Oral Surgeon + Maxillo facial Sugeon   Dr. Kerstin + Dr.  Stefan Bertram  Salzburg / Austria + Freilassing / Germany

 

Removal of a wisdom tooth

 

 

The surgical removal of a translocated third molars

 

State-of-the-art/tips and complications

 

 

Please contact a dental surgeon in case of problems. Only a doctor will be able to give you special tips after a detailed examination. 


 

We produced an animation showing the removal of a wisdom tooth. Take a look at the film on Youtube!

animation wisdom tooth        

Why and at which time has a wisdom tooth to be pulled?

 

Not every wisdom tooth has to be pulled. On principle, a wisdom tooth has to be removed, if the risk of damage or displacement of the other teeth, or the risk of getting an inflammation of the jaw is higher than the possible value leaving the wisdom tooth in its position. Another problem sometimes is an inflammation behind the last molar, caused by the wisdom tooth. This area especially is endangered, because brushing teeth there anyway is difficult.

 

During adolescence the wisdom tooth appears for the first time. But sometimes suddenly it also can be the reason for feeling pain under a denture.

 

Normally, your dentist or orthodontist tells you to make an appointment for pulling the wisdom teeth. The most common reason for referring a patient to the oral surgeon is a forward tilted wisdom tooth, although the wisdom tooth can be translocated in any other direction.

 

The orthodontist wants the wisdom tooth to be removed mostly as soon as he thinks the tooth could push the other teeth in an unesthetic position.

 

The dentist refers the patient to the oral surgeon, if he assumes that the patient gets a more professional treatment there. Furthermore, removing wisdom teeth is a standard operation for an oral surgeon.

 

How long do I have to wait until pulling a wisdom tooth?

 

An inflammation of a wisdom tooth should be treated immediately. After having reduced the acute stadium, the tooth can be removed .

You are able to wait some months with a wisdom tooth free of pain before removing. We hope you understand, that we can´t give you any recommendation for how long you can leave a wisdom tooth without risk.

Isn´t it possible to wait and see, if the wisdom tooth causes any pain?

 

My recommendation: the answer is definitely NO! You can heavily get a grip on the damage, a wisdom tooth can cause.

Besides, the practical knowledge shows, that such problems often appear at that time you need it least of all, e.g. before your holidays or before a test.

 

What about the sequence of such an operation?

 

Lower jaw:

First of all, the mucosa over the bone is taken off until quite a good vision for the surgeon is given (the cut is about 2.5 cm long). Then a special instrument is put into your mouth to protect the nerve of the tongue. During this you could feel a little pressure, but it doesn´t really hurt.

Afterwards, the bone has to be dislodged until the wisdom tooth can be seen just like a normal tooth. If it is not possible to remove the tooth then, there are two further possibilities: either more bone can be removed or the tooth itself must be splitted. While the wisdom tooth is fetched, one often feels an unpleasing pressure, because it depends on the skill of the surgeon to remove the wisdom tooth throughout a hole in the bone, as small as possible.

Then the wound is sutured (1 to 4 sutures). Sometimes a little tamponade is put into the wound therewith the wound is kept open and the wound secretion can drain off. This tamponade should be removed after one or two days and the sutures themselves are removed one week after the operation.

 

Upper jaw:

In the maxilla the cut is smaller than in the mandible. But the principle is the same as in the lower jaw. In the maxilla the covering bone is thinner and therefore much less bone has to be removed. But the sutures of the wounds are sometimes costlier than in the lower jaw, especially if there was a connection between the sinus maxillary and the oral cavity.

 

How long am I put on the sick list?

 

The medical certificate has to be displayed for every patient individually. It not only depends on the complexity of the operation but also on one´s profession. We ask our patients for informing their employees before such an operation, because the patients can potentially be of sick for the operation day and two days further.

 

 

 

Does the health insurance fund pay for removing wisdom teeth?

 

On general, removing wisdom teeth is a service of the health insurance fund. Special services, e.g. giving jabs of decongestant medical drugs like Cortison, which are normally not necessary and just mean an additional amenity, shouldn´t be paid by the supportive society.

 

 

 

Does the austrian health insurance refund your honorarium?

 

Austrian health insurances refund the honorarium of all doctors in the EC in such a way, as if the patients had been treated in their own country at a doctor, they have chosen themselves. Therefore, the german doctors are equated to the Austrian doctors in everything that concerns refunding. I am not able to publish my exact honorarium on this internet page.

 

 

Do I have to expect a swelling or a lot of pain?

 

Not every operation is like another one. Also the swelling is hardly predictable. Often the importance of the behaviour after an operation is underestimated and the wounds are burdened too early. To support our patients with tips, you get some slips of paper after your operation. So you can have a look at those advices at home, too.

We often ask the patients for giving us in a self-rating-scale how they assess their swelling and pain. That´s for our self-control.

It´s always conspicuous, that those patients with a difficult wisdom tooth removal feel more comfortable than those, who had a less difficult oral surgical interference.

Do we have a look on what the patients tell us about their swelling, we see that mostly the patients get an increasing swelling until the second day after the operation.  Then they begin to feel better and the swelling becomes less.

The maximum of pain almost every patient feels at the end of the operation day respectively the day after.

If the pain rises after a painless stadium of 3 or 4 days, it indicates a wound infection and must be inspected.

 

 

What about complications ?

 

What makes you feel less comfortable is a swelling and tolerable pain (see also last paragraph).

Unpleasing for your appearance is a haematoma. This is medically inconsiderable, but it doesn´t look nice in public. The haematoma can possibly last about one week. But fortunately such  discolourations are rarely. Often the patients tell us, that a limited oral aperture and the disorders while swallowing are so cumbersome during the first few days.

In the maxilla the sinus maxillary can be opened. This connection between oral cavity and sinus maxillary has to be sutured densely, therewith no bacteria can infiltrate into the sinus maxillary. The worst case would be, that the sinus maxillary becomes inflamed by such bacteria.

In the lower jaw a nerve passes to the lower lip and another one to the tongue. Only the surgeon is able to tell you by ordaining the distance between nerve and wisdom tooth with a x-ray image, if and how likely it is that the nerves are endangered.


general problems removing wisdom teeth                             some special problems removing wisdom teeth

What do I have to think about after the operation?

 

After the operation every patient gets some slips of paper concerning the behaviour after the operation. The rationale of caring for a surgical wound is tranquillity and cleanness. This applies to the mouth, too. How to reach this precept, please have a look on the slips of paper with a lot of tips you get from us.

 

For patients interested in naturopathy, a doctor who owns this special medical title conceptualized a pamphlet for us, on which these special medicaments are listed, even with informations how to take them in an effective way. This pamphlet is printed on our internet page.

In cases of dire emergency, every patient gets some telephone numbers (even my private one). But it is not possible to offer you a medical care for sure “around-the-clock”. This is only possible for patients staying in the hospital.

 

 

When will it be possible for me to go in for sports?

 

It depends on the form of sport and the complexity of the wound. Normally, I ask you for avoiding stress on your blood circulation during the first week.

If you have any further questions or improvement suggestions, please do not hesitate to contact us per mail.

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