Wisdom tooth extractions - Risks and complications.

- All surgeries have the potential for postoperative complications. When removing 3rd molars, two of the most common are dry socket formation and paresthesia (nerve damage).

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Treating dry sockets animation.
Link to paresthesia graphic.

A) Dry Sockets

What are they?

A dry socket is a painful, foul smelling postoperative condition that develops during the course of the first several days after a tooth extraction. An equivalent term for a dry socket is "alveolar osteitis."

What causes them?

Dry sockets occur when either an adequate blood clot has failed to form in the extracted tooth's socket (the hole left in the jawbone after an extraction) or else the blood clot that did form has been dislodged and lost.

Extraction post-op x-ray.

Post-op x-ray of tooth extraction site.

Since the formation of a blood clot is an important part of the healing process, the healing of the extraction site is disrupted and delayed.

The term "dry socket" comes from the appearance of the wound. Since no blood clot is present, exposed bare bone is visible.

What are the symptoms?

A dry socket's symptoms typically include:

  • A dull, often throbbing, pain that doesn't first appear until three or four days after the tooth has been extracted.
  • The pain can be moderate to quite severe.
  • The socket typically has a foul odor or taste coming from it.

An impacted lower 3rd molar.

An impacted lower right 3rd molar.

How likely is it that a person will experience one?

Although there are risk factors that may predispose a dental patient to the formation of a dry socket, knowing who will actually develop one is totally unpredictable.

Rules of thumb.

  • There is a greater likelihood of their formation with the extraction of lower wisdom teeth, as opposed to upper ones.
  • Their incidence is typically greater with the removal of impacted wisdom teeth, as opposed to non-surgical extractions.

Research.

A literature review performed by Blondeau (2007) suggested an incidence rate for dry sockets following third molar extractions ranged between 5% and 10%. This should be viewed in light of Bui's (2003) review of dental literature that suggested an incidence range of 1% to 3% for all tooth extractions as a whole.

Bui (2003) cited the findings of a study that reported a dry socket incidence rate as high as 30% for impacted lower wisdom teeth. Chuang (2008) found the incidence of "inflammatory postoperative complications" to be more than twice as high when full-bony wisdom teeth were removed, as compared to soft-tissue third molar impactions.

Overall, while having a dry socket is an unfortunate complication for anyone who has to experience it, the potential for one is not typically considered to be a reason not to extract a wisdom tooth. Instead, it is simply recognized as a disappointing, transient side effect.

Placing a medicated dressing in an extraction site.

The dressing is placed directly into the socket.

What is the treatment for dry sockets?

The best treatment for a dry socket comes from your dentist:

  • They will place a medicated dressing down into the socket that can soothe and moderate its pain.
  • This dressing is typically removed and replaced every 24 hours until the patient's symptoms have subsided.
  • Depending on the level of symptoms displayed, they may feel the use of prescription pain relievers is indicated too.

We've created a whole topic just covering the subject of dry sockets. You can find it here: Dry Sockets / Alveolar Osteitis.


B) Paresthesia

A wisdom tooth may have a position in the jawbone where its roots lie in close proximity to a nearby nerve.

X-ray showing an increased risk for nerve damage.

With some tooth extractions, nerve trauma is a possibility.

If so, during the process of extracting it the nerve may be bruised or damaged. As a result, numbness of the tongue, lip, or chin may occur. Having this condition is termed "paresthesia."

Hoping to avoid the complication of paresthesia is one reason why dentists suggest that wisdom teeth should be removed when a patient is relatively young.

That's because, as people age through their twenties, the roots of their wisdom teeth continue to form and develop. Once this occurs, these teeth can be significantly more difficult to extract without disturbing surrounding tissues.

In general, the incidence of nerve damage associated with wisdom tooth removal for people over the age of 35 years runs relatively high, whereas with teenagers it's rare. For more information, visit our page: "Oral paresthesia associated with wisdom tooth extractions."

 

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