impacted wisdom teeth / wisdom tooth extractions

A great deal of the degree of difficulty associated removing a wisdom tooth will have to do with the manner in which it is positioned in the patient's jawbone (see types of wisdom tooth impaction page). In general, the more normal the alignment of the wisdom tooth and the further through the gums it has been able to erupt, the less involved the extraction and its subsequent healing process will be.

Another factor associated with the degree of difficulty of removing a wisdom tooth will have to do with the tooth's anatomy. Wisdom teeth are multi rooted teeth. Lower wisdom teeth typically have two roots whereas upper wisdom teeth usually have three. There can be quite a bit of variation in the way a tooth's roots have formed. In some cases each of a wisdom tooth's roots will be quite distinct and separate. In other cases the tooth's roots may have fused together or taken on an irregular shape when forming. These variations in anatomy will affect the relative degree of difficulty associated with a particular wisdom tooth extraction.

Don't necessarily expect the worst. Some wisdom teeth will be no more difficult for your dentist to extract than any other tooth. As part of your pre extraction examination your dentist should be able to give you an idea of what to expect, both during the extraction procedure and also in regards to healing.

If there is an active infection associated with a wisdom tooth (such as pericoronitis) a dentist will usually delay the timing of the extraction. In these instances your dentist will usually prescribe a course of antibiotics for you to take, typically for seven days or so. The antibiotics will diminish the amount of infection that is present at the time of the extraction, thus allowing both the extraction and the subsequent healing process to go more smoothly.

In order to extract a wisdom tooth a dentist must first gain access to it. If the tooth is underneath the gums and still totally encased in bone then the dentist will first need to make an incision in the gums and then remove a portion of the bone that lies over the tooth. So to minimize the total amount of bone that must be removed in order to get a tooth out, a dentist will often "section" a wisdom tooth into parts during the extraction process. Because each part is smaller than the tooth as a whole, each can be removed through a smaller opening in the bone.

Numbing a wisdom tooth with local anesthetic.

Before a wisdom tooth is extracted the tooth and its surrounding tissues of course will need to be numbed. Dentists numb teeth and tissues by way of administering a "local anesthetic." In slang terms the local anesthetic used is often referred to as "novocaine," however this particular anesthetic has not been widely used by dentists for a number of decades. Now days the most common local anesthetic used by dentists is lidocaine.

Dentists administer local anesthetics by way of an injection (a "shot"). Numbing up a wisdom tooth prior to extracting it is not unlike the way teeth are numbed prior to placing fillings. Many people seem to be convinced that all injections will hurt, and this type of mind set usually results in a self-fulfilling prophecy. Don't prejudge, ask your dentist what to expect. You may be pleasantly surprised by what they have to tell you. As a way of trying to minimize any potential for discomfort during the injection process, a dentist will often paint a skin numbing gel on their patient's gums before the injection is given.

Sedating patients before wisdom teeth are removed.

Some patients can be apprehensive about the wisdom tooth extraction process and in these cases the dentist and patient may together decide that the use of additional medication is indicated so to help to control their anxiety. Listed below are some of the common ways in which sedative medications are administered. Please realize that sedatives are used to control anxiety, not pain. Beyond administering the sedative your dentist will still need to numb up your tooth in normal fashion using a local anesthetic so you won't feel pain during the tooth extraction.

Nitrous oxide.

Nitrous oxide is often referred to as "laughing gas." Nitrous oxide produces its calming effect when a patient breathes it. The gas's effects appear quickly and, once the patient stops breathing the gas, they disappear fairly rapidly also. Your dentist will need to give you specific instructions regarding the manner in which they are utilizing this sedative, but in most cases a patient given nitrous oxide will be capable of driving home after their dental treatment.

Oral Sedatives.

Oral sedatives are often used as a means to control a dental patient's anxiety. The term "oral" here simply means that the sedative medication is administered by way of your swallowing a liquid or a pill. One oral sedative commonly used in dentistry is Valium.

Your dentist will provide you with the instructions you need to follow in regards to the use of the specific oral sedative you are given. Typically a patient is instructed to take their sedative one hour before their dental appointment. Because these medications can make you drowsy and also affect your behavior and capabilities, when oral sedatives are taken you must have someone drive and escort you to your dentist's office and then drive and escort you home also.

Intravenous sedatives.

Intravenous sedatives are medications used to control anxiety which are administered by way of injecting them into one of your veins ("I.V."). In general, a deeper and more controlled level of sedation can be achieved when using intravenous sedatives as opposed to nitrous oxide or oral sedatives. Typically intravenous sedatives are administered by oral surgeons (as opposed to "general dentists") because they have the specialized training and monitoring equipment need when using these medications. Some intravenous sedatives have an "amnesic effect." This means that when they are used the patient will have no recall or memory of the dental procedure.

Your dentist will need to provide you with specific instructions regarding their use of the intravenous sedative chosen for use with you. It is very important that you follow these instructions. Usually included in these instructions are rules about not eating or drinking for some hours prior to the administration of the sedative. When intravenous sedatives are used you will need to make arrangements for someone to drive and escort you home after your dental appointment.

Post extraction healing.

In general, the easier it has been for the dentist to access and remove a wisdom tooth, the less involved the healing process will be. Since the degree of difficulty involved with removing a patient's wisdom teeth can vary greatly, your dentist will need to explain to you what to expect in your specific case.

In regards to simpler wisdom tooth extractions, you may find our "First 24 hours" and "After 24 hours" post extraction instructions of interest. In all cases, print out and show the contents of our pages to your dentist so they can make a determination regarding if their contents are correct for your specific circumstances and needs.