Wisdom tooth extractions - Complications and risks.

What are the most common risks or complications associated with wisdom tooth removal?

The most frequently occurring complications associated with having a wisdom tooth extracted are:    A) Dry sockets.     B) Paresthesia (nerve damage).

A) Dry Sockets

[Dry sockets are discussed in greater detail on the pages of our topic Dry Sockets / Alveolar Osteitis.]

What is a dry socket?

A dry socket is a painful, foul smelling post-operative condition that sometimes develops over the course of the first several days following a tooth extraction.

Dry sockets form when either a blood clot has failed to form in the extracted tooth's socket or else the blood clot that did form has been dislodged and lost. Since the formation of a blood clot is an important part of the healing process, the healing of the bone that makes up the tooth's socket is disturbed and delayed.

The term "dry socket" comes from the appearance of the wound. Since no blood clot is present, exposed bone is visible. An equivalent term for dry sockets is "alveolar osteitis."

What are the symptoms of a dry socket?

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. There is often a foul odor or taste emanating from the socket.

How likely is it that a person will experience a dry socket?

Although there are risk factors that may predispose a dental patient to the formation of a dry socket, actually having one form is an unpredictable event.

There is a greater likelihood of dry socket formation with the extraction of lower wisdom teeth, as opposed to upper ones. The incidence of dry sockets is typically greater with the (surgical) removal of impacted wisdom teeth, as opposed to non-surgical extractions.

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 post-operative 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 a dry socket is an unfortunate complication for anyone to have to experience, the potential for one is typically not considered to be a reason not to extract a wisdom tooth. Instead it is recognized simply as a disappointing, transient side effect.

What is the treatment for dry sockets?

A dry socket needs to be treated by your dentist. Usually the dentist will place a medicated dressing in the socket that can soothe and moderate the pain. This dressing is typically removed and replaced every 24 hours until the person's symptoms subside.

[Dry sockets are discussed in greater detail on the pages of our topic Dry Sockets / Alveolar Osteitis.]

B) Paresthesia

[ We've expanded our coverage of this topic. Use this link to access our new page - Oral paresthesia associated with wisdom tooth extractions. ]

Wisdom teeth can be positioned in the jaw in a manner in which they lie in close proximity to nerves. Sometimes during the process of extracting a wisdom tooth these nerves can be bruised or damaged. As a result, numbness of the tongue, lip, or chin may occur. Having this condition is termed "paresthesia."

A hope of avoiding the complication of paresthesia is one reason why dentists suggest that wisdom teeth be removed when a patient is "young." As humans age on through their twenties the roots of their wisdom teeth continue to form and develop, making these teeth more difficult to extract without disturbing surrounding tissues (like nerves). 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 is rare.