Wisdom teeth are a pain. Most of us don’t have room for them and end up having them removed. The long and the short of it is, “If you have impacted wisdom teeth, you should have them removed, and the sooner you do this, the better.”
Wisdom teeth are generally the last teeth to erupt into the mouth. The philosophy of it isn’t broken so we won’t fix it, is not wise because the problems can get bigger as you get older.
They are called wisdom teeth because they appear in the mouth at the age one should be starting to be wise at about the age of 15 – 18 years. They may in fact not come through until much later.
Impacted Wisdom Teeth
If they do not fit into the mouth, generally due to a disparity in tooth and jaw size or grow crookedly, they will fail to erupt properly and hence become “impacted”. The combination of pressure from the tooth and overlying irritation or infection of the gums can be very painful. Where the tooth is partially through the gum and becomes inflamed this can become a very troublesome problem and is called pericoronitis. Generally speaking this will often only be relieved by removal of the wisdom teeth.
Why Remove Wisdom Teeth?
The x-ray shown here is of a particularly badly impacted wisdom tooth and has the potential to cause major problems unless it is removed. These problems consist of infection surrounding the partially erupted crown.
The follicle ( biological bag ) in which the tooth develops may become a cyst and this will leave to the resorption of tooth and bone surrounding the unerupted tooth. As seen in this following x-ray.
The older you are the worse the problem can develop. As the roots continue to grow, even if the tooth cannot go anywhere, this makes extraction more difficult. So most oral surgeons would consider removing your wisdom teeth at a younger age rather than a mature age, especially if they are causing inflammation or problems.
I do remove wisdom teeth from older patients.
Despite this I do “wizzies” on quite a number of older patients, the oldest to date was 84!
Options for removing wisdom teeth:
- under a local anaesthetic, usually with sedation to make you nice and relaxed
- a full General Anaesthetic (GA) which makes you unconscious for the whole procedure. Sometimes the operation may appear to be very difficult and then I may suggest that you have a GA anyway!
I operate in a number of facilities all of which are appropriate operating theatres.
These are at:
- Shakespeare Surgical Suite, Suite 4, 181 Shakespeare Rd, Milford
- Shore Surgery Ltd, Suite 5, 181 Shakespeare Rd, Milford
- Mercy Ascot Hospital, 90 Greenlane East, Remuera. Auckland
- The Northern Clinic, Wairau Road, Glenfield, North Shore.
All of these facilities have fully equipped theatres and anaesthetic facilities which meet all the current recommendations of the ANZ College of Anaesthetists. You will normally come into the surgical facility on the morning of surgery, after having starved for at least six hours. The anaesthetist will see you and explain the procedure. I have a number of anaesthetists, all of whom are registered specialists with the medical council and very experienced.
After the Removal of Wisdom Teeth
Following surgery most patients are OK with oral pain killers, usually starting with paracetamol (or Panadol), or panadeine (if taken regularly every 4 hours in a decent dose of 15mg/kg., = 1 gram once every 4 hours for an average 70kg person). The Panadol capulets are much easier to swallow than the big round tablets, and they taste better too. Alternatively you might prefer the syrup (especially for kids) or the dissolvable ones, (but NOT disprin or asprin as they can start you bleeding again!)
If there is still some post operative pain then the addition of an anti-inflammatory medication should reduce it to a satisfactory level. Occasionally this is supplemented with a more potent analgesic prescribed by our anaesthetist or myself. The anaesthetist usually gives you some of this in operating theatre and occasionally a prescription for some tablets of this medication to take afterwards.
If you have another anti inflammatory drug such as Cataflam, Brufen or Nurofen at home this will be fine instead, but do NOT take these as well as the prescribed anti-inflammatory. These drugs are not a good idea if you have a history of stomach or duodenal ulcers, a bleeding disorder, kidney problems or if you are taking an ACE inhibitor such as Accupril, Capoten, Renitec, Plendil or Zestril for high blood pressure or heart problems.
You may also get an intravenous antibiotic. This is continued following surgery for approximately 5 – 7 days to minimize the chance of infection. Without this antibiotic the incidence of infection can be as high as 20%. Since the oral cavity is not a sterile environment, and many organisms live there normally, the prevention of these bacteria causing post operative infection is important. You may also get an intravenous dose of steroid called Dexamethasone which reduces inflammation and swelling after surgery.
See also the following for more information