Association OMS Singapore

WISDOM TOOTH

That Wisdom Tooth!

What we dread to hear each time we visit a dentist?

"You have cavities." and "Your wisdom tooth needs to be removed."

What are wisdom teeth?

These are not extra teeth like most of us think. They are part of our normal set of teeth. Each one of us has 32 teeth. 28 would have erupted into the mouth by the time we are 13 years of age. The last four, one in each end of the upper and lower jaws are the wisdom teeth. There is a sequence of eruption and it just so happens that the wisdom teeth are the last ones to erupt at the age of 18 to 24 years of age. By then there is usually a lack of space for them to erupt properly and so most are always stuck(IMPACTED). So we always have this idea that they are extras!

Do we need to remove them?

There criteria most Dental Surgeons will have to determine whether that wisdom tooth of yours need to be removed.

These are:

They have given you gum pains before. These pains will usually subside after some medications and then will recur at a later date. No one can predict the frequency and severity of these recurring pains. They may or may not be accompanied by swelling and pustulent products. They have caused cavities in the teeth in front of them due to food trapping or they themselves have cavities from food trappings. These are usually determined by the dental surgeons after a check up or through x-rays results. They interfere with the treatment you are having. Usually this will happen in those who seek braces treatment. The orthodontist doing the treatment will be the best person to determine this. They are constant causes of food trapping and irritation.

How are they removed?

There are two methods of removing wisdom teeth. They can be by simple extraction or they are removed by simple minor surgical procedures. These are determined by their degree of impaction.

Removing wisdom teeth either by extraction or surgery can be performed under local anaesthesia or under general anaesthesia.

Local anaesthesia means that they can be done in the clinic when you are fully awake or sedated.

General anaesthesia will mean removing them while you are asleep and is usually done in a hospital environment under Day Surgery.ie. you go home about four hours after the procedure is performed. These can be carried out either in the private hospitals or restructured hospitals. The surgeons can be private practitioners or from government service.

What do we need to know when wisdom teeth are removed?

Medical Leave

If you have having an extraction done, you will only need one day's rest at home. The most is two days.

If you are having them removed under minor surgery, then you need to rest for at least five days.

For those who have them removed under general anaesthsia eight days of rest will be given commonly.

Whatever the number of days of medical leave given, it only means that you are not allowed strenuous activity for that duration. It does not mean you have to lay in the bed throughout. You can still carry on with light activities, though speaking is abit difficult.

Pains

There will be certain degrees of pain experience post surgery or extraction. These can usually be controlled with pain killers. Period of pains is variable in most of us. Usually it can last from one day to five days. On average most patients say they are fine after the third day. If extraction is done. The pain is usually only one day.

Sick your dental surgeon's help if the pain cannot be controlled with painkillers.

Bleeding

Bleeding post treatment for both extraction and surgery can be controlled with biting hard on gauze provided and swallowing the saliva. Maintaining the pressure and dryness for 30 minutes to one hour can stop the bleeding. Change the gauze for one to two times if necessary.

Swelling

Swelling post extraction is rare. Seek help if it happens. Swelling after surgery is common and the maximum size will be seen the following day. They will subside after three days. The swelling can be reduced with medication at times. Bruising may be evident in some of us. The swelling also will restrict the opening of the mouth.

Infection

Since there is a wound in the mouth, keeping food out of the wound is important to reduce infection. Brushing may be painful over the area of surgery. So the use of cotton buds to clean the area is necessary. Follow the instructions for medication, especially the antibiotics. No smoking is allowed. One sign of infection is severe pain and foul discharge from the area after two days.

Complications

There are known complications for any type of surgery. And wisdom teeth extraction or surgery are no different.

In the upper wisdom teeth, perforation into the sinus is possible. This can be repaired. One sign is water getting into the nose when you drink after an extraction or surgery. Long term complication is pus discharge from the nose. Seek help from your dental surgeon if this happens.

In the lower wisdom teeth, the most common complication is numbness of half the lower lip and half the tongue on the side of the surgery. This is usually temporary. It can last from three months to six months before the sensation comes back.

Even if it happens, your looks, movement of the affected side, speech are not affected. It usually involves the loss of sensation for pain, pressure, touch and the feeling is of a swelling in the area of concern.

Let the dental surgeon know if it happens and he will help you.

And Lastly???..

Please see the dental surgeon for removal of stitches if you have a minor surgery done. This is usually one week post operation. Even if the stitches are resorbable, it is important to see the dental surgeon to ensure that no infection or complication is brewing!

So now we know that wisdom teeth removal is not such a big mystery anymore!

Email us for further enquiries.

Article contributed by : DR Low Peng Koon

treatments and techniques

Procedures done by Singapore Oral and maxillofacial Surgeons

1.Minor Surgery
- a .Surgical removal of tooth (eg wisdom tooth surgery)
- b. Endodontic(root canal) Surgery
2. Oral and Maxillofacial infections
3. Cysts of the mouth and jaws
4. Benign tumours
5. Disorders of the salivary glands
6. Maxillary Sinus
7. Maxillo-facial Injuries
8. Orthognathic surgery
9. Cleft lip/palate
10. Malignant growth(Cancer) in Head and Neck Region
11. Oral Medicine
12. Control of facial pain / Sedation
13. Dental Radiology / Imaging
14. Care of Surgical Patients
15. Pre-prosthetic surgery
16. Temporomandibular joint(TMJ) Disorders/ Clenching Pain/Surgery
17. Implant surgery
18. Laser Surgery in the Maxillofacial Region
19. Aesthetics procedures around Maxillofacial area, such as fillers, botox etc.
20. Aesthetic surgery (eg. rhinoplasty, blepharoplasty and facelifts)
21. Skeletal recontouring

FreQuently asked Questions

Q1. When do we need to remove our wisdom teeth and how do we decide if it is an extraction or if it is surgery

A1. Our wisdom teeth can sometimes be the cause of gum infection or tooth decay depending on the manner in which it is erupted. If the symptoms are persistent, it is usually indicated for excision. The decision to either extract or to perform surgery is dependant on the type and depth of impaction of the tooth. It is also dependant on the size and shape of the roots. If the tooth is fully erupted with no bony obstruction, then an extraction will usually be successful. In most cases, however, a minor surgical procedure is required.

Q2. What is the difference between local and general anaesthesia.

A2. Local anaesthesia is when a small injection is given to achieve numbness to the surgical site. The procedure is then carried out with the patient's cooperation. General anaesthesia is always performed in an operating theatre. The service of an anaesthetist is required. The surgery is performed after the patient is anaesthetized (sleeping). There is a need for the patient to recover in a ward after the procedure. It is common for healthy patients who undergo general anaesthesia for wisdom tooth surgery to be discharged on the same day. This is known as a day surgery procedure.

Q3. I heard about sedation, what is sedation?

A3. Sedation is when the patient is put into a half sleep state for the surgery to be carried out. Local anaesthesia is also given but this is usually done after the patient is sedated. There are different forms of sedation. Some methods will utilize medical inhalational gases for the sedation. Other methods will an intra-venous line to be inserted through a vein on the hand/arm. The intra-venous method is further divided into a single dose sedation technique and a continuous infusion technique. The latter method will require the full attendance of an anaesthetist. Do discuss with your Oral & Maxillofacial Surgeon with regards to the best technique for your case.

Q4. I heard about excessive bleeding if extractions are done at midday, is that true?

A4. Although this fact has been repeated many times over especially from the older generation, there are no scientific studies to verify this fact. With modern medications and techniques, any form of bleeding in a healthy individual should be easily managed by your OMS Surgeon.

Q5. What are the signs and symptoms of oral cancer?

A5. Most oral cancers start off as a non-healing ulcer in the mouth. The ulcer tends to grow with time and bleeds occasionally. It may or may not be painful. If there is an unusual growth noted in the mouth, the OMS surgeon will usually perform a biopsy during which a small sample of the soft tissue is removed and sent to the histopathology lab for analysis. The results will be known within a week. If you have a history of smoking or betel nut chewing ("Serei") or if you are an alcoholic, then your chances of developing oral cancer increases. Please see an OMS surgeon quickly. Early treatment saves lives.

Q6. I heard about dental implants. Is it safe to have metal in our body and will it set off alarms at the airports?

A6. Dental implants are made of titanium. Titanium has been shown to osseo-integrate or "bond" with bone. It is unlike steel which is usually encapsulated with soft tissue growing and wrapping around it. So, unlike, old steel orthopedic plates which will require removal after a period of time, titanium implants do the opposite and bond with the bone. Many modern orthopedic implants are made of or are at least coated with a layer of titanium due to its osseo-integration properties. Titanium does not set off alarms at the airport. If you travel a lot, you may ask your OMS surgeon to write a letter to certify that you have dental implants in your jaws. Your OMS surgeon will be happy to oblige.

Q7. How long can dental implants last?

A7. The science of Dental implantology has been around since the nineteen sixties. It was discovered quite by accident by a Prof Branemark while he was studying blood flow in rabbit's ears. Since then, dental implants have come along way in terms of clinical research and materials. The modern dental implant is very predictable in terms of success rates and if all conditions are ideal and the dental implants are well maintained in the mouth, it should last for more than twenty years or even a lifetime! The OMS surgeon and the restorative specialist will play their part in the treatment, but the patient plays the more important part of careful use and care of the dental implant retained prosthesis.

Q8. It is true that removal of the upper front teeth can cause mental and eye problems?

A8. Again, this rumour has been heard many times over. The nerves supplying the upper front teeth are sensory nerves. It is not involved in the mental processes and functions of the brain. It is theoretically not possible that extraction of the upper front teeth can directly cause mental problems. Although toothache to the upper posterior teeth can sometimes radiate to the eye on the same side, it is not related directly to the nerves supplying the eye.

Q9. My lower jaw is very long and I really wish to have it surgically corrected, it the procedure safe? What are the long term problems if I undergo the surgery?

A9. The procedure for surgery to the lower jaw is known as orthognathic surgery. Specifically, it will be a Bilateral Saggital Split Osteotomy or a Vertical SubSigmoid Osteotomy. Each procedure has its advantages and disadvantages as well as risks. It will be best that you seek advice with your OMS surgeon as it is too long to be covered here. However, it is a relatively safe procedure which is performed on a regular basis in our local hospitals. It is likely that you will have to undergo braces therapy in preparation for the surgery as well as after the surgery. The long problems are few and are unique for different techniques used. Please see your OMS surgeon for further advice.

Q10. My son fell down and lost his two front teeth when he was 9 years of age. When is the best time for him to have dental implants placed?

A10. The best time to have dental implants placed is when the patient is fully grown. In Singapore, it is usually at the age of 18 to 20 years for boys, and 16 to 18 years for girls. There are variations to this range. If the implant is placed too early, it will remain behind as the rest of the dentition and jaw grows. This will lead to a "submerged" tooth situation and will be difficult to remedy.