Potential Wisdom Tooth Complications
In Part Two of a two-part series on wisdom teeth, Dr. Mark Hochberg looks at the potential risks and benefits of having your wisdom teeth extracted.
When patients have been referred to us to evaluate the possibility of having their 3rd molars (commonly known as wisdom teeth) removed, the first thing we do as oral surgeons is perform an oral exam and analyze their x-rays.
This helps us determine the risks and benefits of removing the wisdom teeth and the risks of not removing them. Complications are possible with either course of treatment and that is something patients need to be aware when making this decision.
Here’s what you need to know if you do have your wisdom teeth removed:
Pain, swelling, bleeding, infection and bruising are common and predictable complications patients experience when they have their wisdom teeth removed and can be, in many instances, easily treated or proactively prevented.
Analgesics help relieve the pain, while sutures and gauze control bleeding. Ice and anti-inflammatory drugs help control swelling. A course of antibiotics, taken approximately one hour before surgery, along with good oral hygiene after the extractions decrease the chances of developing a post-op wound infection.
Bruising usually looks much worse than it actually is and is a self- resolving problem that does not require any intervention.
Two other problems with increasing frequency when wisdom teeth are removed are nausea and vomiting and a “dry socket.”
A dry socket refers to an extraction site that should have clotted blood within it after tooth removal but, for whatever reason, does not. The patient is likely to experience a throbbing pain that usually starts around post-op Days 3-5 and is easily diagnosed and quickly treated.
Possible damage to adjacent teeth, sinus complications from upper wisdom tooth surgery and possible prolonged numbness in the lower lip, chin, tongue, jaw and cheek regions from lower wisdom tooth removal are more serious problems that can occur. Fortunately, these are few and far in between.
Damage to adjacent teeth is obviously something we go to great lengths to avoid, but a piece of tooth structure or filling on the tooth next to a wisdom tooth may occasionally break off and need a new filling, or a loosened crown may need to be re-cemented.
Complications to sinuses and nerve canal rarely require any post surgical intervention, but patients need to know there is always a remote possibility they could have a problem with one of these areas.
Here’s what you need to know if you don’t have your wisdom teeth removed:
Any tooth only partially through the gum tissue is a set up for Pericoronitis, which is inflammation of the gum tissue around the crown of a tooth. Even the best brushers and flossers will not be able to adequately clean under a flap of gum tissue partially covering a wisdom tooth, creating an unhygienic situation that will eventually trap chewed food (plaque) carrying bacteria into an area where it cannot be removed.
Localized Periodontal (gum) disease can occur around erupted or partially impacted wisdom teeth without the patient experiencing any symptoms or even knowing they have a problem. Left unchecked, this will result in bone loss around the tooth in question and, possibly, around the back of an adjacent tooth.
Dental caries, or tooth decay, can occur in between wisdom teeth and adjacent 2nd molars, as well as on any exposed surface of the wisdom teeth. Being in a posterior position makes it harder to reach and adequately see these teeth. This oftentimes leads to these teeth breaking down and decaying with the patient not even knowing until it is too late!
The development of cysts or tumors associated with impacted teeth can lead to the destruction of adjacent teeth and bone.
Weighing the risks and benefits of maintaining or removing your wisdom teeth starts with a clinical and radiographic evaluation by an oral surgeon, preferably when you are in your late teens.
Dr. Mark Hochberg is a Diplomate of the American Board of Oral and Maxillofacial Surgery. He has also earned Fellowship status from the American Association of Oral and Maxillofacial Surgeons, the American Dental Society of Anesthesiology and the International Congress of Oral Implantologists.