What are wisdom teeth?
Wisdom teeth or third molars are usually the last teeth to develop in human being.
There are upper and lower teeth whose function is to grind food. They are located in the very back of the mouth, close to the entrance of the throat.

Usually they complete development between the ages of 15 to 30, a time traditionally associated with the onset of maturity and the attainment of wisdom.

Why are wisdom teeth extracted?

Wisdom teeth cause many problems. There is often insufficient room in the jaw, so that the tooth is still embedded in the bone and cannot erupt in the normal matter.

If you don’t have enough space in your oral cavity to allow your wisdom teeth to erupt, several different results can occur:

Infection:
Without enough space for total eruption, the gum tissue around the wisdom tooth can become irritated and infected, resulting in recurrent pain, swelling, and problems with chewing and swallowing.

Damage of neighbouring teethes

If there is inadequate space to clean around the last molars, the adjacent teeth can be adversely affected resulting in parodontitis (loss of bone and gum) ,dental caries or decay.

Development of dental cysts and other diseases

Other diseases can also occur in association with a retained wisdom tooth. Cysts are often fluid-filled cavities in the jawbone, partially wearing an epithelial membrane. They expand slowly destroying adjacent jawbone and occasionally teeth. 

In rare cases solid tumours can be associated with impacted wisdom teeth.Wisdom teeth especially when they are impacted can become the source of an internal disease.
There are a lot of other reasons for the extraction of wisdom teeth

• it could interfere with long-term success of orthodontic treatment
• it is probably the cause of inflammation in the maxillary sinus
• it causes disorders of the Temporo-mandibular Joint ( TMJ Problem )    
• although controversially discussed it could lead to crowding

Unless you have an active problem at the time of your consultation, the reason for Extraction of wisdom teeth is mostly preventative to avoid long term problems

We will arrange a consultation before it is determined if you will benefit from Wisdom tooth removal. We need a special X-ray in particular cases combined with a 3 D Tomography (Gallileos) to reveal different risks in removing the tooth. 

Are complications to be expected ?

The operation is generally well tolerated. Severe complications are extremely seldom. Nevertheless, minor complications in individual cases can certainly occur. How likely it is that these problems will occur depends on factors like age, general diseases, lifestyle etc.
We often observe swelling, which resolves over time. If pain develops it can be managed very well with pain killers. A limitation in opening the mouth for the first days after surgery is to be expected.

If  post-surgical bleeding occurs, it can mostly controlled by biting on a sterile gauze or a clean handkerchief for half an hour. The wounds are normally sutured with a non resorbable material , removal of the stitches is required after a week. In case of inflammation prescription of antibiotics is necessary.

As with any medical procedure, there can be complications or an unanticipated result that we should be aware of:

In the mandible is a nerve, which supplies feeling to the lower lip, chin and tongue which is often  very close to the roots of the wisdom teeth. Occasionally, when removing the teeth especially in older patients, the roots are longer sometimes twisted ,and become closer to the nerve itself. This nerve can become irritated in the process of removing the tooth.

It is extremely important to remove the tooth by separating the roots in little parts to protect the socket and the nerve itself. In our office problems with longterm anesthesia by damaging the nerve are extremely rare.  Should a anesthesia occur it is usually temporary and will resolve gradually over a period of weeks or lately months.

The upper wisdom teeth are situated close to the sinuses, and their removal can lead to a communication between the sinus and the oral cavity. Like in the mandible if the tooth is removed at an early age, the root formation is not finished , this complication is unlikely to occur. Should this occur we have to close the socket by gaining a flap from the adjacent tissue. You have to follow special instructions:

Don’t blow your nose for ten days after surgery, You can wipe it, but don’t blow!
If you have to sneeze, you have to sneeze with an open mouth. You should not create any pressure in the sinus, which may dislodge the healing clot and reopen the wound. A communication occurring after surgery can be the result and may cause an additional procedure  to close the communication.

How do we perform the procedure?

We have multiple opportunities to choose in extracting wisdom teeth.
If we have only one or two teeth to extract we recommend a local anesthesia. Are
more than two to extract we recommend a combination with local anesthesia and i.v. sedation. The medication will be administered through a vein in your arm. Remember
the intravenous sedation technique used in our office, may  you be vaguely aware of the surgical procedure being performed. You will be relaxed, quite sleeply, and with the combination of local anesthesia you should feel minimal, if any, discomfort during the
procedure. Most patients are not aware of the procedure being performed.

An alternative treatment is to perform the procedure under general anesthesia . The presence of an anaesthesiologist is indicated. He will counsel you about the general anesthesia. 
Please do ask him about your medical history and medication.

The procedure itself is in experienced hands easily to perform. I have more than twenty
five years experience in operating wisdom teeth.
Important is to protect the bony and tissue structures very carefully. So we prevent most
of the described complications. Complications in our office are extremely seldom.
A swelling  after the operation is a normal tissue reaction and does not require any further
treatment.

After Surgery

When you arrive home, the local anesthesia will start to wear off and you may have some discomfort. Then it is indicated to take a pain killer. The pain can be severe especially in the evening and night. We only prescribe painkillers, antibiotics are normally not given.
Only in special cases ( p.e. opening of the sinus with inflammation ) you will get antibiotics  .  If you are given antibiotics and you take birth control pills, you should be aware that the birth control pill might become ineffective and take appropriate precautions.

On the first day after surgery, you do experience some bleeding and some pain. Each individual’s reaction to surgery can vary, and the sensation of pain can range from mild to severe. You must expect two till three days of discomfort after surgery.

A variable amount of swelling can be expected following the surgery. It usually peaks on the second day and should begin resolving on the third day. You can limit the swelling by using ice on your cheek for the first two days. The more ice you’ll take on the cheek the first day the less swelling you will have.  

On the third day, you will notice that your jaw muscles are a little bit stiff, and it is difficult to open your mouth right away. We recommend taking moist heat to your cheek four days after surgery; this will allow your muscles and soft tissues to relax. You will get a leaflet with post-operative instructions after surgery.

If this brochure, combined with information you‘ll receive at your appointment doesn’t answer all your questions, please call the office for further information.