WISDOM  TEETH

Possibly the only teeth that dentists are happy to see extracted are wisdom
teeth.  Often these teeth do not erupt into the mouth properly.  Furthermore,
on many occasions when they do fully emerge through the gum they cannot be 
kept clean and plaque-free.

WHAT  ARE  WISDOM  TEETH?

Wisdom teeth are the very back teeth on either side of the upper and lower
jaws.  They are the last teeth to erupt and are usually first seen between the 
ages of 17 and 25 years. 

WHY  CAN  THEY  CAUSE  TROUBLE?

Quite often the jaws are not large enough to allow wisdom teeth to take up
their correct position and as a consequence they can be completely or 
partially crowded out.

Wisdom teeth that are completely crowded out may stay buried in the bone
and only give problems later in life. 

Those that are partially crowded out often cause problems.  If they are half 
through the gum and are wedged (impacted) so that they can go no further,
the surrounding gums become infected and inflamed.  This condition is known as
pericoronitis.  Antiseptics and antibiotics can be used to bring pericoronitis
under control, however, because there is no way of effectively cleaning the
gum, the condition will recur.
Usually the infected gums continually exude pus which can cause bad breath
and a fast build up of calculus or tartar on other teeth. In general the large
number of bacteria coming from the infected gums tends to increase the onset
of gum disease around the other teeth.

In some people wisdom teeth come thorugh normally and can be cleaned 
properly and consequently cause no trouble.  These teeth do not have to be
removed.  However, others that have fully erupted may be in such a position
and at such an awkward angle that effective plaque removal is impossible.
In these circumstances your dentist will say that such teeth are better 
out of the way.

WHAT  IS  INVOLVED  IN  WISDOM  TOOTH  REMOVAL?

Often fully erupted wisdom teeth can be removed simply and easily under a
local anaesthetic.  For some impacted wisdom teeth a surgical approach
may be required. In such a procedure the gum is incised and lifted up so 
that some of the bone around the tooth can be removed. 
The tooth may then be sectioned and removed in two or more pieces. 
This technique is especially useful for a wisdom tooth that is impacted at
a difficult angle.  After the tooth has gone the flap of gum is replaced
and sutured back into postion.  Sutures are usually removed after a few days.

Your dentist may decide to carry out the removal of wisdom teeth himself or
in many cases he will refer you to a specialist oral surgeon.
If several teeth have to be removed it may be suggested that this be done in
hospital under a general anaesthetic. 

Invariably an x-ray of the tooth is required beforehand so that the dentist
can plan his approach and thereby avoid complications.
An OPG x-ray is often chosen to give a complete picture of upper and lower 
jaws. Your dentist will usually refer you to a radiologist to have this x-ray
taken.

AFTER CARE

Post-operative discomfort can be experienced after the removal of some wisdom 
teeth.  There may also be some visible swelling for two of three days. The
dentist will give post-operative instructions including a prescription for pain
killing tablets if he feels they may be needed.
Any stitches are removed painlessly on the fourth or fifth day, by which time 
any soreness present will be diminishing.  By the end of ten days healing 
should be well under way.
It is advisable not to have wisdom teeth removed just prior to an important
event in case there is some residual soreness and swelling.
After the troublesome tooth or teeth are removed it is important to avoid 
anything that may disturb the blood clot that has formed in the tooth socket.
Therefore, rinsing for the first 24 hours is not advised.  Not only will loss
of the clot cause continual bleeding but, later on, in a day or two this may
give rise to the very painful condition known as "dry socket".

"DRY SOCKET"

However excellent the surgery, or however carefully teeth have been removed, 
some patients get a "dry socket" which may start about two days after the 
extraction.  In fact any marked pain after the second day is usually due to a
dry socket.
Some people are more liable to get dry sockets than others; this may in some 
way be related to their general health.
A dry socket is always due to loss of the blood clot which leaves the jawbone
surrounding the extraction socket unprotected.  This may be accompanied by a 
a bad smell and an unpleasent taste.  To remove the symtoms the dentist washes
out any food debris in the socket and then places into the socket a paste 
specially formulated to ease the pain and promote healing.
If you are unfortunate enough ever to have a dry socket, be patient about 
getting complete relief, because it usually takes about 7 to 10 days before 
the bone is sufficiently covered by healing tissue to be protected.
Unfortunately, at present there is no accurate way of predicting who will get
a dry socket and there is no reliabel preventive measures that can be taken to 
avoid it.