Dr. Maneesh Rai, BDS 

What is an Impacted Wisdom Tooth?

Wisdom teeth are the teeth that come into the mouth last, at age 17-25 years.  Most people get four wisdom teeth, one in the back of each of the four quadrants of the mouth. But it is not uncommon for a wisdom tooth to be missing and some people get none.
An "impacted" tooth is one that is stuck in the bone and cannot fit or come into the mouth properly.  Impacted third molars are a frequent occurrence in teens and young adults. Sometimes they start to come into the mouth but the mouth is not big enough to hold another tooth. They do not completely erupt, remain partially under the gum, and are easy targets for infection.  It is not unusual for teens and young adults to appear in the dental office swollen, unable to open, febrile and in pain when this happens.
If wisdom teeth are positioned in such a way that they are positioned impacted under the bone, covered by bone,  and not partially in the mouth at all, often they are better left alone. 

When a Wisdom Tooth Erupts Partially but the Whole Tooth Does Not Fit in the Jaw

When wisdom teeth are partially in the mouth and partially submerged, the gum around them can become infected and inflamed causing swelling in the area around the cheek or down the neck.  This seems to happen more often at exam time or when young patients are under stress.  Under stress, the immune system does not function as well as usual, and in a standoff with bacteria, the bacteria may start to get the upper hand.  That is usually when the patient with an impacted third molar shows up at the dental office with swelling and pain.   This swelling is called pericoronitis, or infection tissue around the crown of the tooth  Frequently there is flabby gum around the back of the tooth and/or a flap of gum (called an operculum) extending over the biting surface of the  tooth.   Debris and bacteria collect and are trapped under this gum tissue and an infection is the result.

If the tooth is properly erupted and oriented, it may be possible to trim away the excess gum flap around the back of the tooth (an Operculectomy). 

If the tooth is hopelessly submerged and there is no room for it to erupt normally,  the tooth should be extracted.

Care of Your Mouth After Surgical Extraction of Wisdom Tooth (Impaction Surgery)

DO

· You will be leaving with gauze to bite on.  Keep this gauze in place for 45 minutes.  After this time gently remove and discard this gauze. 

· Keep PRESSURE on gauze until the bleeding stops. If HEAVY bleeding continues for more than two hours, call us.

· It is useful to apply pressure and a cold pack to reduce swelling. This can be applied to the outside of the mouth but make sure any local anesthetic has worn off or you may get frost bite.  Never use a hot compress as this will increase the swelling.

· It is normal to find a little bleeding, even for a couple days. To help stop oozing, you can take a tea bag, wet it, squeeze all the water out, place it over the extraction area and bite on it for 20 minutes. The tannic acid in the tea constricts tiny blood vessels in the wound and helps to form a clot and stop the bleeding.

· Drink plenty of fluids.

· Try to eat soft, not too hot, non spicy nutritious foods for the next few meals. Ice creams, yogurt, fruit juices (non citrus), semisolid khichri or dalia.

· Reduce strenuous activity for 24 hours.

· Avoid all rinsing for 24 hours after extraction. This is to insure the formation of a healing blood clot which is essential to proper wound healing. Disturbance of this clot can lead to increased bleeding or the loss of the blood clot. If the clot is lost, a painful condition called dry socket may occur. You may use mild antiseptic rinses after 24 hours only if prescribed.

·  If you have received a prescription for pain or an antibiotic, please take the medication as directed.

· If you have been directed to use an ice pack, please follow the instructions.

· Place an old towel on your pillow to prevent any blood spots.

· Stiffness (Trismus) of the jaw muscles may cause difficulty in opening your mouth for several days following surgery. This is a normal post-operative event which will resolve in time. Gentle exercise of the jaw by opening wide and stretching the muscles will help to clear up the trismus more quickly.

· Occasionally, patients may feel hard projections of bone at the surgical site with their tongue. These projections of bone usually smooth out spontaneously, if not, they can be removed by Dr. Maneesh Rai.

· Sleeping with the head slightly elevated by using an extra pillow during the first three or four nights after surgery will help ease management of oral secretions and minimize swelling.

DON’T

· Do not smoke, or drink alcohol, for a minimum of 24 hours or better avoid for 48 hours.

· Do not rinse or spit vigorously for one week.

· Do not drink through a straw for one week.

· For the first day after the operation do not rinse, poke or brush the area of surgery.

· Do not suck on candy, mints, etc. for at least one week.

· Avoid strenuous exertion on the day of surgery.

If you have prolonged/severe pain, bleeding, swelling, or fever, please contact us.

No two mouths are alike. Do not accept well intended advice from friends. Dr. Maneesh Rai and his team are readily accessible through the office and available to answer any questions you have regarding your surgery or post-operative experience.