Dental Blog

If you’re scheduled to get your wisdom teeth removed, you may be feeling anxious about the appointment.  We’ll help you and your family members get better prepared by outlining what to expect.

Initial Assessment
As part of a routine examination, your dentist may evaluate the presence and position of your wisdom teeth. He or she may obtain a panoramic x-ray image showing your entire mouth. This image is routinely done every three to five years. It shows all the teeth and the upper and lower jaws. It will show the position of the wisdom teeth:

• Erupted
  This means the tooth has popped through the gum just like all the other teeth. Some people simply don’t have room in their mouth for 32 teeth! Patients may find they bite the inside of their cheeks frequently.

• Partially Erupted/Soft Tissue Impacted
  This means the tooth only has a little tip of enamel popping through the gum. This results when the tooth doesn’t have enough room to erupt straight up and may be locked in place by the round contour of the molar in front of it. This is problematic because shifting of other teeth can occur. In addition, the partially erupted wisdom tooth can become a source of acute pain and infection, as well as a site for the development of tooth decay and sensitivity.

• Impacted
  When a wisdom tooth develops on an angle so that it never erupts through the gum at all, it is impacted.  A fully impacted wisdom tooth is not visible in the back of your mouth. This situation doesn’t always cause symptoms of pain, but sometimes patients feel an alternating cycle of mild pressure in the jaw for a few days.

Consultation
Most general dentists will refer their patients to a local oral surgeon to have their wisdom teeth removed. Oral surgeons will typically remove the teeth more quickly and have more sedation options to offer their patients.  The surgeon will start with a consultation appointment.  At this time, your medical health will be reviewed and the panoramic image from your general dental office will be seen. If this image is deemed insufficient by the surgeon, he or she may also obtain a three dimensional view of the mouth using a CBCT or cone beam computed tomography. The surgeon will explain their treatment recommendations and ask if you want to have any type of sedation. Some patients elect only to have local anesthetic.  Local anesthetic is the medicine which the surgeon will administer to numb the tissues, bone, and teeth in your mouth.  

Procedure Basics
Most surgeons offer nitrous oxide or laughing gas. This is a form of conscious sedation. It is a gas combined with oxygen that is continuously inhaled through a mask placed on the nose. You will be awake but your senses will be altered. Noises, voices, sense of touch, and passage of time are changed, but you are not asleep. Nitrous oxide has an amnestic quality, which means you don’t remember things very well later. The surgeon may also have a deeper sedation, a twilight sedation to offer you. For this type of sedation, an IV will be started and medication will be administered into the line, providing a deeper sense of detachment.  Oral surgeons will require patients to have an escort to bring home the patient after surgery.  A family member or close friend can get you home safely, get you to a comfortable place in your home and dispense pain medication to you if indicated.

In preparation for your appointment, the surgeon will require that you do not eat or drink for at least six to eight hours before the appointment. After you are situated in the treatment room, the surgeon will greet you and see if there are any questions that you may have. After the sedation and the anesthetic, the surgeon will perform the treatment or removal of wisdom teeth. Sometimes, at the discretion of the surgeon, you will have sutures placed. You may be biting on gauze to compress the surgical site and you may be given cold compresses to hold against your cheek to reduce swelling to the areas involved. It is not unusual following any surgery to experience soft tissue swelling.

The Journey to Recovery
After your oral surgical procedure, you will be escorted to a recovery area. There will be an assistant with you who will provide after care instructions and any prescriptions for antibiotics and /or pain medication, as well as phone numbers to reach the surgeon if concerns arise. In some instances, if the surgeon has placed sutures, an appointment may be made for their removal. Often surgeons use resorbable sutures, which dissolve and fall out on their own.

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