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 years, in children they are not yet present.

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


Causes of a retained wisdom tooth

A retained wisdom tooth is a tooth that fails to penetrate the gums or that appears only partially.
This usually happens when there is not enough space for the wisdom tooth to break through.
It gets stuck on the tooth in front of it.
Often the enclosed wisdom tooth lies horizontally, but it can also stand vertically or obliquely.
Sometimes overlying gums can also be the cause of the non-appearance of the tooth because it gets stuck in the gum tissue.
The teeth can break through, bend, tilt or displace when trying to break through.
Healthy and correctly positioned wisdom teeth do not cause any problems during breakthrough and can easily puncture the gums and protrude completely.

Symptoms of wisdom tooth eruption

  • Irritation: Because of insufficient space in the mouth, a wisdom tooth sometimes gets 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 dental infection.
  • Fever: Often the infection leads to an increased body temperature and you feel tired.
  • Difficulty swallowing: One may suffer from a jaw blockage when opening the mouth and difficulty swallowing if the tooth breaks through.
  • Pus: Sometimes infection leads to the formation of pus in the cavity or surrounding gums.
  • Swollen lymph nodes: Due to a worsening infection or an awkward angle when erupting the teeth, the lymph nodes below the jaw can swell and cause a sore throat.
  • Inflamed and reddened gums: The erupting tooth usually reddens or inflames the surrounding gums.
  • Difficulty brushing: Growing teeth cause difficulty brushing and flossing.
  • Bad breath: An infection can lead to foul odor in the mouth.

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

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

Intervention of the dentist

When must the wisdom tooth be removed?
In the following cases, the dentist may advise extraction:

  1. if there is tooth decay;
  2. in case of an abscess;
  3. if the wisdom tooth is enclosed or grows horizontally.

Method for extracting the wisdom tooth

First of all, the patient is prepared for the procedure.
Then the surgeon 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.

If the area is anesthetized, an incision is made to expose the area and see the tooth.
The incision must be sufficiently large to allow any 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 necessary to open the jaw and create enough space to remove the tooth.
If one corner of the tooth is inaccessible or the cover through 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.

In most cases, the wound is relatively large due to the incision and must be sutured in most cases.
The suture can be done with resorbing stitches, otherwise the patient will have to go to the dentist again after about a week to have the stitches removed.

Risks of wisdom tooth extraction

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

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

Another rare complication that can arise due to this extraction is a condition called jaw clamp (trismus), which makes it difficult for the patient to open the mouth.

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

Anesthesia can also be performed during breastfeeding to extract the wisdom tooth, but the subsequent breastfeeding meal should be suspended in order to safely exclude any risks.

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

  • Swelling
  • Fever
  • Toothache
  • Long-lasting foul or salty taste in the mouth with or without discharge from the operated area
  • Difficulty opening the jaw

Jaw fracture
A jaw fracture can occur due to the wide opening of the mouth during surgery.
Since the mouth must be wide open during surgery, 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 jawbone lies near these two nerves.
During extraction, permanent paresthesia can occur if the tooth is enclosed and located near the root.
The trigeminal nerve can be injured during the extraction of a lower wisdom tooth.

Air embolism
An 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 eventually 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 is about $300 without insurance.
Wisdom teeth removal can cost around $600 to $1500, including:

  • Consultation
  • Anesthesia
  • Radiogram
  • Possibility of oral surgery
  • Drug
  • Hospitalization

The extraction costs can range from 128 to 380 euros per tooth (excluding the costs of consultation, X-ray, medication, etc.) and the extraction of all four teeth can also cost 975 euros.

  • Easy extraction: at least 128 euros
  • Surgical extraction: 255-380 euros (cost with intravenous anesthesia 325-620 euros; Costs with nitrous oxide 60-220 euros)

Recovery after an extraction of the wisdom tooth

The following steps must be observed for postoperative recovery:

  • The bleeding continues for some time after 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 pulling. This supports the clotting of the blood and stops the bleeding.
  • Do not eat hot or solid food until 48 hours after extraction. Most dentists recommend moving the jaw as little as possible. You can eat cold and soft foods such as ice cream.
  • After extraction, do not gargle vigorously or spit out for 24 hours, as this could hinder the formation of the blood clot and thus stop the bleeding.
  • Avoid any physical contact of the tongue or fingers with the affected gum area.
  • Rest as much as possible after surgery.
  • The anesthesia continues to work for about 4 hours. When the effect ends, one feels pain, albeit with a lower 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 relieve the pain that may occur in the first few hours after the anesthesia has passed.

Of course, a prescribed painkiller will significantly relieve the pain. The painkillers and antibiotics prescribed by the dentist should be taken.
During sleep, the head should be 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.
One should avoid using straws for drinking and stop smoking for about 24 hours after surgery, as this can affect blood clotting and the time needed for complete healing.

Natural remedies

  • One can also place a black tea bag near the affected area for temporary relief.
  • The pain can also be relieved by applying a cotton ball soaked in clove oil.
  • You can gargle with lukewarm salt water to kill the bacteria.
  • Some people chew a clove of freshly cut garlic covered with rock salt.
  • Placing a piece of cucumber on the extraction area can also help.
  • One can get the pain under control by avoiding eating extremely hot, spicy or sweet foods.

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