Impacted wisdom tooth extraction

WHAT'S THE EXTRACTION OF AN IMPACTED TOOTH?

A tooth is said to be impacted when it has not emerged yet:

Its crown is therefore under the gums, inside the bone.

A tooth can also be partially impacted when only a part of it has emerged, while the other part is still under the gums, inside the bone.

The extraction of this type of teeth is a surgery that requires the removal of the gum and the bone surrounding the tooth, with or without sectioning the tooth.

WHY IS IT NECESSARY TO EXTRACT AN IMPACTED TOOTH?

In some cases, the jaws are too small to fit all the teeth properly. In case of an important teeth overcrowding, we speak of dento-maxillary disharmony. This causes gums' problems because of the difficulty to brush all the areas, periodontal problems ("receding gums"). Pericoronitis is an inflammation around the crown of a partially or totally impacted tooth. It's painful and can sometimes lead to serious infections.

Your dentist or orthodontist diagnoses and refers you to a surgeon to remove this overcrowding and either heal or prevent future problems.

TESTS PRIOR TO SURGERY:

The surgical procedure is performed under local or general anesthesia and is generally an out-of-hospital procedure, at the hospital as a day-patient or in a private practice (you get in and out of the hospital the same day).

If you wish to have a private room, please inform the anesthesiologist and the surgeon as soon as possible and complete the administrative formalities specific to hospitals for private rooms (those rooms must be booked in advance).

In case of general anesthesia: a blood test and an appointment with the anesthetist are required.

In case of local anesthesia: prophylactic antibiotherapy (1 to 2 antibiotic tablets 2 hours before surgery as advised by your surgeon).

THE ACTUAL SURGERY:

After performing a local anesthesia and having checked that everything is numbed and that you don't feel anything, the surgeon makes an incision in the gum, takes off the mucosa and disengages the impacted tooth from the bone with the dental drill.

If necessary, he will split the tooth to extract it more easily. Once the tooth is extracted, he will stitch the gum with absorbable suture (which will disappear after 3 weeks). All the intervention is painless. The surgeon will then check the wound 3 weeks later.

POSTOPERATIVE RECOVERIES AND INSTRUCTIONS:

Directly after the surgery, you can feel that your lip, chin or tongue are swollen and numb. This is simply due to the effects of local anesthesia, which usually wears off within hours.

You will need to put ice on the cheeks (cold pack) to reduce the swelling. The swelling of the cheeks appears gradually and reaches its maximum 48 hours after the surgery. The swelling varies from a patient to another: some swell more than others. In some cases, a hematoma may occur. All this is of course temporary.

A minor bleeding may occur in the operated areas, but it stops quickly.

A temporary mouth opening limitation can also occur, but it is temporary. Physiotherapy sessions will be exceptionally prescribed if necessary.

Postoperative instructions:

• Do not smoke (smoking slows down the healing processes and increases the risks of postoperative infections)
• Brush your teeth from the following night, after each meal, with a soft-bristled toothbrush. Good postoperative oral hygiene is essential and a guarantee of healing.
• Soft, lukewarm or cold food for 2 days after surgery (creams, soups, pasta...)
• Apply cold ice on the cheeks for 2 days after surgery, then progressively return to a normal diet, 3 days after surgery.
• In case of bleeding, bite on a gauze or on a tea bag (better), for 30 minutes: the tea has hemostatic properties. Do not spit, it stimulates salivation and increases stress and therefore bleeding.

Postoperative medication: 

Carefully follow the prescription and dosage.

OPERATIVE RISKS AND COMPLICATIONS:

Any surgical procedure, even performed in the best conditions of competence and safety in accordance with the current scientific data and the regulation in force, carries risks of complication. Although very rare, the complications of the wisdom tooth extraction are:

Hemorrhagic complication:

Very rare during the surgical procedure, it can exceptionally require a transfusion of blood or blood derivatives.

Infectious complication:

It's also very rare (1 case out of 60 on average), it occurs more often during the month following the surgery. It can be an abscess in the cheek that sometimes requires surgical drain and another antibiotic therapy (it's very important not to smoke postoperatively and to brush your teeth to reduce this infectious risk!).

Nervous complication: 

A partial or total loss of sensitivity (hypoesthesia or anesthesia) of the lower lip, chin, and lower incisors on the right or left side may occur. This is due to the lower dental nerve, which is responsible of the sensitivity of the lower lip and incisors, and which can be very close to the dental roots. These disorders generally disappear within a few weeks, or more rarely, a few months after surgery. A permanent loss of sensitivity is extremely rare.

Rarely, an elongation of the lingual nerve which goes along the inner side of the mandible may occur and cause a loss of sensitivity of half the tongue. Disorders disappear within a few weeks to a few months. A permanent anesthesia is exceptional. The mobility of the tongue is never affected.

Dental complications: 

Very rarely, the crown or root of an adjacent tooth can be damaged during surgery and require treatment by devitalization. Exceptionally, the tip of a root can be left in place, without any consequence.

Rarely, the extraction of a higher wisdom tooth can cause a communication between the sinus and the mouth, it is called oroantral communication (OAC). This will be carefully closed by your surgeon. To do this, your surgeon will make a flap using the Bichat’s fat pad (small fat mass in the cheek). Filling of the OAC falls within the competence of stomatologists and maxillofacial surgeons, and no one else.

The closing of the OAC is objectified at the clinical examination by your surgeon and not by scanner.

You will be advised not to blow your nose for 3 weeks and use nasal drops for 10 days. Depending on the case, an obturator splint (small removable prosthesis) can also be manufactured by your surgeon to protect the closure of the OAC.

Exceptionally, when the impacted upper tooth is very high, it can fall backwards, in the pterygopalatine fossa, and in this case the surgeon may leave the tooth without extracting it (Some cases are described in the literature).

Joint complications:

The occurrence or aggravation of a pre-existing dysfunction in the jaw joint (TMJ) may occur. For example, a crack and/or pain in the TMJ, or a mouth opening limitation can rarely occur. They are also usually temporary and will be treated by your surgeon, who's familiar with this kind of conditions.

In all cases, your surgeon operates and provides immediate postoperative follow-up, but also short, medium and long-term follow-up. He is trained to operate but also to manage all the possible and rare complications of surgery.

Follow every one of his postoperative advices, and know that if you have a question or face any problem, your surgeon will help you and knows how to perfectly handle the situation.

Upon admission to the hospital, the following documents will be required:

• ID card,
• Supplemental insurance documents, if you have one,
• Signed informed consent (available here),
• Admission documents specific to the institution.