October 9, 2009

Introduction

No one escapes the agony and pain caused by wisdom teeth. It is not unusual for us to treat this problem as part of our maturing process, hence the word “wisdom” to teeth which pop up in our adult phase. But it is always important that we see our dentist regularly so that problems with wisdom teeth can be dealt with at the first sign of the problem.  There are risks associated with the removal impacted wisdom teeth by surgery. This article discusses in reasonable detail how wisdom teeth can cause complications.

Something that is considered elementary or routine for young patients can be serious, especially for 25 year olds and above, especially those who have deeply impacted wisdom teeth. It pays to err on the side of caution, making sure that you see your dentist when you detect early signs of pain due to your wisdom teeth.

What are the risks of an operation to remove impacted wisdom teeth?

All operations have risks, and your oral surgeon should talk to you about things that could go wrong.  Anaesthetics can have side effects. These are more likely with a general anaesthetic. You may have an allergic reaction to the anaesthetic, or get breathing or heart problems. These problems are serious. If you have any allergies, you must tell your doctor.

It’s hard to say exactly how often problems happen with surgery to remove wisdom teeth. About 1 in 20 people get problems during or after an operation to take out their wisdom teeth. These problems aren’t always serious or permanent. You may get more serious problems if you’re over 25 and have deeply impacted teeth.

1. Sinus Complications

The upper wisdom teeth roots are very close to the maxillary sinus and some people even have roots that go into the sinus. An opening into the sinus after the removal of wisdom teeth occurs once in a while. If this occurs it is likely that bacteria can prevent healing and get into the sinus. This infection does not respond well to antibiotics and often requires additional surgery to drain the sinus. A material called gelfoam is typically placed in the extraction site to promote clotting and serve as a framework for granulation tissue to accumulate. If this does occur patients are often given antibiotics, decongestants, should avoid certain activities, and should see an Ear, Nose, and Throat (ENT) Doctor.

It is also possible that a fragment of the tooth can end up in the maxillary sinus. Irrigation with saline may allow the tooth fragment to be brought back to the site of the opening through which it entered the sinus, and may be retrievable. At other times a procedure called a caldwell luc must be performed.

2. Numbness/ Nerve Damage

Nerves in your mouth may be damaged during surgery to remove your lower wisdom teeth. Your lower lip, chin or tongue may feel tingly or numb. This happens to between 1 and 8 out of 100 people. For 1 in 100 people, the numbness is permanent, where as others regain feeling after 3 months. The lingual nerve may be permanently damaged in up to 1 in 100 people which is the nerve that helps you sense pain and temperature in your mouth. Dentists and surgeons often use an instrument called a lingual nerve retractor to move the nerve out of the way. But this can actually increase the risk of damage. The inferior alveolar nerve can also be damaged. This nerve supplies sensation to the lower teeth on the right or left half of the dental arch and the sense of touch to the right or left half of the chin and lower lip.

3. Dry Socket (Alveolar Osteitis)

Between 1 in 10 and 1 in 100 people get a throbbing pain after their operation, which is when a blood clot does not form properly in the socket. In some cases, this happens because the patient has disregarded the instructions given by the surgeon. Smoking, spitting or drinking with a straw in disregard to the surgeon’s instructions can cause this, along with other activities that change the pressure inside of the mouth, such as playing a musical instrument. The extraction site will become irritated and pain is due to the bone lining the tooth socket becoming inflamed. The symptoms are made worse when food debris trap in the tooth socket. Dry sockets can heal in a couple of weeks without treatment. Dry socket is not an infection and is inflammation within the bony lining of an empty tooth socket. A dry socket presents as a sharp and sudden increase in pain which usually starts around 2 to 5 days after wisdom teeth removal.

4. Jaw Fracture

In very rare cases, the removal of a wisdom tooth will weaken the jaw bone. This is due to the obligatory removal of bone to obtain access to the impacted tooth. It is very rare of the jaw to fracture after the removal of a wisdom tooth due to weakening and chewing normal foods.

5. Infection

Infection following the surgical removal of wisdom teeth happens to about 1 or 2 out of 100 people. Signs of infection include fever above 100 degrees, abnormal swelling, pain or a salty or prolonged bad taste, with or without evidence of discharge from the surgical site.

6. Injury to Teeth

Damage to fillings and adjacent teeth, to bridgework or to surrounding bone can occur during the removal of impacted wisdom teeth. Even the best surgeon will occasionally have this type of complication. This is rare and happens to less than 1 in 100 people.

7. Root Fragments

This happens to about 5 in 100 people. You might need to have the fragment removed if it causes problems. Usually the fragment is close to a nerve or adjacent sinus. Removal of the root tip could jeopardize adjacent structures. The oral surgeon uses his clinical expertise to determine the benefit to risk ratio of removing a root tip. The fragments can be monitored using x-rays.

8. TMJ pain

TMJ dysfunction following the removal of wisdom teeth is unusual and usually temporary. If treatment is required, it is usually conservative in nature and includes anti-inflammatory medicines, physical therapy and in some cases short term bite splint therapy.

9. Bleeding

Everyone bleeds after surgery, but it should stop by the time you go home. Less than 1 in 100 people have bleeding that is difficult to stop. Small amounts of blood within the first 48 hours after extraction is normal.

10. Air Embolism/ Subcutaneous Emphysema

A gas related embolus can be caused by inadvertent injection of a mixture of air and water under pressure which then passes into the mandible (jaw) to the veins and then to the large vessels leading to the heart. Large amounts of air can cause serious problems including cardiac arrest and death, by traveling to the large veins leading to the heart, and mechanically blocking the flow of blood through the heart. Microbubbles, not detectable by conventional imaging techniques may provoke an inflammatory response and cause tissue damage. Doppler ultrasound may aid in detection and Hyperbaric Oxygen Therapy for treatment.

11. Chronic Headache

Your head can pound 24/7 and cause you severe pain every day.

12. Trigeminal Nerve Damage

Trigeminal neuralgia can develop if there is injury to the trigeminal nerve. This causes episodes of intense pain in the eyes, lips, nose, scalp, forehead, and jaw. Trigeminal neuralgia is considered by many to be among the most painful of conditions and once was labeled the suicide disease because of the significant numbers of people taking their own lives before effective treatments were discovered.

13. Hematoma

A hematoma is a pooling blood in tissues that can happen when a needle moves through blood vessels.

14. Anaphylaxis

A loss of vascular tone indicated by a precipitous fall in blood pressure caused by contact with an allergen (due to anesthesia or another chemical given) can result in bilateral facial manifestations with possible cardiorespiratory symptoms.

15. Angiodema

A massive escape of fluid into the tissue from blood vessels causing large edematous swellings usually appears in the maxilla as a reddened area with well circumscribed rings and a buring sensation.

16. Vertigo/Dizziness

I have found no literature to support this; however, multiple patients have described strange feelings inside the head along with dizziness and vertigo. One such patient complained of these symptoms continuing to persist 12 years after the extractions.

17. Myoclonus

There is some literature suggesting perhiperal nerve damage causes myoclonus and body pounding symptoms/ palpitations.

18. Brain Damage

Anesthetics have been linked both mechanistically and phenomenologically to brain damage in non humans. No human studies have verified this. A few people have noticed cognitive impairment after recieving anesthesia.

19. Death

We can’t exclude the possibility of death during surgical removal of teeth. Multiple people have died as a direct result of having their wisdom teeth removed. Learn about death occuring after wisdom teeth removal.

For some people this third set of molars can grow inside without complication, especially those that  NOT been giving  any problems such as acute chronic pain or swelling, because a lot of other surgical removal of wisdom teeth is necessary . Your dentist will advise you if it is necessary to remove your wisdom teeth.

Conclusion

As in all matters related to our personal  health and well being, it is absolutely essential that we take  action at the first sign of a problem brewing with your wisdom. It is best to consult your dentist early so that a proper routine can be established to monitor and manage the problem with your wisdom teeth. With modern X-ray technology and imaging, you can be informed in advance of the severity of your problem. Usually it is easier if you are young and active to deal with it. Your dentist will recommend what steps you need to take. Usually a surgical procedure is required to remove your troubling wisdom teeth. But there are risks associated with surgery which we need to bear in mind.