By the age of 18, the average adult has 32 teeth; 16 teeth on the top and 16 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. The back teeth (molar teeth) are used to grind food up into a consistency suitable for swallowing.
The average mouth is made to hold only 28 teeth. It can be painful when 32 teeth try to fit in a mouth that only has enough space for 28 teeth. These four other teeth are your third molars, also known as “wisdom teeth.”
Why Should I Have My Wisdom Teeth Removed?
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 successfully erupt.
These poorly positioned impacted teeth can cause many problems. When they are partially erupted, the opening around the teeth allows bacteria to grow and will eventually cause an infection. The result: swelling, stiffness, pain, and illness. The pressure from the erupting wisdom teeth 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 teeth, resulting in the destruction of the jawbone and healthy teeth. Removal of the offending impacted teeth usually resolves these problems. Early removal is recommended to avoid such future problems and to decrease the surgical risk involved with the procedure.
With an oral examination and x-rays of the mouth, Dr. Benjamin Foley and Dr. Thao Le can evaluate the position of the wisdom teeth and predict if there are present or may be 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.
All outpatient surgery is performed under appropriate anesthesia to maximize patient comfort. Drs. Benjamin Foley and Thao Le has the training, license and experience to provide various types of anesthesia for patients to select the best alternative.
Anesthesia For Tooth Removal
The removal of wisdom teeth can be performed under local anesthesia, laughing gas (nitrous oxide/oxygen analgesia) I.V. moderate sedation or I.V. general anesthesia. Most commonly, wisdom tooth removal is performed under I.V general anesthesia to alleviate patient anxiety and maximize comfort.
- Local Anesthesia – May be used alone or with sedation to “numb” teeth to be removed. Numbness may last up to 8 hours. All patients receive local anesthesia whether fully awake or sedated.
- Nitrous Oxide (“laughing gas”) – Provides light sedation. You are aware of your surroundings, and you will remember the procedure. Local anesthesia must always be used.
- I.V. Moderate Sedation – An IV line is started for administration of sedative drugs. You will be very relaxed but conscious. You may remember some aspects of the procedure. Most patients are comfortable with this level of anesthesia for most Clinic procedures.
- I.V. Deep Sedation – This is similar to moderate sedation except that you will not be conscious and will not have any significant recall for the surgery.
With all forms of I.V. sedation you must arrange to have a responsible adult with you at the check-in, remain in the Clinic during the procedure, and be available to drive you home after surgery. You must not eat or drink anything after midnight prior to a morning appointment. Woman of child-bearing age may be asked to provide a urine specimen after arrival to clinic for a pregnancy test.
Our services are provided in an environment of optimum safety that utilizes modern monitoring equipment and staff who are experienced in anesthesia techniques.
If you would like more information before your consultation regarding the above anesthetic options please read Anesthesia Surgical Instructions.
You will rest under our supervision in the office until you are ready to be taken home. Upon discharge, your postoperative kit will include postoperative instructions, a prescription for pain medication, and a follow-up appointment in one week to evaluate healing.
opioid/narcotic free option
Many parents are concerned about their child being exposed to narcotic pain medication following wisdom tooth removal. A long lasting local anesthetic medication called Exparel is available which can eliminate or diminish the need for prescription narcotic pain medication after wisdom tooth removal. Patients may still require narcotic pain medication even with the administration of Exparel but usually less is required to relieve their discomfort. If you are interested in this option please ask the doctor during your consultation and visit the Exparel website for more information. Prescription pain medication has the potential to be addictive. Only take the prescription pain medication to control significant post operative pain. If you have medication remaining after your pain has resolved please take any unused medication to the police station and they will dispose of the medication responsibly for you. Never leave unused medication in your medicine cabinet at home.
You should not return to work/school on the day of your surgery. You may also need an additional 1-2 days away from work/school following surgery to fully recover.
Normal healing after tooth extraction should be as follows: The first two days after surgery are generally the most uncomfortable and there is usually some swelling. On the third day you should be more comfortable and, although still swollen, can usually begin a more substantial diet. The remainder of the post-operative course should be gradual, steady improvement.
Risks and Consequences of Surgery
The information contained herein is important. You should read it carefully and ask any questions that you might have at the time of your consultation.
Generally tooth removal is considered a very safe procedure, however, every surgery has expected consequences and associated risks. Many of the side effects of having teeth removed are common and expected (pain, swelling, bleeding and jaw stiffness). Other, less common, events are not generally expected and are complications of tooth removal (infection, sinus problems, tooth displacement or damage, nerve injury and jaw fracture). Part of being a patient and making an informed decision requires that we discuss risks and consequences of surgery with you prior to your treatment. This information is not intended to scare you or to be a complete list of all possible side effects and complications resulting from oral surgery. However, it does include what we believe to be the most important considerations. We will discuss all of these risks and consequences with you in greater detail at your consultation.
Pain is common, but usually of short duration (a few days). The pain will be well managed with ibuprofen and/or prescribed medication. New or dramatic increases in pain several days after surgery may represent a dry socket. Management of this problem is usually straightforward but will require that you return to the Clinic, usually prior to the routine one-week follow-up appointment. Please contact the Clinic if you experience a dramatic increase in pain prior to your follow-up appointment.
Swelling is common, but rarely severe. Swelling usually peaks on the second or third day after surgery. A dramatic increase in swelling several days after surgery can be a sign of infection. Please contact the Clinic if you experience any problems with swelling. Bruising of the face and/or neck may also occur and may persist for a week or two.
A slight ooze of blood causing blood tinged saliva is common. Severe bleeding is rare. Oozing is treated with intermittent pressure applied by biting on a folded gauze pad. Severe bleeding may require an unscheduled return to the office for evaluation. It is important that you reveal any past history of bleeding problems, as well as the use of aspirin, blood thinner (Coumadin), platelet inhibitor (Plavix) or herbal preparations.
Jaw stiffness is common and usually temporary. Tooth removal may aggravate a pre-existing jaw joint (TMJ) problem leading to the possibility of joint pain, noise (popping) and/or locking. If you have experienced any of these jaw symptoms in the past, you should discuss them with your surgeon before undergoing tooth removal. Aggravation of a pre-existing jaw joint problem will usually respond to simple measures; however, more prolonged treatment of the symptomatic jaw joint may be required.
Infection is uncommon and can usually be managed without hospitalization. Occasionally, infection will require hospitalization for intravenous antibiotics and/or a surgical drainage procedure. Even less common is a bone infection (osteomyelitis) that may require prolonged treatment including antibiotics and additional surgery. Women receiving medications for osteoporosis (e.g. Fosamax) may be at increased risk for impaired socket healing. Any patient who has received drugs for bone cancer (e.g. Zometa, Aredia) is at risk for compromised bone healing. It is very important that you inform your surgeon if you have taken any medications for low bone density or for breast cancer, prostate cancer or bone cancer (multiple myeloma, etc.).
Rarely, an opening into the maxillary sinus will result from removal of an upper tooth. Some openings may be closed at the time of tooth removal or will close spontaneously over a period of weeks. In rare circumstances, a separate surgical procedure will be required at a later date to close a sinus opening. Sinus infection can be a complication of sinus exposure and may require antibiotics and, possibly, sinus surgery.
TOOTH/TOOTH PARTS DISPLACEMENT OR DAMAGE:
Rarely, in the process of removing a tooth, a tooth or part of a tooth (usually a tooth root) will be displaced from the socket into surrounding tissue or the sinus cavity. This tooth/tooth part may not be removed or removal may be necessary at a later date.
Damage to adjacent teeth and dental restorations (filling, crowns, bridges, implants) may also occur during tooth extraction. Such damage might lead to the loss of additional teeth and/or dental treatments to repair or replace damaged dental restorations.
Nerve injury resulting from administration of local anesthesia and/or from the removal of a lower tooth (especially wisdom teeth) can result in partial or complete numbness of the tongue, lower lip, chin, teeth and/or gums on the operated side. The nerve injury can also produce painful burning sensations in these areas. If numbness or other altered sensation occurs, it may persist for several months or, in rare circumstances, may be permanent. In general, adults are at greater risk for permanent nerve damage.
A broken jaw is a very rare complication of tooth removal. This can occur at the time of surgery or in the days following tooth removal as a result of chewing or other normal jaw activities. If a jaw fracture does occur, hospitalization and/or another surgical procedure may be required to treat the fracture.
If you have any questions, please do not hesitate to call us at Boulder Office Phone Number 303-444-2255.