Wisdom teeth removal is a surgical procedure that involves the extraction of the third molars, commonly known as wisdom teeth, from the back of the mouth. These teeth typically emerge in the late teens or early twenties. However, many people do not have enough space in their mouths to accommodate these extra teeth, which can lead to various dental problems.

The procedure is generally performed by an oral surgeon or a dentist with special training in oral surgery. It is usually done under local anaesthesia, although general anaesthesia may be used for more complex cases or for patients who prefer to be completely unconscious during the procedure.

During the surgery, the dentist or oral surgeon will make an incision in the gum tissue to expose the wisdom tooth and surrounding bone. If the tooth is impacted, meaning it is not fully erupted from the gum, a small portion of the bone may also need to be removed to access and extract the tooth. The tooth will then be gently rocked back and forth to loosen it before being lifted out of the socket.

After the removal, the surgical site will be carefully cleaned and stitched up. Gauze may be placed over the extraction site to control bleeding, and the patient will be given post-operative care instructions.

Recovery time can vary, but most patients experience some swelling, pain, and discomfort in the days following the surgery. Pain medication and cold compresses can help alleviate any discomfort. It is important to follow the instructions given by the dentist or oral surgeon to minimize the risk of complications and promote proper healing.

Complications that can arise from wisdom teeth removal include dry socket, infection, nerve damage, jaw stiffness, and sinus issues. However, these complications are relatively rare and can be minimized by following proper post-operative care instructions and seeking prompt medical attention if any concerns arise.

It is worth noting that not everyone needs to have their wisdom teeth removed. Some individuals have enough space in their mouths for the teeth to emerge and function properly without causing any issues. However, regular dental check-ups and X-rays are important for monitoring the growth and position of wisdom teeth to determine if extraction is necessary.

Indications for the Removal of Wisdom Teeth:

There are several indications or reasons why wisdom teeth may need to be removed. These include:

1. Impacted wisdom teeth: When wisdom teeth do not have enough space to fully emerge or develop properly, they can become impacted. This means they are trapped beneath the gum line or jawbone. Impacted wisdom teeth can cause pain, swelling, infection, and damage to surrounding teeth.
2. Crowding or shifting of teeth: Wisdom teeth can exert pressure on the neighbouring teeth, causing crowding or shifting. This can lead to misalignment or crookedness in the teeth, which may require orthodontic treatment to correct. Removing the wisdom teeth can prevent these issues.
3. Tooth decay or gum disease: Wisdom teeth are located at the back of the mouth, making them difficult to clean properly. They are more prone to tooth decay and gum disease due to their position and limited accessibility. If cavities or gum infections are recurrent or severe, removing wisdom teeth may be necessary to improve oral health.
4. Cysts or tumours: In some cases, a cyst or tumour can form around an impacted wisdom tooth. These growths can damage the surrounding bone, teeth, and nerves. Removing the impacted tooth and the associated cyst or tumour may be necessary to prevent further complications.
5. Sinus problems: Upper wisdom teeth that are close to the sinuses can occasionally cause sinus issues. The pressure or inflammation caused by these teeth can lead to sinus pain, congestion, and recurrent sinus infections. Removing the wisdom teeth can alleviate these problems.

It is important to note that not everyone will need to have their wisdom teeth removed. Regular dental check-ups and X-rays, along with the assessment of an oral surgeon or dentist, are necessary to determine if wisdom tooth removal is appropriate based on individual factors and conditions.

Steps and Procedure of Wisdom Teeth Removal:

Prior to the surgery, a comprehensive evaluation of the patient’s medical history is conducted, along with specialized radiographs like Panorex and CBCT. Diagnostic tests such as a complete blood count and clotting and bleeding time are checked to ensure a safe surgery with minimal complications.

To begin the procedure:

1. The operative site is isolated by scrubbing and painting the skin and oral mucosa with a cetrimide and povidone-iodine solution. This is done to prevent the growth of microbes and ensure a sterile environment.
2. Anaesthesia is administered, either local or general. Local anaesthesia is commonly used to remove impacted teeth, injected into the nerve or surrounding area. General anaesthesia may be used in certain medical situations, rendering the patient unconscious during the surgery.
3. The gum tissue is incised, and a flap is raised to expose the bone and tooth. Different flap designs are employed to promote faster healing, minimize pain, swelling, and infection. For lower jaw third molars, a mucoperiosteal flap is raised, while other types of flaps include buccal envelope flap and triangular flap.
4. The overlying bone above the impacted tooth is removed using hand instruments or dental burs. Care is taken to minimize bone loss to facilitate faster healing. Removing the bone provides access to the target tooth.
5. The tooth is sectioned into segments to ensure safe and minimally traumatic removal. The number of sections depends on factors such as root shape and number. Anatomical considerations, such as nearby nerves, are also taken into account. Sectioning allows for easier removal of the tooth.
6. After the tooth is removed, the surgical site is properly cleaned to minimize the risk of infection. Stitches are placed to close the surgical site, and the patient is advised not to touch the area to prevent infection. Gauze may be placed over the stitches to manage any bleeding.

It is important for the patient to follow post-operative care instructions provided by the dentist or surgeon to promote proper healing and minimize complications. Regular follow-up visits are scheduled to monitor the healing process and ensure the patient’s well-being.