Wisdom Tooth Extraction: When It Is Necessary And Post-Surgery Care

What are wisdom teeth

Adults have up to 32 teeth, of which four are wisdom teeth. These are the last to come through the gums. They are right at the back of the mouth and usually appear between the ages of 17 and 25, although sometimes they can appear in the later years. If there is enough room in the mouth, the wisdom teeth will come through (erupt) in a useful position and there will only be minor discomfort as they erupt. However, wisdom teeth can cause problems if there is not enough room in the mouth, if the wisdom tooth erupts at an angle and gets stuck against the tooth in front; the dentist will describe this as ‘Impacted’.

Why is wisdom tooth extraction done

A wisdom tooth extraction is done to correct an actual problem or to prevent problems that may come up in the future. When wisdom teeth come in, a number of problems can occur:

Your jaw may not be large enough for them, and they may become impacted and unable to break through your gums.
The teeth are not able to fully erupt through the gum and are causing an infection in the surrounding tissue; this is known as Pericoronitis.
There is decay present – wisdom teeth will often decay as it is very difficult to clean them as thoroughly as your other teeth.
More serious problems can develop from impacted teeth, such as infection, damage to other teeth and bone, or a cyst.
One or more of your wisdom teeth may come in at an awkward angle, with the top of the tooth facing forward, backward, or to either side.

Our doctors will be able to assess whether there is sufficient room for the teeth to come through by taking an x- ray which will show the position of the root. Once the x-rays have been taken, our doctors will be able to tell how easy or difficult it will be to remove the tooth. If the tooth requires a minor surgery, our visiting Specialist Oral Surgeon will take care of your extraction.

Wisdom tooth extraction: Post-Surgery Care

The removal of impacted teeth is a surgical procedure and post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimised if the instructions are followed carefully.

Immediate care following wisdom tooth extraction

The gauze pad placed over the surgical area should be kept in place for a half hour. After this time, the gauze pad should be removed and discarded.
Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
Take the prescribed pain medications as soon as you begin to feel discomfort. This will usually coincide with the local anaesthetic becoming diminished.
Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
Place ice packs to the sides of your face where surgery was performed.

What if there is bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for thirty minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimise further bleeding, do not sit upright, become excited or agitated. Please be sure to avoid exercise. If bleeding does not subside, call us at +65 6282 0122 for further instructions.

What to do if there is swelling after wisdom tooth extraction

The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the body’s normal reaction to surgery and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operation. However, the swelling may be minimised by the immediate use of ice packs. Two baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 36 hours, ice has little beneficial effect and can be replaced with the application of moist heat to the sides of the face. This is generally beneficial in reducing the swelling and increasing the range of motion of your jaws.

Medication and pain management

For pain post operation, take two tablets of prescribed pain medicine per day. Remember that most pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the clinic. 5 days of antibiotics will be given to help treat or prevent infection, it is necessary to complete the dose. Discontinue antibiotic use in the event of a rash or other unfavourable reactions. Call us at +65 6282 0122 if you have any questions.

Diet restrictions

After general anaesthetic, liquids should be initially taken. Drink from a glass. You may eat anything soft by chewing away from the surgical sites. High calorie, high protein intake is very important. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 5-6 glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat. Caution: If you suddenly sit up or stand from a lying position you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing.

Mouth hygiene

No rinsing should be performed until the day following surgery. You can brush your teeth the night of surgery but rinse gently. The day after surgery you should begin rinsing at least 5-6 times a day especially after eating, with a cup of warm water mixed with a teaspoon of salt.

If there is nausea and vomiting

In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on coke, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine.

Other complications after wisdom tooth extraction

In some cases, discolouration of the skin follows surgery. The development of black, blue, green, or yellow discolouration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discolouration.
If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, this is usually temporary in nature. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. So be careful. Call us if you have any questions.
Slight elevation of temperature immediately following surgery is not uncommon. If it persists, notify the office. Over the counter medication can be taken to reduce the fever.
You should be careful going from the lying down position to standing. Taking pain medications can make you dizzy. You could get light headed when you stand up suddenly. Before standing up, you should sit for one minute then get up.
Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots, they are the bony walls which supported the tooth or teeth. These projections usually smooth out spontaneously. If not, they can be removed by the doctor.
If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as vaseline.
Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days.
Stiffness (Trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event which will resolve in time.

Some things to take note of

Sutures are placed in the area of surgery to minimise post-operative bleeding and to help healing. Sometimes they become dislodged; this is no cause for alarm. Just remove the suture from your mouth and discard it. When you return for the removal of sutures, the process takes just a moment and requires no anaesthesia or needles. There is no discomfort associated with this procedure.
The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur please call our office for instructions.
There will be a socket or a cavity where the tooth was removed. The area will gradually fill in with the new tissue over the next month. In the mean time, the area should be kept clean especially after meals with salt water rinses or a toothbrush.
Brushing your teeth is okay – just be gentle or avoid the surgical sites.
A dry socket may be when the blood clot gets dislodged prematurely from the walls of the tooth socket. Symptoms of severe and/or throbbing pain at the surgical site 3-4 days following surgery, that does not respond to pain medication, can indicate a dry socket. Call us at +65 6282 0122 if this occurs.
If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.

Don’t hesitate to consult our dentists to resolve any of your dental concerns. Please call 62820122 or WhatsApp us at 9012 8562. Also READ: How to prevent tooth decay and early tooth loss