Problems Associated With Wisdom Tooth Removal?

Risks and potential complications associated with wisdom tooth removal are very few, but just like any surgical procedure there are certain potential complications that you need to be aware of:

Nerve Damage

Although extremely rare, the major complication associated with removal of a lower wisdom is the possibility of nerve damage. There is a sensory (feeling) nerve which supplies sensation to our lower lip, chin and tongue that travels close to the roots of our lower wisdom teeth. As our third molars develop, the roots become longer. The longer and more developed the roots become, the closer they come in contact with this underlying nerve. Most patient's third molars are fully developed by the age of 18. Therefore, having your wisdom teeth removed before they are fully developed is very important in decreasing the potential risk of nerve damage. As a general rule, the possibility of permanent nerve damage, resulting in a permanent numbness to the lower lip and chin region for a teenage patient is typically less than 1.0%. However, depending on the position of the wisdom tooth and its relationship to the underlying nerve, the possibility of permanent numbness in an adult patient can be as high as 10 to 12%. It is best to remove these teeth, if indicated, while you are young and healthy, at a time in your life when you will heal quickly and in a more predictable fashion, and while the potential complication of nerve damage is as low as it can be. The type of x-ray which we take in our office, called a panorex, will clearly show the position and development of your wisdom teeth, and their location to the underlying nerve so that we can make appropriate recommendations and answer all your questions.

Sinus Exposure

The roots of our upper wisdom teeth are typically located very close to our maxillary sinuses. The maxillary sinuses are located behind our cheek bones. Removal of upper wisdom teeth can result in a communication between your mouth and your sinus. Once again, if the teeth are removed at an early age, before complete root formation, this complication is very unlikely to occur. Even in our adult population this is a rare complication, and if it does occur, the opening normally will close spontaneously without any further treatment. Should the opening persist, additional surgery would be necessary to permanently close the opening. If we do detect a sinus exposure at the time of surgery we may give you special post-operative “sinus instructions” to help the area heal in an uneventful fashion. Even if there is not a sinus exposure, the tissue between the tooth extraction socket and the sinus is commonly very thin and porous, which commonly allows blood to pass from the socket site into the sinus. Therefore, you may notice a small amount of blood in your nose the first few days following upper wisdom tooth removal.

Dry Sockets

Normal Healing


Dry Socket

A dry socket is not a true complication, but rather a delayed healing response. None-the-less, dry sockets continue to be the most common problem people experience following dental surgery. When a tooth is removed, the remaining socket is initially filled with a blood clot. The blood clot is the first step of the healing process. If the blood clot is lost prematurely, the socket walls are no longer covered and protected. Obviously, the socket is not “dry”, because fluid (saliva) is still in the socket, but the bony walls of the socket are no longer protected by the blood clot. So we call the socket “dry”. Without the blood clot, the bony walls of the socket are exposed to the environment and this can cause extreme discomfort. Although we don't know exactly what causes dry sockets, they tend to occur more frequently in patients who smoke and in patients taking birth control pills. While both jaws can be affected, dry sockets occur more commonly in the lower jaw. If a dry socket does occur, it will typically arise on the third to fifth day following your surgery – just when you are ready to start to feel better. A dry socket will cause a deep, dull, continuous pain on the affected side that can radiate to the ear, mimicking an earache. The pain can even persist after taking narcotic pain medication. Fortunately, we can greatly decrease the pain caused by a dry socket. Treatment involves placing a medicated dressing in the empty (dry) tooth socket. The medication will not bring back, or regenerate, the lost blood clot, but rather the medication is design to help control the pain. The dressing will also protect the socket from food particles which can further irritate the area and delay the healing. Again, the dressing does not aid in the healing process. The only reason to place a dressing in the socket is for pain control. Typically, the dressing is placed and the patient begins to feel better immediately. The medicated dressing is usually effective for 3 to 7 days. We will ask you to return to the office during that time so we can re-evaluate the area and replace the dressing with a new one if necessary. Treating the area one time is usually all that is required.

Infection

Occasionally, post-operative infections do occur. This usually requires an office visit and clinical examination. Many times, just placing the patient on a antibiotic for one week will take care of the infection. Sometimes, the infection may require drainage along with antibiotic therapy. Very rarely is hospitalization required.

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