Third molar (wisdom tooth) surgery

Wisdom teeth are the third molars and are the last teeth to erupt (appear).

Often, a lack of space in the tooth bearing part of the jaw (alveolus) means that the wisdom tooth cannot fully erupt. Since a proper attachment of the gum to the tooth can only occur at the neck of the tooth, inadequate eruption of a third molar can lead to problems including infection (pericoronitis).

In addition, forward pressure on the other teeth is thought to transfer to the front
teeth which can then overlap and crowd. This may be especially significant following orthodontic treatment.

Surgical removal of wisdom teeth may be recommended for either of these reasons, or potentially due to other pathology associated with the crown of an unerupted tooth.

Surgery usually involves the uncovering of the tooth (by elevating the gum and drilling away the bone) and then the splitting of the tooth. The gum is usually then sewn closed with absorbable sutures.

Risks associated with surgical removal of third molars include

  1. Infection - of the surgical site, most common in the lower jaw ( mandible) and may lead to the development of alveolar osteitis (dry socket). For this reason, antibiotics may be prescribed following third molar surgery, particularly in smokers.
  2. Nerve injury - both the inferior alveolar and lingual nerves are implicated in third molar surgery. Injury to these nerves can cause a numb lower lip and chin or tongue and may be permanent. Thankfully this is uncommon and usually recovers. Careful surgical technique limits the likelihood of this complication, but a small risk is always present.
  3. Injury to nearby structures - the gingiva (gum) of the nearby teeth and indeed the adjacent teeth can be traumatized by surgery.
  4. The corner of the mouth can be traumatized by surgery and might be inflammed or sore as a result.

Likely post operative course following surgical removal of third molars

  1. It is very likely to have significant pain and swelling for up to 10 days following third molar surgery.
  2. It will be difficult to open the mouth for up to a week following surgery (trismus).
  3. It is possible some bruising will develop under the lower jaw and fall with gravity onto the neck and chest. This is less common.
  4. It is normal to have some sensitivity to cold in the adjacent teeth as the gum settles following surgery. Cold fluids may make this worse.
  5. It is normal for some bleeding to occur from the gum for up to 48 hrs. When mixed with saliva, this may cause concern. If this occurs, use one of the bite packs and leave for 2 hours. This may need to be repeated. If the problem persists, call the Office (42266111) or attend the Emergency Department of your nearest Hospital if we cannot be contacted.
  6. Often nausea os related to strong painkillers, particularly those containing narcotic (codeine). If this occurs, we recommend using plain paracetamol 1g/6hrs for adults as a background pain relief and then only using the stronger painkillers as required.

Post Operative instructions

  1. DO take any medication prescribed
  2. DO NOT have any hot drinks or food until all numbness has resolved
  3. DO NOT vigorously rinse out your mouth for the first 48 hours
  4. DO use warm salt water mouth rinses after 48 hours and brush your teeth up to the area where it is uncomfortable.
  5. DO NOT undertake strenuous exercise for at least one week following surgery
  6. DO NOT smoke for at least a week following surgery
  7. DO only eat soft food for the first 72 hours
  8. AVOID contact sport for the next 6 weeks

Third molar surgery is not minor surgery, and you should expect to feel quite
miserable immediately following the surgery and for the next few days. Give
your body time to recover and heal.