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Extractions & Surgical Exposures

Removal of Wisdom Teeth

This information is for patients who may need to have an operation to remove their impacted wisdom teeth.

The wisdom teeth - Adults normally have 32 teeth and wisdom teeth (3rd molars) are the last to come through at the back of the mouth. Normally there are 4 wisdom teeth, one in each side of the upper and lower jaw.

Impacted wisdom teeth - If the jaws are too small to accommodate all the teeth, there may not be enough space for the wisdom teeth to come through properly and they become impacted (stuck), often causing problems.

Reasons for the removal of wisdom teeth

1. The most common reason is recurrent infection of the gum overlying a tooth that is part way through the gum (pericoronitis).

2. Decay (caries) in the wisdom tooth, which your dentist cannot restore.

3. Infection of the tooth (abscess) due to advanced dental decay.

4. When the adjacent molar tooth is affected by gum (periodontal) disease or dental decay due to the impacted wisdom tooth.

5. Progressive cystic (fluid filled sac) formation around the tooth.

6. As part of other surgical procedures involving the jaw.

7. There may be other less common reasons that your surgeon will discuss with you.

The removal of wisdom teeth

There is great variation in the difficulty of removing wisdom teeth.

The procedure can be carried out under local anaesthesia (injection in the gum to numb the area), with or without intravenous sedation (injection in the arm or hand to reduce anxiety).  Your surgeon will discuss with you which method is most appropriate.

The degree of difficulty of the surgery, any underlying medical conditions and other personal circumstances will be taken into account choosing the method.

Uncovering (Exposure) of Impacted Upper Canines & other Teeth

This information is designed to help your understanding of the condition where an upper canine tooth fails to erupt normally and what treatments are available to help remedy it.

The problem

The upper canine, or “eye tooth”, normally erupts into the mouth between about the ages of 11 and 13. Sometimes teeth can develop in an abnormal position and the upper canine is the most common tooth to be affected in this way. Either one or both teeth may be affected. Often they will lie across the roof of the mouth behind the front teeth.

Why is treatment required?

The upper canine has a long root making it a strong tooth and is an important tooth both for biting and in the development of a normal smile.

Sometimes they may be left alone and will remain un-erupted for many years, possibly a whole lifetime. They can, however, damage the roots of other front teeth or push them out of position. They can interfere with the orthodontic movement of other teeth. More rarely cysts can develop around them. Treatment is almost always provided as part of on-going orthodontic treatment to help the teeth to erupt normally into the mouth.

What does the treatment involve?

Helping the tooth to erupt into the mouth involves a relatively minor surgical procedure. This may be carried out under local anaesthetic (injection in the gum) Depending on the exact position of the un-erupted tooth; generally one, or a combination of two possible procedures, will be carried out:

1. If the tooth is in the roof of the mouth a small window of gum can be removed plus some bone if it is necessary from the palate. Usually an antiseptic pack is placed over the tooth, which is held in place by one or two stitches. This both protects the wound and helps to prevent the gum growing back over the tooth.

2. If the tooth is very deeply impacted then often the gum over it will be lifted up, the tooth exposed and a gold chain and bracket will be glued onto the crown. The gum is then put back and the chain is stitched to the outside of the gum where the orthodontist can use it to pull the tooth gradually into the correct position. Pulling can usually begin a couple of weeks after surgery when healing is complete.

What are the after effects? Following surgery there is usually very little swelling but there will be some soreness. This is normally taken care of with simple painkillers such as paracetamol. It is not usually necessary to take antibiotics. A review appointment is usually made 2 weeks following surgery, either with the surgeon or orthodontist.

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