Case study
Wisdom teeth are the third molars, the last ones to grow in at the back of the mouth. They grow in at between 17 and 25 years of age, when people are precisely considered to have acquired wisdom.
At the latest, they may try to grow in until 30 years of age. After that time they neither move nor apply pressure to the molars in front of them. However, starting from 40 years of age, the gum starts to lose depth and any wisdom teeth blocked when trying to grow will become more visible as the gum recedes, but they are no longer pushing.
In the above panoramic X-ray of a 42 year-old man, we can see:
- The two top wisdom teeth, impacted in the bone.
- The two bottom wisdom teeth, which have only grown in half way, causing problems:
- The one on the left has tooth decay and has caused tooth decay in the molar next to it.
- The one on the right has produced a posterior periodontal pocket of infection.
Symptoms
Generally speaking, wisdom teeth can cause discomfort when growing in, but in normal circumstances the discomfort is very slight, similar to that experienced when their first and second molars grow in from 6 to 12 years of age, something which the majority of children hardly notice.
The problem is that often there is not enough space for the whole wisdom tooth to grow in, meaning that it only comes out half way and sometimes knocks against the molar immediately before it
This may mean:
- In the wisdom tooth:
- An infection causing sharp pain, and swelling in the gum around the molar.
- Lockjaw, or difficulty when opening the mouth.
- Discomfort or pain when chewing or touching the area.
- Tooth decay, which can react painfully to heat or cold and may reach the nerve, causing sudden, pulsating pain.
- In the molar immediately before it:
- Tooth decay on the part nearest the wisdom tooth, which can cause pain and require a root canal.
- Sometimes, if the decay is very deep, this second tooth will also have to be extracted.
In the next image, corresponding to the X-ray, we can see the wisdom tooth either impacted or embedded in the molar beside it. Both had bad tooth decay and there was no other option but to extract them.
The top wisdom teeth, if they cause no discomfort, are often left in place
Surgery
We will start by studying the panoramic X-ray and the patient’s mouth to decide what to do with the molar. In some cases, if we suspect that the roots may have curled around the nerve of the bottom tooth, we send the patient for a scan of their jaw. The surgical process is the same as extracting any molar, but rather more painstaking. The fact that the tooth is partially or completely within the upper or lower jawbone means that the gum covering the piece must be open and the tooth freed by removing the bone blocking it. We then apply a little leverage to lift and remove the tooth.
Quite often we must section the molar into two or three parts with their respective roots to make extraction easier. This occurs when the roots, instead of being straight or fused, are highly curved, separated, or end in a hook shape.
After the extraction we make several stitches to help the healing process. These are removed during the standard 10-day check-up following the operation.
At our surgery, thanks to the sedatives taken by our patients prior to such extractions, they feel relaxed and open their mouths wide, leaving them with a satisfactory recollection of the operation. We also prescribe strong and effective anti-inflammatory medication which prevents the area of the extraction or the cheek from swelling, meaning that discomfort is minimal.
What to do after extraction
The patient must take the prescribed medication and, if possible, take the rest of the day off to rest in case they suffer discomfort. This will depend on the simplicity or complication of the surgery
It is advisable:
- Not to drink hot liquids during the day, since heat expands the arteries and increases bleeding.
- In the event of bleeding, to bite on a ball of gauze, and even better soaked in hydrogen peroxide. This usually does the job. It is also a good idea to eat cold yoghurt or ice cream. You can call our surgery if you have any doubts.
- To eat warm rather than hot food for two days, choosing options which don’t take much chewing: pasta, pulses, vegetables, omelettes, fish, etc. Leave the cider house beef chop for another week.
- To place ice or something similar against your cheek for a few hours. This will stop swelling and reduce discomfort.
- To rinse your mouth with water after brushing your teeth and with the disinfecting mouthwash prescribed. The mouthwash should be used gently for two days in order not to move the stitches or hinder the healing process. From the third day onwards, however, you can energetically rinse the cavity to stop food from entering it and causing infection.
Medication pre- and post-surgery
Two or three days BEFORE the extraction (we will tell you how many days beforehand, depending on the state of your tooth):
- Augmentine 500 mg tablets (antibiotic): 1 tablet every 8 hours for 10 days.
- Ultralevura 50 capsules (stomach protection): 2 capsules every 8 hours for 8 days.
AFTER extraction, in addition to the above:
- Ibuprofen 600 mg tablets (anti-inflammatory medicine): 1 tablet after every meal in the event of discomfort or pain.
- Paroex 0.12% chlorhexidine (mouthwash): after every meal for 10 days.
We can change this medication in the event of allergy or intolerance. Similarly, as indicated when talking about surgery, we can give the patient a sedative prior to the operation and an anti-inflammatory tablet afterwards. It is important to take the medication and to follow the post-extraction indications stipulated.
