wisdom tooth

The wisdom teeth or third molars (as they are often called in medicine) are the last teeth that break through the gums.
They usually appear between the ages of 17 and 25, but are not yet present in children.

There are 4 wisdom teeth, two upper (one on the right and one on the left) and two lower.

Causes of a retained wisdom tooth

A retained wisdom tooth is a tooth that is unable to penetrate the gums or that only appears partially.
This usually happens when there is insufficient space for the wisdom tooth to break through.
It sticks to the tooth in front of it.
The enclosed wisdom tooth is often horizontal, but it can also stand vertically or at an angle.
Sometimes overlying gums can also cause the tooth not to appear because it sticks in the gum tissue.
Teeth can break, bend, tip, or shift when attempting to break.
Healthy and correctly positioned wisdom teeth do not cause any problems when they break through and can easily pierce the gums and fully protrude.

Symptoms of wisdom tooth eruption

irritation: Because of the insufficient space in the mouth, a wisdom tooth is sometimes stuck and causes irritation.
pain: An infection around the tooth is known as pericoronitis and can cause pain in the affected area. Unbearable pain is one of the most common symptoms of a tooth infection.
fever: Often the infection leads to an elevated body temperature and you feel tired.
difficulties swallowing: A jaw blockage when opening the mouth and difficulty swallowing if the tooth breaks.
pus: Sometimes infection leads to pus formation in the cavity or in the surrounding gums.
Swollen lymph nodes: Due to a worsening infection or an unfavorable angle when the teeth break through, the lymph nodes below the jaw can swell and cause a sore throat.
Inflamed and reddened gums: The surrounding gums usually redden or ignite due to the erupting tooth.
Difficulty brushing teeth: Growing teeth are difficult when brushing and flossing.
halitosis: Infection can lead to bad smell in the mouth.

A retained tooth can cause various problems such as infection of the teeth or gums, caries, etc..

cysts: Very rarely, cysts around the enclosed tooth can be observed. An unbroken tooth (which is enclosed in the jaw) can lead to the formation of cysts.

Intervention by the dentist

When must the wisdom tooth be removed?
The dentist can recommend extraction in the following cases:

if there is caries;
with an abscess;
when the wisdom tooth is trapped or growing horizontally.

Wisdom tooth extraction procedure

The patient is first prepared for the procedure.
The surgeon then administers local anesthesia to numb the extraction area of the wisdom tooth.
Sometimes (especially if the patient is very restless and uncooperative or if several wisdom teeth are extracted at the same time) this operation can also be performed under general anesthesia.

When the area is numbed, an incision is made to expose the area and see the tooth.
The incision must be large enough to allow possible access with dental instruments.
Since this causes bleeding, sterile swabs are used to stop the bleeding.
If the enclosed wisdom tooth is very deep, a drill may be needed to open the jaw and allow enough space to remove the tooth.
If a corner of the tooth is inaccessible or the covering by the bone is very thick, it may be necessary for the surgeon to cut the tooth during removal so as not to damage the jaw.

The wound is usually relatively large due to the incision and in most cases has to be sewn.
The suture can be sutured, otherwise the patient will need to go to the dentist again after about a week to have the sutures pulled.

Risks of wisdom tooth extraction

A Alveolitis sicca occurs when no blood clot (which is important for healing) develops in the tooth cavity (alveolus) or when the blood clot disintegrates.
A dry socket can cause severe toothache and bad breath.

Another risk is callousness, which can occur to anyone due to nerve damage, especially if the procedure was performed incorrectly.
This disease is called paraesthesia, in which parts of the mouth or even the chin become numb due to nerve injuries.

Another rare complication that can arise from this extraction is a condition that changes Jaw clamp (trism) names and gives the patient difficulty opening the mouth.

The extraction of the wisdom tooth can also be a bleeding cause that lasts for at least a day.

Anesthesia can also be performed to extract the wisdom tooth during breastfeeding, but should stop the subsequent breastfeeding in order to safely rule out any risks.

Postoperative infection
In rare cases, bacterial infection can occur after tooth removal. The most common symptoms of such an infection are:

swelling
fever
toothache
Long-lasting bad or salty taste in the mouth with or without discharge from the operated area
Difficulty opening the jaw

broken jaw
A broken jaw can occur due to the wide opening of the mouth during the operation.
Since the mouth has to be opened wide during the operation, the joint ligaments of the jaw can overstretch and cause discomfort in and around the jaw.

nerve damage
The inferior alveolar nerve supplies the lower lip and chin, while the lingual nerve is responsible for the sensitivity of the tip of the tongue. A wisdom tooth enclosed in the lower jaw bone is close to these two nerves.
Extraction can result in permanent paraesthesia if the tooth is enclosed and close to the root.
The trigeminal nerve can be injured when extracting a lower wisdom tooth.

air embolism
Air embolism is one of the most serious complications. It is a rare complication that occurs when a mixture of air and water under pressure makes its way from the jaw into the veins and finally into the large blood vessels leading to the heart. Depending on the size of the air bubbles, this can ultimately lead to cardiac arrest or death.

Cost of wisdom tooth extraction

The initial cost of the procedure begins with the consultation and x-ray, which would cost about $ 300 without insurance.
Wisdom teeth removal can cost around $ 600 to $ 1,500, including:

consultation
anesthesia
X-ray photograph
Possibility of oral surgery
drug
hospitalization

The extraction costs can be between 128 and 380 euros per tooth (without the costs for consultation, x-rays, medication, etc.) and the extraction of all four teeth can also cost 975 euros.

Simple extraction: at least 128 euros
Surgical extraction: 255-380 euros (costs with intravenous anesthesia 325-620 euros; costs with nitrous oxide 60-220 euros)

Recovery after extraction of the wisdom tooth

The following steps have to be followed for a postoperative recovery:

The bleeding continues for some time after the extraction. The cotton tampon must not be removed and the pressure must be maintained with the opposite teeth on the extraction area for about an hour after the extraction. This helps the blood to clot and stops the bleeding.

Up to 48 hours after the extraction, you must not eat warm or solid dishes. Most dentists recommend moving the jaw as little as possible. You can eat cold and soft foods like ice cream.
Do not gargle or spit vigorously for 24 hours after extraction, as this may hinder the formation of blood clots and cause bleeding to stop.
Avoid any physical contact of the tongue or fingers with the affected gum area.
Rest as much as possible after the operation.
The anesthesia continues for about 4 hours. When the effect ends, pain is felt, albeit with a lesser intensity.

You can regularly replace the cotton gauze over the affected gum area with a new one.
After 48 hours you can gargle with salt water to ward off infections.
An ice pack placed on the outside of the affected area can help alleviate the pain that may occur in the first few hours after anesthesia has passed.

Of course, a prescribed pain reliever significantly relieves the pain. The pain reliever and antibiotics prescribed by the dentist should be taken.
While sleeping, you should keep your head elevated so that the blood flow to the affected area is reduced and the pain is less stabbing.

After two days you can start eating normal food. Train the jaw by slowly opening and closing. In the beginning this causes pain.
When brushing your teeth, you should not disturb the affected gum area, as this hinders any previous healing success.
Avoid using straws to drink and stop smoking for about 24 hours after the surgery as this can affect blood clotting and the time it takes to heal completely.

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