Wisdom teeth removal

The eruption age of wisdom teeth or permanent third molars is very variable, but generally ranges from 18 to 25 years. The formation of their roots ends on average around the age of 21. Sometimes people do not have one or more wisdom teeth or they do not have the opportunity to erupt normally.

To this end, it is strongly recommended, as a preventive measure, to examine the third molars around the age of 15 or 16 years using a panoramic radiograph or a 3D scan.

The dentist will evaluate the wisdom teeth according to several parameters including

Their position;
Their orientation and eruption path;
The space available to properly accommodate them in the jaws;
Tissue health and the presence of infection, cysts or other lesions
around the perimeter;
The presence of carious lesions on the teeth themselves, or adjacent teeth;
The presence of gum disease (periodontal) around the edges.

The dentist will then determine whether or not these teeth can be kept. If extraction is necessary, it is often safer to remove wisdom teeth between the ages of 18 and 21 when their roots have not yet fully formed.

Prevent or treat pericoronaritis (inflammation of the tissues surrounding the erupting tooth);
Prevent decay in the second molar;
Prevent root resorption at the second molar;
Eliminate a tooth that is too damaged by decay;
Prevent or treat the appearance of a cyst or lesion around the wisdom tooth;
Prevent the supra-eruption of a wisdom tooth if no tooth is coordinated with it;
Facilitate dental hygiene in hard-to-reach areas;
Improve gum health around the second molar.

Disadvantages

The procedure is often stressful for the patient;
The recovery time varies according to the procedure and the patient (age, state of health, etc.);
The procedure requires a rest period or a temporary slowdown in activities;
The procedure generally requires the use of painkillers;
The procedure occasionally requires the use of antibiotics.

Risks and consequences of not treating

Infection of the tooth and/or surrounding tissues, causing bleeding, pus, swelling, discomfort and pain;
Possibility of carious lesions to neighbouring teeth;
Possibility of resorption of neighbouring teeth, depending on the position of the wisdom tooth;
Possibility of increasing the risk of damage to adjacent nerve structures or contact with the maxillary sinus depending on the position of the tooth to be extracted, if the procedure is delayed and the roots are completely formed;
Possibility of gum disease (periodontal) and bone loss around wisdom teeth and adjacent teeth due to difficulty of access for hygiene;
Possibility of supra-eruption of the upper molars if no lower teeth are coordinated and risk of cheek bite or pain in the jaw joint.

Processing steps and times

First appointment:
- Consultation with review of the patient’s dental and medical history;
- Clinical and radiological examination of the tooth(s) to be extracted;
- Cost estimates.
Second appointment:
- Extraction of the selected teeth;
- Stitches (if necessary);
- Prescription of antibiotics and/or painkillers (as appropriate).
Third appointment:
- Healing follow-up and removal of sutures (as appropriate).

Postoperative indications

Please note that these recommendations are provided for information purposes only and that the best recommendations are those of your dentist or specialist who performed the surgery.

The following is a list of the most common recommendations from practitioners:

Take prescribed or recommended analgesics;
Take the prescribed antibiotics;
Use a prescribed antiseptic mouthwash as recommended;
Avoid drinking straw, spitting and smoking for the first 24 hours;
Apply ice in periods of 10 to 15 minutes alternating with a rest period;
Avoid brushing teeth near the wound for a few days;
Avoid intense sporting activities as recommended;
Avoid foods that are too acidic, very hot, salty or vinegar;
In case of bleeding, apply a sterile compress to the wound or a moist tea bag and maintain pressure for 15 minutes.
When lying down, keep your head elevated by adding an extra pillow;
If they have been used, the stitches are fragile. Some are melting, some are not. It is necessary to be informed of the specific care according to each case. It should be noted that sutures often fall off by themselves. Do not pull on the wires, do not cut them;
The recovery period following surgery varies from person to person depending on the complexity of the surgery and how the patient complies with post-operative advice;
Allow about two days of rest following complex surgery. The swelling will usually peak during this period;
The discomfort associated with surgery often occurs within the first five days.

Cost

Varies according to the number of teeth to be extracted and the complexity of the surgery;
The estimate of the interventions and costs will be given to you in writing;
It is possible to ask your insurer for a predetermination. This will make it easier to reimburse your benefits based on your dental coverage.

Restrictions

The risks and consequences in terms of benefits are always assessed before the procedure. In some cases, the dentist or maxillofacial surgeon may choose not to extract one or more wisdom teeth.

Examples of unprocessed cases:

Wisdom teeth included under the bone and without symptoms in the elderly patient;
Danger of damage to nerve structures with the possibility of too great a loss of permanent sensitivity (paresthesia);
Danger of damage to the maxillary sinus too great;
Patient’s medical condition

A consent form will be given to you to inform you about the issues involved in surgery, to inform you about possible risks and complications, to provide you with post-operative advice and to ensure that you have answered all your questions;

In the case of a risky extraction or outside the scope of your general dentist’s expertise, you may be referred to a maxillofacial surgeon, a dentist who specializes in more complex surgeries.

The device used for x-rays

The device used for taking panoramic x-rays is different from that for routine x-rays. Indeed, in order to be able to get an image of the entire mouth (including the joints and the position of your teeth), the x-ray apparatus will move around your head (it will be mobile) and will be oriented on your cheek or the front of your mouth.

Regular inspection of the radiology equipment

Rest assured, x-ray devices are rigorously and regularly inspected. Although the dose of x-ray is calibrated to minimize the risk of radiation exposure, the number of radiographs should be limited for a given period of time. Thus, a dentist may often agree to lend or duplicate a panoramic radiograph to avoid additional exposure. Nowadays, some dental clinics can be equipped with a digital radiology device, but the procedure for taking x-rays will be very similar.

Preliminary examination for wisdom teeth removal

This assessment can be done during your follow-up exam, but often, a separate appointment is necessary to provide you with explanations about the procedure and its cost.

The dentist will examine the position of your third molars, their formation as well as your joints and your jaw. He or she will also be able to detect the presence of cysts using a panoramic radiograph. After studying your case, it is possible that the dentist would recommend the removal of your wisdom teeth.

Since wisdom teeth are rarely in proper position and completely erupted, simple extraction of these four teeth is unlikely and they will possibly require a surgery.

Alternative solutions

Wait and watch for the eruption of teeth;
Wait and monitor the included teeth with periodic radiological examination;
Clear the gums around teeth that are not sufficiently erupted to facilitate hygiene;
Repair cavities on affected teeth;
Treat gum disease around the affected teeth;
Check hygiene as best as possible around teeth that are difficult to access.

ask you about your overall health;
give you a written estimate of costs;
explain the procedure, risks and duration of the surgery;
evaluate your anxiety level.