Dentistry-Online

Pull wisdom tooth

introduction

The wisdom teeth are the last, rearmost molars, also called 8th by the dentist. They sit very far back in the jaw and are the last to appear in adulthood from around the age of 16. Since there is often very little space for these teeth, it is necessary to remove them before they cause damage to the other permanent teeth.
The so-called “pulling” describes the process of removing the wisdom tooth from the oral cavity and is referred to as “extraction” by experts. If the teeth are already on the surface, this can happen very quickly. However, if they are still deep in the jawbone, the removal may take longer because bone must be removed.

The process of removing wisdom teeth

The process of removing wisdom teeth is always very similar, even if it can sometimes change slightly due to difficulties caused by a misalignment.
At the beginning, the dentist will paralyze the area with a syringe and anesthetic to make it painless. After about five minutes the syringe works and the actual tooth extraction can begin. If the teeth are well aligned, they can be removed like "normal" teeth.

The gum fibers around the tooth are detached from the tooth and the tooth is loosened. Then the tooth is removed from its tooth socket with forceps or with a dental instrument called a "lever" and pulled.
However, due to the lack of space, the lower wisdom teeth in particular are often found below the gums. Then an additional incision must be made with the scalpel and the tooth exposed. Depending on how deep it is, bone is removed using a drill before the tooth becomes visible. Then the tooth can be removed with the lever.

The tooth socket must then be thoroughly cleaned and rinsed and any remains of the inflammation must be thoroughly removed. Finally, the gums are sutured in the right place and sometimes a drug is given to the wound area. The cheek should then be cooled well and a swab should be bitten for about half an hour to stop bleeding.
After about a week the stitches are pulled again.

Also read: Wisdom tooth surgery

Duration

The duration of a wisdom tooth removal can only be estimated in advance, but cannot be predicted in detail. It depends, among other things, on where the teeth are, how badly they are already destroyed, how old the patient is, how much experience the practitioner has, whether the mandibular nerve is nearby or what other diseases the patient brings with it.

With ideal conditions and an experienced practitioner, the removal of a tooth that has already completely erupted (i.e. is normal in the row of teeth) only takes about 1-2 minutes.

However, if the wisdom teeth are only partially visible or have even grown transversely in the jaw, surgical removal is due. Here, the gums above the tooth have to be separated with a scalpel and folded to the side to make the tooth visible. Depending on the location, it may also be necessary to remove the bone around the tooth, which significantly increases the duration of the treatment.

Here the removal can take about 5-15 minutes per tooth. In many cases, the gums are then sutured so that the removal of all four wisdom teeth can take about half an hour to an hour.

Learn more at: Duration of the wisdom tooth extraction

Accompanying symptoms when pulling wisdom teeth

When removing the wisdom tooth, the following symptoms are very likely to occur after pulling the tooth:

Pain
swelling
bruises
restricted mouth opening
Rebleeding

Since pulling the wisdom tooth leaves a complicated wound, the symptoms mentioned above are normal accompanying symptoms.
If, however, there is a fever, heavy bleeding or swallowing problems or breathing difficulties, a visit to the dental emergency service is indicated.

Pain

There is usually no pain during the wisdom tooth extraction, as the dentist paralyzes the region beforehand with a local anesthetic. The anesthetic relieves the pain, but not the pressure caused by the pull.

However, it can happen that the effects of the pain reliever wear off very quickly. This often occurs with severe inflammation of the wound area around the wisdom tooth. Then it should be re-injected.
There are several options for patients in whom pain cannot be eliminated at all due to a possible illness, e.g. sedation of the patient. This means either twilight sleep or general anesthesia so that the patient sleeps and does not notice anything about the treatment.

After treatment, the wounds can cause pain, but pain relievers such as ibuprophen or paracetamol can help.

You can also find out more at: Pain after wisdom tooth extraction

swelling

It is normal for the cheeks to swell after the wisdom teeth are removed. This swelling is triggered on the one hand by the removal of the teeth, but on the other hand also by the duration of the treatment. The shorter the duration of treatment, the lower the swelling. However, if the tooth is very crooked, the scalpel is used or even bone has to be removed, i.e. a complicated extraction is involved, larger swellings are more common. Often these are also accompanied by a bruise, which means that the cheek turns blue.

Another reason for severe swelling is the weather. The warmer the weather, the stronger the swelling will develop after surgical removal of wisdom teeth. Therefore, the following always applies: good cooling reduces the risk of thick jaws.

Usually, however, it is harmless swelling, as long as it is soft when pressed. However, if the swelling becomes hard, the cheek red, or if the mouth does not open properly after a few days, the dentist should be visited again. Then an abscess may have formed, which has to be removed with antibiotics and further treatment, otherwise serious consequences can occur.

Read on below: Swelling after removal of the wisdom teeth

The most common questions about pulling wisdom teeth

When can I eat again after the operation?

You should eat enough before the wisdom tooth operation so that the treatment is survived well. Afterwards, eating is not easy for a few hours. Nothing at all should be eaten until the local anesthetic has subsided and the lip and tongue feel completely again. Before that, there is a risk of biting your tongue, lip or cheek.

Dairy products or very crumbly or hard foods should be avoided until the wounds have healed, so as not to provoke inflammation. Alcohol, coffee and tea should also be removed from the menu for the first few days. This increases the blood pressure and can quickly lead to wound healing disorders or to the wound bursting again.

Everything else, especially soft ones (porridge, pasta, potatoes) can be consumed without any problems as soon as the anesthesia wears off. Of course, care should be taken not to open the mouth too much so as not to cause pain and not to tear the wound apart.

How long are you on sick leave?

Since this is a difficult procedure, which can be accompanied by swelling, especially in warmer weather, sick leave for up to three days is possible. The duration depends on the type of occupation, the existing inflammation around the wisdom tooth and the difficulty of the procedure.
If the teeth are easy to extract, no sick leave is often necessary.

However, if bone has to be removed so that the wisdom teeth become visible, greater swelling and severe pain can occur. Then a longer sick leave is possible. As a rule, the dentist is allowed to issue a certificate of incapacity for work of around 3 days.

When can you do sports again?

Since the removal of the wisdom teeth is a major intervention that sometimes results in larger wounds, exercise should be avoided until the wounds have healed at least superficially. The prohibition of sports should be strictly observed beforehand, as otherwise wound healing disorders (inflammation, rupture of the wound) and the associated delayed wound healing will occur.

As a rule, it takes just under 10 days to be fit for sport again. Before doing this, however, you also notice yourself that you are still very weak due to the major surgery. As with any illness, the body needs all energy to heal at the beginning.

When can I smoke again?

When smoking, there is a constant irritation of the oral mucous membranes during the smoking process. The smoke causes a change or remodeling of the tissue, creating a kind of cornea in the mouth and reducing blood flow. In addition, the blood clot in the extraction wound decays and the wound can become infected. If a tooth is extracted and you start smoking again too soon, the reduced blood supply can delay wound healing.

Therefore, you should refrain from smoking for 14 days. Most smokers find this very difficult. Nevertheless, they should keep at least 3 days of abstinence. Nicotine patches are recommended for people with particularly high addiction.

Which is better for wisdom tooth extraction: general anesthesia or local anesthesia?

Whether the wisdom teeth are pulled under general or local anesthesia depends on various factors in the individual case. As a rule, it is not absolutely necessary to carry out general anesthesia, since with the wisdom teeth a sufficient elimination of pain can also be achieved with local anesthesia. However, if the teeth are very close to the mandibular nerve or in a place that is difficult to access for the dentist, general anesthesia can be a good supplement to therapy.

Fear patients in particular benefit from this, as they do not notice the procedure and the fear does not increase further. Since the health insurance company only covers the costs of general anesthesia in certain cases, this aspect also plays a certain role. Not everyone can afford general anesthesia. The cost is around € 300 per hour of dental treatment.
However, it is only accepted in the case of recognized dental fear, patients with allergies to the narcotics, children under 12 years, as well as patients with confirmed mental or motor disorders.

You might also be interested in: Pull wisdom tooth under general anesthesia

Can you have all 4 wisdom teeth pulled at once?

Pulling several teeth at the same time is usually not a problem at all. The same applies to the wisdom teeth. If you want this, you can have all four drawn at once. The treatment is particularly useful if the teeth are pulled during general anesthesia, as only one procedure is then necessary. W.

However, if the teeth are extracted with a local anesthetic, then it is often decided - depending on the position of the wisdom teeth and the degree of difficulty - to remove the teeth one side at a time. This means that two interventions are necessary, in which the two right and the two left wisdom teeth are removed.

Does it have to be sutured after the wisdom tooth extraction?

Each practitioner decides for himself whether a wisdom tooth is to be sewn after pulling it. However, the two lower wisdom teeth often have to be sewn. These are often located across the lower jaw or are severely inflamed, which makes it necessary to push the gums to the side and remove part of the bone. So that the displaced gums grow together properly, they are then sutured in the right place. Since no rule can be named here according to which a decision is made, you should simply speak to the treating doctor yourself shortly before the procedure.

What are the costs for a private patient?

The removal of the wisdom teeth is completely covered if a private patient is insured for the teeth.
However, the costs must be paid yourself if there is explicitly no insurance for the wisdom teeth for private patients, if the patient is requested treatment without medical necessity or if the patient is not insured at all.

Then, depending on the degree of difficulty, costs of up to € 250 must be expected. Additional investments are then necessary if general anesthesia is desired but not absolutely necessary. An additional € 250 will then be incurred. With four existing wisdom teeth, you can expect costs of up to € 1250.

Can wisdom teeth be extracted during pregnancy?

During pregnancy, the child’s wellbeing is paramount at all times. As a rule, the extraction of a wisdom tooth is therefore not scheduled for an appointment during these nine months.

However, there are a few important reasons that speak for removal even during pregnancy. And then when the mother's health is in danger. This is the case, for example, when a pus (abscess) has formed around an existing wisdom tooth and there is a large inflammation in the oral cavity. This inflammation, if left untreated, can spread and spread through the body through the bloodstream. In this case the pregnancy would be in danger. Therefore, in such an exceptional case, a wisdom tooth must be extracted at any time during pregnancy.

X-rays and anesthesia are to be viewed as critical here, which means that they should be used as little as possible. The best time is between the 4th and 6th month, as the child's vital organs have already been developed and the pregnant woman is still easily treatable. The further the pregnancy progresses, the more difficult the treatment becomes due to the position, abdominal circumference and resilience of the patient.

Why are wisdom teeth removed?

The reasons for removing wisdom teeth are manifold. Quite often, however, there is a serious problem with space for these teeth. Because they are so far back in the jaw, they do not break through at a suitable point and then grow crooked into the oral cavity. Sometimes the teeth are even across the lower jaw and can shift or even damage the other permanent teeth.

Mucous membrane hoods form, i.e. niches that cannot be cleaned properly, which provokes inflammation and the development of caries. If these areas are not recognized in time, the affected permanent tooth may even have to become.

Furthermore, there is the problem of "difficult tooth eruption" in this context. In the so-called "dentitio difficilis“The wisdom tooth cannot get to the surface properly due to lack of space and the gums around the tooth begin to swell and become inflamed. This can go so far that pus forms and the cheek becomes thick.

Transverse wisdom teeth can damage the roots of the teeth in front of them and absorb them, i.e. break them down. In this case, too, the wisdom tooth should be removed before serious damage can occur.

diagnosis

Not every wisdom tooth has to be extracted in principle. Sometimes, however, there are several reasons for this. The dentist will determine this using several examination methods.

In addition to the visual diagnosis, the treating doctor uses his instruments to determine whether the gums around or above the wisdom tooth are inflamed. By palpating the area, it can be determined whether there is a swelling of the area or even an obstruction of the mouth opening, which occurs with severe inflammation.
As a rule, the dentist then takes an X-ray overview to see exactly where the wisdom teeth are in the jaw. After evaluating all the test results, the doctor will be able to say exactly whether the wisdom teeth need to be extracted or not.