Dentistry-Online

Operation on the wisdom tooth

definition

The wisdom tooth operation is an operative, surgical procedure. This can either be carried out by an experienced dentist, an oral surgeon (dentist with surgical training) or an oral, maxillofacial or facial surgeon.

Wisdom teeth are known as third molars or third molars. In the short form they are also called "eighth", since they represent the eighth teeth starting from the middle. Two wisdom teeth can be created per jaw (upper jaw and lower jaw), although in some people there are no attachments for them. Size, shape and root proportions (number of roots, curved course, thick / thin) can vary.

In very few cases they grow out of the jaw normally and do not cause complications. In this case, they do not need to be extracted and they do the same job as the other permanent teeth. Pain, Inflammation, Lack of space or a wrong growth in the jaw are reasons for removing the wisdom teeth.

Causes of surgery on wisdom tooth

There are many reasons for an operation. If the tooth does not grow out of the jaw completely, you can recurrent inflammation occur. In such a case it comes to the training of Gingival pocketsthat are either difficult or impossible to clean of bacteria and decomposing food particles.

If the wisdom teeth are very close to their neighboring teeth, they cannot be cleaned properly. The Root caries risk increases significantly and due to the horizontal pressure it can also increase Bone loss come. Because of their great variability in shape and size, many form wisdom teeth Obstacles in the area of the jaw. These can cause tooth damage, deformation of other teeth, grinding of teeth at night (Bruxism) or TMJ discomfort to lead.

diagnosis

A detailed preliminary examination of the patient is carried out to establish the diagnosis. In this the current tooth status and the current one general health of the patient. Particular attention is paid to familiar ones Allergies, Bleeding tendencies / Bleeding disorders or infectious diseases placed. All of these things can lead to unwanted complications during the surgical procedure. A normal, two-dimensional one is usually sufficient for the attending physician for the removal X-ray image out. This is known as an orthopantomogram (OPG) and shows the anatomical relationships of all teeth in the upper and lower jaw.

In the case of complex wisdom teeth in the jaw, the use of a three-dimensional X-ray (DVT) may be necessary. This enables an exact, spatial representation of all structures involved (roots, nerves, surrounding blood vessels). In this way, reliable planning can be carried out for complicated operations and the risk of structural damage is minimized.

Course of the operation

After a careful diagnosis and education of the patient about the upcoming operation, the Anesthesia and Elimination of pain of the area to be operated. This can be done via a local anesthesia by injection or by a special anesthetic procedure respectively.

If the wisdom tooth has completely grown out of the jaw and has no complicated shape, it can be removed relatively easily with the help of pliers and levers. No sewing is required here. If the wisdom teeth are difficult to fit, the gums are cut open with a scalpel and folded to the side. The tissue covering the jawbone is now pushed aside. A surgical burr is used to drill an opening in the jaw, under which the tooth is located. This takes place under constant cooling with a sterile saline solution.

Once the tooth is exposed, it is usually divided into several small individual pieces using a drill. Thus, the tooth can be removed from the jawbone more easily and gently. After removal, the gums are shifted back and closed with sutures. In the area of the missing tooth, a so-called one forms Blood cake (Blood clot). This blood cake is a gelatinous product of blood clotting and consists of red blood cells, white blood cells, platelets and fibrin. Wound healing proceeds from him.

A follow-up check is carried out on the first and third day after the operation. Wound healing is usually complete after approx. 7-10 days and the sutures can be pulled. At the end of the procedure, the patient is given a wrapped cold compress to reduce swelling and pain relievers to relieve the pain. Became a general anesthetic Chosen as the form of anesthesia, the patient should remain in the practice for at least 30 minutes to observe the circulation.

How long does the operation take?

The duration of a wisdom tooth operation varies depending on the number of teeth to be removed as well as their position, size and shape. A wisdom tooth that sits easily in the jaw can be removed in a relatively short time (approx. 30 - 45 minutes). If several, difficult-to-fit teeth are to be extracted within one treatment session, the operation can take several hours. Therefore, before the operation, you should carefully consider whether you want to have all four wisdom teeth removed in a single treatment or whether you want to have 2 wisdom teeth removed on two separate dates.

Read more on the topic: Duration of a wisdom tooth operation

What are the risks of the surgery?

As with all operations, there are some risks to be aware of when removing wisdom teeth. Next Inflammation the penetration of bacteria into the wound can lead to pain and redness. Secondary bleeding from the wound sometimes appear within the first few days. Swelling as well as the training of Bruising can also occur.

In the area of the upper jaw it can lead to Opening of the maxillary sinuses come because these are in the immediate vicinity of the tooth roots of the upper teeth. This creates a direct connection between the upper jaw and the maxillary sinuses, which allows bacteria to migrate into these two parts of the oral cavity. To prevent this, the access to the maxillary sinus is sutured using a mucosal flap.

In the area of the tooth roots in the lower jaw, two important nerves run that can be damaged or injured during the operation. They supply the lower lip, part of the gums, the lower teeth, the back third of the tongue and the taste sensations through the tongue. During the procedure, care must be taken to protect and preserve these structures.

Broken jaws are also among the risks, although these rarely occur. The operation itself as well as an incorrect position of the wisdom teeth in the jaw (displacement) lead to a weakening of the jawbone. This increases the risk of breakage, especially at first. After approx. 8 - 12 weeks the bone stabilizes again.

Another risk factor can be a Alveolitis sicca (dry tooth socket) occur. This means that in a few days the blood cake can break down, exposing the bone. Severe pain, unpleasant smelling bad breath and inflammatory reactions in the wound area are the result.

General or local anesthesia?

The choice of anesthetic method depends on several factors. The number of treatment sessions and the general health of the patient play an important role. Two wisdom teeth can be removed using local anesthesia using pain relieving injections. This eliminates pain, but the patient experiences all work noises such as drilling, cracking, vibrations, etc. during the treatment with full awareness. This can be perceived as very uncomfortable by some patients.

The use of general anesthesia may be necessary if several wisdom teeth are to be extracted in one treatment session. Choosing this anesthetic method also makes sense for anxious patients. An anesthetist (specialist in anesthetic medicine) must be on site to monitor the course of the anesthesia. The initiation takes place by laying a venous access in the area of the elbow or the hand. In order to ventilate the patient during the procedure, a breathing tube (tube) is placed through the mouth or nose up to the windpipe and connected to a ventilator.
Read more on the topic: General anesthesia at the dentist

With general anesthesia, complete freedom from pain is guaranteed and the patient does not notice the treatment noises. The costs for this procedure are usually not covered by the statutory health insurance companies. Neither is it allowed to eat or drink anything six hours before the operation. In addition to the two methods mentioned, nitrous oxide anesthesia or sedation are possible alternatives.

Learn more at:

Wisdom tooth pulling under general anesthesia - when does it make sense?
General anesthesia for a wisdom tooth operation

Can the operation be carried out despite having a cold?

The removal of wisdom teeth is a complex, surgical procedure that involves many risks. Therefore, this operation should only be performed on patients who do not have any infectious disease such as have a cold. The body and the body's own defense system are weakened as a result, which means that bacteria can multiply very quickly and lead to inflammation. This is particularly important when removing wisdom teeth in the upper jaw, because the teeth there have a close spatial relationship with the so-called maxillary sinuses. If these are irritated and inflamed as a result of a cold, bacteria from the maxillary sinuses can get into the tooth wound.

Accompanying symptoms after the operation

Pain and Swelling are the typical accompanying symptoms after the operation. But both let through cooling and Painkiller to treat well.At the same time, the opening of the mouth can be restricted and there can be problems eating and speaking. These symptoms resolve relatively quickly. In rare cases, the taste sensation and the sensitivity of the oral mucous membranes may be reduced. Secondary bleeding from the wound usually occurs in the first few days due to excessive physical activity.

Pain after surgery on wisdom tooth

The pain after the operation should be within reasonable limits and should get significantly better after a few days. As a rule, they can be brought under control very well with painkillers (e.g. ibuprofen). A slight cooling of the operated side, even during the night, can relieve pain.

If severe pain persists for more than three days, this may indicate an acute inflammation in the operated area. In this case, the attending physician should be consulted as soon as possible. The drug aspirin (ASA, acetylsalicylic acid) should not be used to relieve pain before or after an operation, as it has a blood thinning effect. Due to the thinned blood, on the one hand, bleeding can occur from the wound and, on the other hand, it can lead to heavy bleeding during the surgical procedure.

Read about it too: Pain after wisdom tooth surgery

Post-op swelling on the wisdom tooth

Swelling around the wound and cheek are normal body reactions. At the same time, there may be a bluish discoloration of the cheek. This is also known as a "bruise" or a bruise and is caused by the escaping blood.

Repeated, light cooling of the affected area can reduce the swelling.

Read on below: Swelling after wisdom tooth surgery

Inflammation after surgery on wisdom tooth

Inflammation after surgery can occur, but is relatively rare. As a preventive measure, you should refrain from smoking before the operation. A thorough oral hygiene is also advisable. This should be continued urgently after the operation. After difficult, very bloody procedures or if the patient is known to have a tendency towards inflammation, the prescription of a Antibiotic, from the group of penicillins (e.g. Amoxicillin), be useful. This will reduce the risk of inflammation. The drug should be taken for at least seven days.

How can you minimize the swelling?

Swelling can be minimized with a few simple rules of conduct.

Light cooling within the first 48 hours after the operation relieves pain and swelling. Cold gel pillows can be wrapped in a towel. The cooling measures should be several times a day and no longer than 15-20 minutes be applied. If possible, cooling should also take place at night. Never place the cooling substances directly on the skin for long periods of time (risk of hypothermia!).

At the same time you should be Save your body, move as little as possible and speak and chew little. An elevated sleeping position is recommended at night, whereby the upper body should always be slightly elevated. In this position, blood pressure and heart rate decrease, which reduces blood leakage from the wound.

What should you do if you have rebleeding?

Occasionally there may be slight bleeding from the wound after the operation. If these occur, you should spit out the blood (do not swallow!) And then take your mouth with it cold, rinse out clear water. If the bleeding does not stop by itself, you can use a clean tissue handkerchief (no paper or speed handkerchief) to gently press the wound several times for approx. 10-20 minutes. The pressure prevents any further leakage of blood and helps stop the bleeding. Slight bleeding from the nose may occur after the removal of wisdom teeth in the upper jaw. Post-bleeding that lasts for several days or does not stop on its own should be treated immediately by a doctor.

What to do if the wound festers

Slight, superficial pus formations in the wound area are to be regarded as unproblematic. These should be done with disinfecting mouthwashes (Chlorhexidine) disappeared within a few days. In the case of strongly festering wounds, these must be examined again, cleaned and disinfected by the treating doctor. At the same time, thorough oral hygiene should be ensured.

Headache after surgery

Postoperative headaches can sometimes occur. Most of the time, it is caused by decreased fluid intake. The working noises (vibrations, drilling noises, cracking etc.) can be transmitted from the jaw to the skull. This can lead to a slight headache on the day of the operation as well as on the following day.

Sore throat after surgery

Sore throats after surgery are very rare. If general anesthesia is performed, placing the air tubing can lead to a dry, sore throat with a sore throat. Sucking hard candy and drinking enough water can quickly relieve symptoms. If leaking blood is swallowed, this can also lead to irritation of the throat mucosa.

How can healing be accelerated?

First of all, the dentist often inserts a tamponade made of hemostatic cotton wool into the wound, which promotes blood clotting and thus accelerates wound healing. In addition, several rules of conduct for the patient have proven themselves to accelerate the healing process: physical rest in the first few days, elevation of the upper body, light, repeated cooling, avoidance of spicy foods as well as alcohol and nicotine. Disinfectant mouthwashes should not be used until 24 hours after the procedure for a maximum of two weeks. In order to lower the blood pressure in the wound area, only lukewarm or cool foods and drinks should be consumed at the beginning. Taking arnica globules before and after the operation has proven itself to improve wound healing. Cool, unsweetened liquids made from peppermint, chamomile, or fennel can be soothing and anti-inflammatory.

When and what can I eat after the operation?

Eating soft foods is usually possible again a few hours after the operation. Since the opening of the mouth, chewing and speaking are hindered due to the surgical procedure, meals rich in carbohydrates should be pureed or taken in liquid form. The temperature of the food should be cold or maximally lukewarm. This prevents irritation of the wound and the oral mucosa.

After approx. 2-3 days you can start eating again, paying attention to soft, easy-to-chew food. In principle, spicy foods should not be used in the first week after the operation, as they lead to additional irritation of the surgical field.

More on this: Eating after a wisdom tooth operation

When is it allowed to smoke again after the operation?

Smoking releases tissue toxins, which delay wound healing and encourage inflammation. You should therefore start smoking again after seven to ten days at the earliest.

When can you do sports again after the operation?

Sports activities may only be resumed after the wound has healed. This prevents unpleasant secondary bleeding from the wound. In the first week after the operation, you should move as little as possible and avoid sport. From the second week onwards, light sporting activities are possible again. However, if the wound becomes painful or throbbing, it should be stopped immediately. Competitive sports or competitions can be practiced again after about six weeks.

When can you drink alcohol again?

In the first few days after the operation, alcohol should be completely avoided. Many alcoholic beverages contain substances that irritate the wound and thus lead to inflammation. Since the body is weakened by the operation, the consumption of alcohol is an additional burden.

When can you drink coffee again?

Coffee should not be drunk in the first few days after the operation, as the caffeine it contains causes blood pressure to rise. With its increase, the risk of rebleeding increases. After approx. 5 - 7 days, the wound has healed enough that coffee can be enjoyed again.

What are the costs of an operation on the wisdom tooth?

The operational costs are covered by the statutory and private health insurances if the procedure is performed under local anesthesia. The exact amount depends on the surgical effort and the number of teeth to be removed. The following additional services are not covered by statutory health insurance and must be billed as a private service: creation of a three-dimensional x-ray, wisdom tooth operation under general anesthesia, special surgical techniques and other anesthetic procedures (e.g. laughing gas or sedation) The costs for a general anesthetic depend on the respective effort and are billed directly by the anesthetist. Usually these are around 150 - 400 euros. In order to clarify the exact cost coverage you should submit a cost estimate to the respective health insurance company before the operation.

Length of sick leave

The length of the sick leave depends on the difficulty and length of the operation.

If the wisdom teeth can be extracted without complications (without cutting the gums), the patient can theoretically go back to work the next day. Realistically, however, in this case you should allow yourself three days of rest so that the wound can heal without complications. A difficult operation that requires opening the gums requires seven to ten days' sick leave. If complications arise within this time, the duration can be extended.