Ifyoufeeltheurgetospit(suchasafterbrushingyourteeth),takeasipofwaterandgentlyrinseyourmouthandthenletthewaterfalloutofyourmouthandintothesink.
Avoidusingastrawforaweek.Justlikespitting,usingastrawcanrestartbleedingandleadtopainatthesurgicalsite(drysocket).Ifyouwanttohaveasmoothieormilkshakeaftersurgery,eatitwithaspoonordrinkitoutofacup,butavoidstraws.
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Avoidsolidfoodsforthe`irstday.Startwithclearliquidslikewater,applejuiceorvitamindrinks.Iftheseliquidsaretoleratedwell,thenadvancetosmoothies,milkshakes,proteinshakes,icecream,Jell-Oorothernutritiouscoolliquidsforthe`irsttwenty-fourhours.Fortherestoftheweek,haveasoftdiet(e.g.,mashedpotatoes,scrambledeggs,macaronietc.).Toavoidpainandbleeding,donotconsumespicyorhigh-temperaturefoods;allowahotsouporhotcoffeetocooltoroomtemperaturebeforedrinkingit.
Avoid`lossingaroundthesurgicalsite.Brushyourteethgentlywithasoftbristletoothbrush.Rinsegentlywithanalcohol-freemouthrinseorsaltwaterandthenletthewaterfalloutofyourmouthandintothesink.Over-the-counteralcohol-freemouthrinsescanbefoundatanypharmacy.
Avoidexerciseforoneweekaftersurgery,asexercisecancausepainfulthrobbingorbleedingwheretheteethwereremoved.Restisimportantaftersurgery.
Finally,torepeat,avoidsmokingforatleastaweek.Nicotinedecreasestheamountofoxygenthatblooddeliverstothehealingsurgicalsite,thusdelayingthehealingprocess.Inaddition,smokeirritatesthesurgicalsite.Smokingisadouble-barreledthreat.Itcandelayhealingandincreasepain.
RisksofRemovingWisdomTeeth
Aswithanysurgery,therearerisksassociatedwiththeremovalofwisdomteeth.Themostcommonrisksareswelling,painandbleeding.Whileuncommon,theadditionalcomplicationslistedbelowmayhappenduringoraftersurgery:
•Painandswellingatthegumsandtoothsocketwherethetoothwasremoved.
•Bleedingthatcontinuesformorethantwenty-fourhours.
•Dif`icultyandpainwhenopeningthejaw.
•Slow-healinggums.
•Damagetoexistingdentalwork,suchascrownsorbridges,ortorootsofnearbyteeth.
•Apainfulin`lammatoryprocess,calleddrysocket,whichhappensiftheprotectivebloodclotislosttoosoonordoesnotform.
•Temporarynumbnessinthemouthandlipsafterthelocalanestheticwearsoff,duetoinjuryorin`lammationofthenervesinthejaw.
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•Anopeningintothesinuscavitywhenawisdomtoothisremovedfromtheupperjaw.
Thereareotherrisksthatcanoccurwhenremovingwisdomteeth.Alwaysdiscusstherisksofyourspeci`icsurgerywithyouroralsurgeonsothatyouknowwhattoexpectafteryoursurgery.
Conclusion
Whileallpatientsdonotneedtohavetheirwisdomteethextracted,thereareclearindicationsthatwarrantremovalofwisdomteeth.Theageofthepatient,thepresenceofgumdisease,thepotentialfordentalcrowding,andthelong-termhealthofthesecondmolarsareallfactorsthatmustbeconsideredwhendecidingifwisdomteethneedtobeextracted.
FrequentlyAskedQuestions
Whycan’tmyregulardentistremovemywisdomteeth?
Atonetimealldentistswouldremovewisdomteeth.Butbecauseofthedif`icultiesassociatedwithremovingwisdomteeth,moreandmoredentistsreferwisdomteethremovaltospecialists,whointurngaveuptheirbroaderpracticetospecializeinwisdomteethextraction.
Today,whilesimpleandroutineextractionscanbeperformedsafelybygeneraldentists,impactedwisdomteetharebesttreatedbyoralandmaxillofacialsurgeons,whoremoveimpactedteethroutinely.Additionally,generaldentistsareusuallyequippedtoutilizeonlylocalanesthesiaornitrousoxide,whileoralsurgeonsarepreparedtousetwilightsleep,deepsedationorgeneralanesthesia.Thesespecialistshavetheextensivetrainingandexperiencenecessarytoperformthisproceduresafelyandwithminimaltrauma.
Howlongwillittaketorecoveraftermywisdomteethareremoved?
Somepatientscanhavewisdomteethextractedearlyinthemorningandthenperformafullday’sworkwithlittlediscomfort.However,mostpatientswillneedonetothreedaysofrestbeforegoingbacktoschoolorwork.Everyprocedureisdifferent,andsoiseverypatient,soit’sbesttoallotuptosevendaysofrestfollowingsurgery.Swellingandpainwillusuallyguideyourrecovery,butrestisalwaysrecommendedimmediatelyaftertheprocedure.
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Whatkindofanesthesiadomostpeoplechoose?
Mostpatientschoosetohavetheirwisdomteethextractedundertwilightsleep(intravenoussedationwithlocalanesthesia).Underthisformofanesthesia,patientsarerelaxed,comfortableandstress-free,andhaveminimalmemoryoftheprocedure.
AtwhatageshouldIhavemywisdomteethremoved?
Werecommendthatwisdomteethbeextractedbeforetheformationoftheroots.Thisresultsinverypredictableandsuccessfuloutcomes,withhardlyanygumpockets,drysockets,nerveinjury,orinfectionsdevelopingpost-operatively.Whiletheformationofrootswillvarybetweenpatients,werecommendthatpatientshaveaninitialscreeningx-rayperformedbyanoralsurgeonbytheageof`ifteentoevaluateteetheruption,position,anddevelopment.
Mymedicalinsurancedoesn’tcoverroutinedentalwork,butwillitpayfordentalsurgery?
Possibly.Everyplanisdifferent,andstatelawsregulatingwhatmedicalinsuranceplanscovervaryfromstatetostate.Beforeyouhavetheproceduredone,checkwithyourinsuranceagentorcompanybene`itsof`icial.Someplanswillcoversurgerythatisdeemedamedicalnecessityorthatisperformedundergeneralanesthesia.
Mostdentalinsurancepoliciescovertheremovalofwisdomteeth.Again,it’sbesttocheckpriortothesurgerysoyoucanmake`inancialplansaccordingly.
Myparentsneverhadtheirwisdomteethextracted,sodoIneedtogetmineremoved?
Whetherornoteitherparentneededtohavewisdomteethremovedhasnobearingontheirchildren’ssituation.Everyperson’sdentalmakeupisunique.Therefore,everyteenageroryoungadultshouldobtainacomprehensiveexamtodetermineifwisdomteetharepresentandiftheyneedtoberemoved.
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AbouttheAuthors
RonaldM.Achong,M.D.,D.M.D.
RonaldM.Achongisanoralandmaxillofacialsurgeonspecializingintheremovalofteethandsedationdentistry.Dr.AchongisaBoardCerti`iedOralandMaxillofacialSurgeon.AftergraduatingfromcollegeattheUniversityofTorontoinCanada,heattendedHarvardDentalSchoolwherehereceivedhisDoctorateinDentistry.HisMedicalDegreewasobtainedatLouisianaStateUniversityMedicalSchool,NewOrleans,wherehealsocompletedhisresidencyinOralandMaxillofacialSurgery.
Dr.AchonghasanactivemedicalanddentallicenseintheStateofFlorida;healsomaintainsadentallicenseinCanada.
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RonaldM.Achong,D.M.D.OralFacialSurgicalArts,P.A.3180CitrusTowerBoulevardClermont,Florida34711 (352)243-5599
10437MossParkRoad,SuiteB,Orlando,Florida32832
www.OralSurgicalArts.comwww.NoMoreWisdomTooth.com
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RubenCohen,D.D.S.
BorninFrance,RubenCohengrewupinParisandLosAngeles.Dr.CohenobtainedhisBachelor’sofArtsatBrandeisUniversity,Waltham,Massachusetts.HethenobtainedhisDoctorateofDentalSurgeryatNewYorkUniversityCollegeofDentistry.HesubsequentlycompletedaresearchfellowshipatLouisianaStateUniversityHealthSciencesCenterinNewOrleans.HecompletedhisresidencyinOralandMaxillofacialSurgeryatAlleghenyGeneralHospitalinPittsburgh,Pennsylvania.
Dr.Cohen’spracticefocusesontheremovalofteethandthedeliveryofambulatoryanesthesiaandsedationinadultandpediatricpatients.Hehasappearedontelevisionnewsprogramsdiscussingwisdomteethextractionandhaswrittenarticlesonthesafeextractionofwisdomteeth.HeisthefounderofParkAvenueOral&FacialSurgery,P.C.,Manhattan’spremieroralandmaxillofacialsurgerypractice,whichopenedin2010.Theof`iceisnewlyrenovatedwithstateoftheartequipmentandisamongthe`irstoralsurgerypracticesinManhattantobeaccreditedasanambulatorysurgeryfacilitybytheAmericanAssociationforAccreditationofAmbulatorySurgeryFacilities,Inc.
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RubenCohen,D.D.S.ParkAvenueOral&FacialSurgery,P.C.970ParkAvenueNewYork,NewYork10028 (212)988-6725
www.ParkAvenueFaces.com
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References
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15.ImagingSciencesInternationalletterfromHenrikRoos,datedNovember23,2010.