Impacted Wisdom Tooth Removal

Wisdom teeth (third molars) begin to erupt between the ages of 17 and 25. However, there is high individual variability in this regard, and the eruption period may vary. The number of wisdom teeth can also differ: a person may have anywhere from four to none. Wisdom teeth can safely be called a vestigial organ, and today the norm for an adult is 28 teeth.

While our distant ancestors needed third molars for chewing raw or very hard food, modern humans find wisdom teeth bring more problems than benefits.

Through evolution, the human skull and jaw have changed, and quite often there is simply not enough room for wisdom teeth to erupt normally. To avoid future problems, many dentists recommend that their patients have unerupted wisdom teeth removed on a planned basis.

An impacted wisdom tooth is a tooth that cannot erupt normally. It is important to understand that a wisdom tooth that has not yet erupted should not automatically be considered impacted, since in this case we are talking about a tooth that physically cannot erupt even given sufficient time.

Causes of impacted wisdom teeth:

• lack of space (there is insufficient room in the jawbone for normal eruption);
• bone obstructions (dense bone or other structural features of the jaw).

Wisdom teeth can be not only impacted but also dystopic — that is, positioned incorrectly (tilted, protruding, or rotated along their axis).

Situations in which a wisdom tooth is both impacted and dystopic are possible and frequently encountered in practice. This means that even before eruption, it is clear that the tooth is already in an incorrect position. This can be determined based on an X-ray.

The presence of an impacted and especially an impacted and dystopic wisdom tooth is a direct indication for its removal. Patients often hesitate to undergo surgery, justifying their reluctance by saying the tooth does not bother them, but this is only a matter of time.

An impacted wisdom tooth should be removed to avoid:

• pain. Sooner or later the tooth will begin to press on tissues, causing first discomfort and then pain. Sometimes unerupted wisdom teeth also cause headaches;
• infection. Impacted wisdom teeth create problems for cleaning and hygiene, increasing the risk of infections and oral diseases;
• damage to adjacent teeth. The tooth can put pressure not only on soft tissues but also on neighboring healthy teeth, thereby destroying them;
• tumor development;
• malocclusion formation.

1. Diagnosis

Quite often, patients begin to suspect that an impacted wisdom tooth requires removal based on the following symptoms:

• discomfort and pain;
• mucosal swelling;
• pain when chewing;
• pain and difficulty when opening the mouth.

Ideally, it is better not to wait for such symptoms to appear, and for this one should not neglect routine check-ups with a doctor. The doctor can take an X-ray and immediately determine whether the tooth needs to be removed or if there is a chance for its physiological eruption. Let us emphasize: removal of impacted wisdom teeth, even with symptoms present, is impossible without a preliminary X-ray — before the operation, the surgeon must see the full picture.

2. Impacted Wisdom Tooth Removal Surgery

Wisdom tooth removal can be performed under local anesthesia or under general anesthesia.

During the operation, the surgeon must first gain access to the tooth: the mucosa is incised, and in some cases, part of the bone tissue may also be removed. The doctor then removes the tooth and places sutures.

3. Rehabilitation

After impacted wisdom tooth removal, a period of rehabilitation and recovery begins. The patient is prescribed painkillers and anti-inflammatory medications. It is also recommended to refrain from smoking, alcohol consumption, and to limit physical activity for the first few days after surgery. It goes without saying that the patient must also follow hygiene guidelines.

4. Suture Removal and Examination

Depending on the patient’s individual characteristics, sutures are removed 7-14 days after surgery.

The operation may be complicated by a number of factors, requiring greater experience from the doctor and the use of more instruments.

Factors affecting the complexity of the operation:

There are also specific considerations when removing impacted wisdom teeth depending on whether they are in the upper or lower jaw.

Removal of upper impacted wisdom teeth is complicated by the fact that these teeth are anatomically adjacent to the maxillary sinuses. Therefore, there is a risk of perforation and penetration into the sinus, which can lead to odontogenic sinusitis. To avoid such complications, dental surgeons often use so-called cautious approaches when removing impacted upper jaw teeth.

Removal of lower impacted wisdom teeth may be complicated by their close proximity to the inferior alveolar nerve. Trauma to this nerve is highly undesirable and can lead to numbness of the lip, tongue, and chin. Despite the fact that the numbness eventually passes, the surgeons at our clinic avoid causing additional trauma when removing impacted lower jaw teeth.

Some dental clinics in Kyiv offer impacted wisdom tooth removal under general anesthesia, positioning it as some kind of new service. In reality, performing dental operations under general anesthesia is nothing new. At our clinic, we also perform dental operations under general anesthesia, but only when there are direct medical indications.

It should be noted that in Europe, impacted wisdom tooth removal operations are performed under general anesthesia and are considered comparable in complexity to appendectomy procedures. European medical professionals also take into account the severity of psychological trauma inflicted on the patient. Impacted wisdom tooth removal under general anesthesia has its merits, as the operation is not only complex but also lengthy (at least 30 minutes).

However, wisdom tooth removal under general anesthesia in Kyiv has become more of a marketing gimmick than a medical necessity.

Among the significant disadvantages of using general anesthesia, two should be noted:

• it is more difficult for the surgeon to work with a completely unresponsive patient;
• the cost of the operation increases significantly.

The cost of impacted wisdom tooth removal under general anesthesia increases substantially. The patient should understand that they will additionally need:

• a package of tests;
• an anesthesiologist consultation;
• anesthesiological support.

At our clinic, we recommend using general anesthesia when it comes to complex and expectedly lengthy operations, and we also advise taking the opportunity to remove all wisdom teeth at once.

The cost of impacted wisdom tooth removal under local anesthesia will be at least three times lower than the cost of a similar operation under general anesthesia. At the same time, the use of good patented anesthesia guarantees patient comfort and the absence of pain. In Kyiv, the average cost of impacted wisdom tooth removal ranges from 5 to 8 thousand hryvnias.

In conclusion, here are the words of our clinic’s chief surgeon, Ihor Osadchyi: «Experience, skill, and speed — these are the keys to success. The faster the operation, the easier it is for the patient. We first remove two wisdom teeth and then ask: is the patient ready to continue, or should the removal of the remaining teeth be rescheduled for another time. As a rule, we manage to quickly remove all four wisdom teeth at once and relieve the patient of suffering».