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.
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.
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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