Wisdom teeth extractions are a fairly common procedure. Wisdom teeth often cause problems as they are trying to protrude through the gums. When a wisdom tooth is impacted, it means the tooth is coming in at an angle and not straight through the gum line. This can cause pain, the tooth can come in unevenly, or the tooth may only emerge partially.
When a wisdom tooth only emerges partially a flap of skin, called an operculum, may form over the tooth. This can make the tooth hard to clean, and pieces of food may be caught under the skin. This makes it easy for an infection, called pericoronitis, to develop. It will usually go away on its own, but it causes swelling and pain in the area.
Impacted teeth and wisdom teeth that can potentially cause problems, like infections, need to be removed. Extractions can range from a single tooth, to removing all four wisdom teeth at once. Based on the preference of the doctor and/or the patient, a local anesthetic could be used to numb the areas where the teeth will be extracted. Others will prefer to go under a general anesthetic so that they will be sedated during the procedure.
The gum tissue around the wisdom tooth is cut open to reveal the tooth. The tooth is loosened by gripping it tightly and wiggling it back and forth until it can be lifted out of the gums. Sometimes a tooth may be impacted so tightly that it cannot be simply lifted out of the gums. In cases like this the tooth will be broken up into pieces first before being removed. Depending on the incision and extraction site, sutures may be needed to close the area. Soluble sutures are the best option, which will dissolve on their own.
After the surgery you will need to rest. You need to be driven home by a friend or family member because of the anesthesia. You can expect for the extraction site to bleed for a little while after the surgery. Gauze will be applied at the completion of the surgery, and you will need to change it when it becomes soaked. If bleeding continues for longer than 24 hours you should call your dentist. Rest when you return home, but do not lie flat. This could prolong the bleeding. Prop your head up on a pillow when lying down. Your dentist will prescribe you pain medication, so if you become sore take as directed. You can also use an ice pack for the pain. Your dentist might also provide you with a cleaning solution to clean the extraction site.
You will be limited to soft foods for a few days after your surgery. Some recommended foods are:
- Mashed Potatoes
- Ice Cream
- Thin Soups
- ...and other food you can eat without chewing.
When drinking, make sure you do not use a straw. The sucking motion can loosen your sutures and slow the clotting process. The same goes for smoking. If you have prolonged pain, bleeding, irritation, or don't feel that the extraction site is healing properly call your dentist for a follow
DENTAL EXTRACTION TYPES AND COMPLICATIONS.
A dental extraction is the removal of teeth from the mouth. If a tooth is badly decayed or the teeth are very loose due to trauma or periodontal disease and it’s not savable than those teeth are extracted. Sometimes wisdom teeth are impacted (stuck and unable to grow normally into the mouth) and may cause recurrent infections of the gum (pericoronitis). In case of crowded teeth to create space for the rest of teeth so they can be straight
Tooth extraction is done by using local anesthetic injections to eliminate painful sensations. Local anesthetic blocks pain, but you can still feel the pressure applied to move the toothsome teeth are more difficult to remove for several reasons, especially related to the tooth's position, the shape of the tooth roots and the integrity of the tooth.. If a tooth is buried in the bone and gums than it’s surgically removed , which involves cutting the gum away and removal of the bone which is holding the tooth in with a surgical drill. After the tooth is removed, stitches are applied to the gums
Pressure applied after the extraction with a bite pack into the tooth socket to stop the bleeding. You should not disturb the blood clot in the socket by not touching the area with a finger or the tongue, by avoiding vigorous rinsing of the mouth and avoiding strenuous activity. If the blood clot is dislodged, bleeding can restart, or alveolar osteitis ("dry socket") can develop, which can be very painful and lead to delayed healing of the socket. Smoking is avoided for at least 24 hours as it impairs wound healing and makes dry socket significantly more likely. Most advise hot salt water mouth baths which start 24 hours after the extraction.
There are two types of extraction simple and surgical.
Simple extraction: Simple extractions are performed on teeth that are not complicated and are visible in the mouth, and are easily removed under local anesthetic, and require only the use of instruments to elevate and/or grasp the visible portion of the tooth. Typically the tooth is lifted using an elevator, and using dental forceps, rocked back and forth until the periodontal ligament has been sufficiently broken and the supporting alveolar bone has been adequately widened to make the tooth loose enough to remove.
Surgical extraction A surgical approach may be chosen because without it the extraction might be very difficult, potentially damaging to neighboring teeth and tissues, unpredictable, or even impossible. A dentist may determine if using of some surgical procedure will make the removal of their patient's tooth easier and safer and might be the best, or even only, option
Some teeth are hard to reach due to gum tissue or bone covering over it and hard for dentist to see or reach the tooth easily. In this case the gum tissue flapcan be created and reflected back. Bone tissue can be removed too. Like in case of broken or damaged teeth. If a tooth has been severely damaged and its top part the crown has been lost, than to remove what’s left of the tooth a surgical extraction may be needed .sometimes teeth break during the extraction process e.g. a root canal treated teeth gets brittle with time and if not savable, during extraction it can break. If the initial attempt at removing a tooth fails and surgical intervention becomes necessary. e.g., the crown of the tooth may have broken off, leaving just the root(s). Or a part of the root has fractured and still remains in the tooth's socket. If so, a "simple extraction" may need to be transformed into a "surgical" one so it can be completed. Impacted wisdom teeth are removed surgically. Some time a tooth may be cut into sections to remove it surgically. If a tooth is difficult to extract ,brittle or abnormally positioned or has multiple or curved or hooked roots, tooth sectioning the tooth before removal can help reduce the difficulty of extraction. Because once the tooth has been split up, the dentist can focus on removing each individual portion separately. The goal, when sectioning a tooth, is to divide it up into smaller parts. But each one must still remain large enough to be easily manipulated. In the case of a two-rooted lower molar, a logical place to cut the tooth is in half, right between its roots. With some impacted teeth, the tooth's crown portion may need to be cut off and removed first. Then the root portion can be sectioned. Teeth are typically sectioned using a dental hand piece. The individual pieces are removed using extraction elevators and/or forceps. Since your tooth has already been numbed, it won't be painful. You'll feel the vibrations of the drilling process and pressure. Factors, such as very dense bone (such as that surrounding teeth that function under heavy chewing forces) or inelastic bone (a change often associated with aging), may make some bone removal necessarily before a tooth can be easily, or at least predictably, removed. This bone removal may or may not be performed in conjunction with tooth sectioning.
A dentist will determine if surgical extraction is necessary, to facilitates the removal of the tooth and the extraction more predictable with less force needed, less potential for unexpected tooth or bone fracture and less tissue trauma or damage which is good for the healing process .
Complications: There are complications to any surgery ,here are some of the complications associated with extractions.
Infection: Dr. ail will prescribe antibiotics ,pre- and/or post-operatively ,if patient to be at risk.
Bleeding: Small amounts of blood mixed in the saliva after extractions are normal, even up to 72 hours after extraction. Usually, however, bleeding will almost completely stop within eight hours of the surgery, with only a little amounts of blood mixed with saliva coming from the wound. To stop bleeding and complications ,follow Dr.Ali's instructions .
Swelling: Often dictated by the amount of surgery performed to extract a tooth and surgical insult to the tissues both hard and soft surrounding a tooth. Generally, when a surgical flap must be elevated ,minor to moderate swelling will occur. Similarly, when bone must be removed using a drill, more swelling is likely to occur.
Bruising: Bruising may occur as a complication after tooth extraction. Bruising is more common in older people or people on aspirin or steroid therapy. It may take weeks for bruising to disappear completely.
Sinus exposure This can occur when extracting upper molarsand in some patients, upper premolars. The maxillary sinus sits right above the roots of maxillary molars and premolars. There is a bony floor of the sinus dividing the tooth socket from the sinus itself. In some patient this bone is thick and in some it’s thin. In some cases it is absent and the root is in fact in the sinus. At other times, this bone may be removed with the tooth, or may be perforated during surgical extractions. The sinus cavity is lined with a membrane called the Sniderian membrane, which may or may not be perforated. If this membrane is exposed after an extraction, but remains intact, a "sinus exposed" has occurred. If the membrane is perforated, however, it is a "sinus communication". These two conditions are treated differently. In the event of a sinus communication, the dentist may decide to let it heal on its own or may need to surgically obtain primary closure—depending on the size of the exposure and the likelihood of the patient to heal. In both cases, a resorbable material called "gelfoam" is typically placed in the extraction site to promote clotting and serve as a framework for granulation tissue to accumulate. Patients are typically provided with prescriptions for antibiotics that cover sinus bacterial flora, decongestants, and careful instructions to follow during the healing period.some times displacement of tooth or part of the tooth into the maxillary sinus can occur in upper teeth extractions.In such cases, the tooth or tooth fragment must almost always be retrieved. In some cases, the sinus cavity can be irrigated with saline(antral lavage) and the tooth fragment may be brought back to the site of the opening through which it entered the sinus, and may be retrievable. At other times, a window must be made into the sinus in the Canine fossa,a procedure referred to as a "Caldwell-Luc".
Dry socket (Alveolar osteitis) is a painful phenomenon that most commonly occurs a few days after the removal of tooth. It typically occurs when the blood clot within the healing tooth extraction site is disrupted. More likely, alveolar osteitis is a phenomenon of painful inflammation within the empty tooth socket because of the relatively poor blood supply to this area of the mandible. Inflamed alveolar bone, unprotected and exposed to the oral environment after tooth extraction, can become packed with food and debris. A dry socket typically causes a sharp and sudden increase in pain commencing 2–5 days following the extraction of a mandibular molar, most commonly the third molar. This is often extremely unpleasant for the patient; the only symptom of dry socket is pain, which often radiates up and down the head and neck. A dry socket is not an infection, and is not directly associated with swelling because it occurs entirely within bone – it is a phenomenon of inflammation within the bony lining of an empty tooth socket. Because dry socket is not an infection, the use of antibiotics has no effect on its rate of occurrence. The risk factor for alveolar osteitis can dramatically increase with smoking after an extraction.
Bone fragments: Particularly when extraction of molars is involved, it is not uncommon for the bones which formerly supported the tooth to shift and in some cases to erupt through the gums, presenting protruding sharp edges which can irritate the tongue and cause discomfort. This is distinguished from a similar phenomenon where broken fragments of bone or tooth left over from the extraction can also protrude through the gums. In the latter case, the fragments will usually work their way out on their own. In the former case, the protrusions can either be snipped off by the dentist, or eventually the exposed bone will erode away on its own.
Nerve injury: This is an issue with extraction of any tooth should the nerve be close to the surgical site..
Trismus: Jaw joints and chewing muscles may become sore after tooth extraction and it may become difficult for the patient to open the mouth.
Loss of a tooth: If an extracted tooth slips out of the forceps, it may be swallowed or inhaled. The patient may be aware of swallowing it, or they may cough, which suggests inhalation of the tooth. The patient must be referred to for a chest X-ray in hospital if a tooth cannot be found. If it has been swallowed, no action is necessary as it usually passes through the alimentary canal without doing any harm. But if it has been inhaled, an urgent operation is necessary to recover it from the airway or lung before it causes serious complications such as pneumonia or a lung abscess.