The Wisdom Tooth Dilemma

Dr Nurul Aida Ngah   Senior Lecturer, Universiti Teknologi MARA (UiTM)

Mention “oral surgery” and most people would cringe. However, most of the common fears associated with oral surgery are exaggerated, even unfounded.

Basically, oral surgery is a branch of dentistry that addresses the diagnosis and treatment of various diseases, injuries and defects in the region involving the face, mouth, lips and jaw (the orofacial region). Common types of oral surgery include the general tooth extraction, dentoalveolar surgery (removal of impacted or buried teeth, etc), pre-prosthetic surgery, treatment of cysts and tumours in the jaw bones, bone grafting and more.

One of the more common oral surgery is the removal of impacted wisdom tooth.

When wisdom hurts

Our wisdom teeth are the last few teeth to emerge in our oral cavity, usually “erupting” when we are 17-25 years old. Unfortunately, their eruption is often blocked or hindered (such a condition is known in dentistry as “impacted” ”). A common reason is because, by the time it erupts, the wisdom tooth is often bigger than the jaw size.

As anyone with an impacted wisdom tooth can tell you, there can be painful consequences, such as:

• Recurrent swelling and inflammation of the surrounding gum tissue (pericoronitis)
• Destruction of the supporting tissue and bone around the impacted tooth, causing deep pockets to form – bacteria can move in to these pockets and further damage these tissue and bone.
• Formation of cysts and abscesses in the affected areas.

As a result, the poor person may experience pain and swelling, with on-and-of pus discharge. Opening the mouth may become difficult. Additionally, he or she may develop bad breath (halitosis), earache, swollen lymph nodes and fever.

Dentistry to the rescue

If you have an impacted wisdom tooth and you approach a dentist for medical attention, the dentist would first take an X-ray to determine the type of impaction and, hence, the best next step.

There are four types of impaction, determined by its depth, angulation and arch length.

Mesioangular impacted (image A)

Horizontal impacted (image B)

Vertical impacted (image C)

Distoangular impacted (image D)

To remove or not to remove?

If your impacted wisdom tooth is well-behaved and you don’t experience any painful symptoms, your oral surgeon may recommend conservative management instead of tooth removal. Conservative management involves practising proper oral hygiene daily to avoid these symptoms, and the oral surgeon would also offer appropriate advice and tips.

If there are symptoms and you are in pain, then tooth extraction is most likely necessary. Let’s review the process so that you will know what to expect and, hopefully, calm any trepidation and fear you may be feeling!

Hello, tell me about yourself. Your oral surgeon would ask you about any existing medical problems, allergies and other important information that can help minimise or avoid any complications that may arise. You will also be given information on the procedure itself, any matters you may have to tend to after the surgery as well as any complications that may arise.

Let’s prepare yourself. You will be asked to take breakfast or lunch before the surgery, as well as any routine medication you are on.

The big moment. You will be asked to give a written consent, and then you can go ahead to have that pesky wisdom tooth removed. Surgical procedures would be done under local anaesthesia to numb the affected area. With all the research and development done, the latest anaesthesia can create a minimally painful (sometimes even pain-free) environment during the surgery. Don’t worry about infections – all equipment used have been sterilized to create a germ-free (aseptic) environment.

Your oral surgeon would make a small incision to expose your impacted wisdom tooth, and he or she may trim a small amount of the bone to make it easier for the tooth to be removed.

Once the tooth is removed, your oral surgeon would place sutures in the affected area to control bleeding and aid in wound healing.

And that is it!

After the surgery

You may experience some swelling and pain after the surgery. It may also be hard to open your mouth. Don’t worry – these are all temporary, and look at the bright side: once they are over, you will not be bothered by the symptoms of the impacted wisdom tooth anymore!

You will not be suffering greatly throughout this phase, fortunately. You will be given painkillers and sometimes antibiotics to reduce the symptoms. You can also use ice packs to reduce any swelling that occurs. 

After one week, you will return for a review session with your oral surgeon. He or she will then remove your sutures.

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