Patient Information

Frequently asked questions about wisdom teeth removal and intravenous sedation.

What are wisdom teeth?

Wisdom teeth are the third set of molars (double teeth) that erupt at the back of the mouth usually between the ages of 17 and 25. Most people have four wisdom teeth, one in each corner of the mouth. However, it is not uncommon for people to be missing one or more wisdom teeth. It is also possible to have more than four wisdom teeth.

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What are impacted wisdom teeth?

Impacted wisdom teeth are wisdom teeth which are not growing in proper alignment. They may be growing forwards pushing up against the tooth in front, growing out towards the side, or growing backwards into the jaw bone. Wisdom teeth which are impacted will never grow through the gum into proper alignment with the rest of the teeth and will never be of any use.

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Do I need to have my wisdom teeth removed?

Not all wisdom teeth need to be removed. Not all wisdom teeth needing removal will immediately cause you symptoms. Because wisdom teeth are at the back of the mouth and often not completely through the gum they are difficult to keep clean. Indications for having them removed include the following:

› Repeated infections and pain of the tooth or gum.
› Caries (tooth decay) of the wisdom tooth or adjacent teeth
› Impacted wisdom teeth.
› Cyst formation.

In some situations wisdom teeth may be extracted prophylactically. For example, if you are heading away to a remote place for an extended period of time where having surgery done would be unsafe, or unsanitary, it may be in your best interest to have them removed. Also, the presence of wisdom teeth may weaken the jaw and increase the likelihood of suffering from a fractured jaw. Hence, it is not uncommon for professional rugby players to have their wisdom teeth extracted prophylactically.

Impacted wisdom teeth may also cause crowding of the front teeth especially in the lower jaw. This is another reason as to why you may consider their removal. Everybody should know what the status of their wisdom teeth are. This can be done be seeing your dentist who will examine you and take an xray to determine their presence, position and whether or not they need to be removed.

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When is the best time to have my wisdom teeth removed?

The best time to have your wisdom teeth removed is in your late teens or early 20s. This is because at this age the jaw bone tends to be more elastic and therefore the teeth are more straight forward to remove. At this age you tend to recover quicker from the surgery and you have a lower post-operative infection and complication rate.

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What will happen if I do not have my wisdom teeth removed?

If you have been advised by your dentist to have your wisdom teeth removed and do not proceed with it, you will be at risk of repeated infections and pain of the teeth, gum, and jaws. This tends to cause facial swelling and in some cases an abscess may form which may spread infection down the neck or up towards the eye.

In addition to this, the impacted wisdom tooth may cause tooth decay to the adjacent tooth. If a cyst (fluid-filled sack) forms, it may gradually enlarge which will slowly erode away the surrounding bone or teeth. It is best to have your wisdom teeth removed before they start to cause problems.

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What are the options available for having my wisdom teeth / dental extractions done?

Dental extractions, including wisdom teeth removal, can be done under local anaesthetic where injections are given to numb the mouth. The patient remains fully conscious during the procedure.

The other option is having the treatment done under intravenous sedation where the patient has little or no memory of the procedure. The advantage of having sedation is it will reduce the anxiety related to the procedure, it will make the procedure more pleasant and seem much shorter, and it is often easier for the practitioner to carry out the surgery.

Intravenous sedation can also be used for those individuals who have a phobia of dentistry to get their normal restorative dental treatment (fillings) done.

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What is intravenous (IV) sedation?

A sedative known as midazolam is given via a vein through a small canula placed in the hand or arm which will makes the patient feel calm and pleasantly relaxed. It is not a general anaesthetic so the patient remains in a semi-conscious state while sedated and may fall asleep. While sedated the patient’s blood pressure, heart pulse, oxygen saturation (breathing) will be monitored by a machine during and for a period of time after the procedure. The majority of people have little or no recollection of the surgery. Local anaesthetic is also used to make the mouth numb to ensure that no pain is felt during the procedure.

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What do I need to know for IV sedation?

If receiving IV sedation it is important to do the following:

1. Avoid eating or drinking for at least four hours before the procedure.
2. Arrange to have a responsible adult drive or escort you home. You must not drive or operate machinery, or make any major decisions for the rest of the day.
3. Arrange to take the rest of the day off work, as you may feel drowsy for a few hours afterwards.
4. You must be supervised for six hours after the procedure, during which you are not to walk up and down stairs unaided.
5. Refrain from any alcohol consumption for twenty-four hours before and after the operation.
6. Wear a short-sleeved top for easy access to the veins in your arms and to measure your blood pressure. A sensor for the pulse oximetre will be placed over your finger so please do not wear any nail varnish as it may affect the readings.
7. Refrain from smoking for twenty-four hours before your appointment.

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What can I expect after the surgery?

Oral surgery including the removal of wisdom teeth is a more invasive procedure than the simple extraction of teeth. As a result there are more post-operative changes to expect. You may notice some or all of the following after the operation; these are common and do not necessarily indicate a complication:

1. Slight oozing of blood mixed with saliva can be expected for a short time (up to six hours) following surgery.
2. The face will swell considerably on the side operated on. Ice packs will help in the first 24 hours.
3. There may be some bruising of the face and neck on the side operated on.
4. There may be some stiffness of the jaw muscles making it difficult to open the mouth for up to a week.
5. The corners of the mouth may dry out and crack if they have been stretched. Application of a strong moisturiser (such as Vaseline) to the lips will make them more comfortable.
6. The teeth adjacent to the operation site may be tender for a short time.
7. There may be a cavity where the tooth was removed. This should be kept as clean as possible with either warm salty water or Savacol mouthwash. This cavity may fill in with time.
8. After your surgery your mouth, lower lip, chin and tongue will feel numb. This is because local anaesthesia has been used to make you feel comfortable during and after the surgery, so take extra care to avoid biting or burning the lip or tongue while numb. In very rare cases there may be an area of residual numbness in the lower lip, chin or tongue on the side of the operation. This is usually temporary which will correct itself in time.
9. You will be prescribed adequate pain relief and possibly a course of antibiotics.

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What are the complications of wisdom teeth removal?

All surgery has risks. The most common risk of wisdom teeth removal or surgical dental extractions includes post-operative bleeding and infection. To reduce the risk of infection you may be placed on a course of antibiotics. Your surgeon will make sure the bleeding has stopped before you leave the surgery.

A dry socket which is a localised infection of the bone where the tooth was can occur in up to ten percent of people who have had their wisdom teeth removed. Symptoms include a throbbing pain that often radiates towards the ear. Dry sockets are easily treated. Smoking is one of the major risk factors. There is the possibility of developing some temporary bruising or swelling of the face.

In rare situations there may be a change in sensation, numbness or tingling of the lip, chin, gum or tongue which is often temporary but occasional permanent. In some cases the taste of food may be affected. This is due to the proximity of two nerves to where the lower wisdom teeth are. There is also the risk of an opening between the mouth and sinuses (which is easily corrected), injury to adjacent teeth, temporomandibular joint problems and poor healing.

Though exceedingly rare, there is also the possibility of an allergic reaction to the medications administered.

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What is the cost?

The cost varies according to difficulty of the extractions. You will be given a formal estimate at the time of your consultation.

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