Dentistry is the art and science of treating teeth. Teeth and dental surgery go hand in hand, and be it tooth whitening or wisdom teeth, it will always be a dentist in a dental surgery clinic who will be treating you.
Oral & maxillofacial surgeons are specialist dentists. Like ENT surgeons are specialist doctors.
But not all doctors can take out your tonsils. Neither can all dentists take out wisdom teeth. If you are wondering why your dental surgeon or dentist has referred you to a specialist to have your wisdom teeth removed, then read on. This website is designed to explain to you why and how wisdom teeth can cause problems, and how specialist surgeons are available to take care of your special wisdom teeth needs.
What are wisdom teeth, and what are wisdom teeth for?
Wisdom teeth are the third molars that grow into your mouth in the age group of 16-25. Wisdom teeth are almost redundant amongst almost all the various human races. Wisdom teeth can grow in weird ways or shapes, or when wisdom teeth erupt, they are impacted, or maybe they just don’t develop at all. They are called wisdom teeth, because they come at the age of wisdom. Usually, when you have just left home. And usually, when you can least afford to have them treated.
When humans first began to walk the planet, our immediate ancestors likely also didn’t need them. But 120,000 years ago, we didn’t live in houses, read books, eat bread, or have modern medicine. Our life spans were quite short, so by the time we were old enough to have a wisdom tooth problem at 25, we probably already had grandchildren, and living our twilight years in cave-style retirement.
So with the rise of civilization, the advent of modern medicine, and the rise and rise of our life spans... Along with all our other body parts, we have come to expect all our teeth to last forever too.
And all of this means, that wisdom teeth need to be addressed in all of us, as part of our lifetime score card on good dental health.
I have a recommendation to have my wisdom tooth removed. What does this mean?
Your general dentist (also called a dental surgeon in some countries), is someone who looks in your mouth, checks for dental decay, cleans your teeth, extracts badly decayed teeth, performs root canal treatment, offers teeth whitening, makes crowns, and gives dentures.
Part of their job is to also take dental x-rays, like bitewings or OPGs (orthopantomogram), and look for evidence of dental disease which may be hidden from a simple visual view. It’s often then, that when you have your first OPG, those wisdom teeth (and also other problems) may become apparent to you for the first time.
Being told about a problem you didn’t know was there, can come as a deep surprise.
If your dentist sees that you have wisdom teeth, he (or she) is going to start asking some questions. First off, they are going to ask “is this a problem now” and secondly “will these wisdom teeth be a problem later on.”
Of course, your dentist is there to look after you. That is what you are paying them to do. If they feel that they are better off removed, then that is usually going to be good advice. Your next step is to ask “who is going to remove my wisdom teeth?”
Who is going to remove my wisdom tooth?
You may be asking why can’t my normal dentist remove my wisdom tooth? Why do I need to be referred to have my wisdom tooth extracted?
Your general dentist is trained in basic removal of wisdom teeth using minor oral surgery or extraction techniques they learnt during their basic dental degree training. These extraction techniques may have also been refined during their practice years.
Oral and Maxillofacial surgeons are specialist dentists. The foundation of their specialist training is in wisdom teeth surgery and wisdom teeth removal. Your dentist will refer you to a specialist oral and maxillofacial surgeon (or their practice registrar) if they see your wisdom tooth is not just a simple extraction or falls under the term of “minor oral surgery”.
What does wisdom tooth surgery involve?
Some wisdom teeth can be a simple tooth extraction performed by a dental surgeon (general dentist). But the majority of impacted wisdom teeth are going to need a formal operation, and these may be more appropriately performed by a specialist surgeon (oral & maxillofacial surgeon) or specialist practice registrar under in-house specialist support.
Wisdom teeth can be removed either in the dental clinic, under local anaesthetic or LA, or with intravenous or IV sedation. Some wisdom teeth will need a general anesthetic or GA, and this is performed in a private hospital. You wouldn’t expect your medical GP to take out your tonsils, and neither is it fair to your general dentist to expect them to remove your complex wisdom teeth in a private hospital setting.
Often impacted wisdom teeth are completely buried, or they are partially erupted. This means that gum has to be lifted away from the wisdom tooth, before the wisdom tooth can be removed in a piece by piece fashion from your jaw. Whilst this may sound painful, if it is done carefully, and with minimal handling or trauma to your normal surrounding gum and nerve tissues, swelling and pain can be greatly minimized or even possibly avoided.
Of course like all things in dentistry, removing wisdom teeth is both an art and a science. Going to specialist oral surgery school imparts the science. But practice and experience provides the art and the finesse. Be confident in asking the qualifications of your wisdom tooth specialist. Check their formal registration status. Are they a registered dental specialist (oral & maxillofacial surgeon), or are they a general dental practitioner (dental surgeon), or are they under the in-house support of a registered specialist (practice registrar)?
Whether you are having a brain operation, an operation on your leg, or an operation in your mouth... Ask yourself whether your practitioner is both trained and reliable to perform your procedure. What happens if things go wrong? Will your practitioner fix the problem, or will they simply send you to the person who should have performed your operation in the first place?
At the time of your consultation, you should be allowed to ask all of these questions. But the most important explanation is of the procedure itself. Everyone is different, and you should carefully question how the operation that you need is titrated and customized to your individual condition and treatment needs. Most of all, ask what the potential complications are, how complications are avoided or planned for, and how they would be handled if a complication were to arise.
Remember, complications from wisdom teeth do occur. Some are rare, and some are common. Some are more common in people’s hands than is normal. Unless it has been predicted for, you should not expect to have lip numbness or tongue numbness. Even adverse swelling or post-operative pain or infection from having wisdom teeth removal can be avoidable or the risk greatly minimised. Even if it is unexpectedly severe, then your specialist should be able to actively treat and monitor it, so that it diminishes, or does not worsen, or at least is actively planned or managed for.
What happens after my wisdom teeth are extracted?
Wisdom teeth surgery is not pain free or painless, or absolutely free of swelling. You should never expect that.
But you should also not expect to have excessive swelling, or excessive discomfort, or even prolonged numbness following your wisdom tooth surgery.
The following are good rules of thumb when considering for the effects of wisdom teeth surgery...
- Usually the shorter duration of operation, the less surgical swelling there is.
- If you have been sent to a dental specialist to have your wisdom teeth removed, usually it is because your wisdom teeth are harder to remove, than easier.
- With an experienced and well trained specialist (or specialist supported practice registrar) in wisdom tooth surgery, your operation is usually shorter, not longer. Most operations to take out four wisdom teeth take no longer than 15-20 minutes, regardless of surgical difficulty.
- If your operation over one wisdom tooth was to take more than an hour, then this is considered very unusual. There may be the presence of post-operative complications like prolonged pain or prolonged or even lasting numbness of your cheek, lip or chin.
- There is the added burden of recovery from general anesthetic, in addition to recovery from your surgery. But there is no general anesthetic recovery burden, if your treatment was carried out under local anaesthetic alone.
- Pain from wisdom teeth removal is minimized by being quick, efficient and gentle. Pain is also reduced through use of regular Tylenol, but only when properly prescribed and administered by your treating practitioner.
- Most surgical practitioners will review for the effects of surgery several days or even weeks after surgery. This is also true for wisdom tooth surgery. In some instances someone else may be delegated this task, like your general dentist who originally made your referral. But you should always expect that there is someone who has been arranged to follow up on your ongoing healing and care.
What happens if I leave my wisdom teeth, despite being advised to remove them?
It is hard enough to predict tomorrow’s weather, let alone next year’s weather.
But we can make general assumptions. Likely in winter it will be cold. Next summer will have several days of rain.
Wisdom teeth also have general predictions, but we cannot say when, or how severely, or in what precise form these predictions will occur.
Leaving your wisdom teeth to fully develop, when clearly they are already impacted... will likely worsen the degree of wisdom tooth impaction, and make later surgery to remove them... harder... And your risk of prolonged or more difficult surgery or surgical risk exposure... much higher.
Whilst this is not true for all patients in all situations, it is hard not to see the obvious general logic here.
Treating your impacted wisdom tooth which is partially erupted, and with local pericoronitis will likely clear your infection and take away your current pain. But antibiotics do not stop your tooth being impacted, nor the likelihood that your next episode of pericoronitis will not develop into full facial swelling, and a hospital admission.
Wisdom teeth are often difficult to clean, and easily get gum disease or caries. The presence of dental disease in your wisdom tooth is also likely to cause, or aggravate or predispose adjacent molar teeth to the same condition of periodontitis or tooth decay. Eventually you won’t be needing just your wisdom teeth out but adjacent teeth as well.
Remember, prevention is so much better than cure...
If you have a problem with wisdom teeth, ask your dentist first. If it is a simply matter of a quick local anaesthetic, and an easy extraction, then that’s what your dental surgeon is there for.
But if you have an impacted wisdom tooth, that’s lying deeply, maybe even without symptoms… get an opinion from an expert who is specialized in wisdom teeth removal, and ask whether he (or she) thinks it needs removal...
If you have impacted wisdom teeth, get a referral to your wisdom tooth specialist clinic... if only for an opinion.
When is the best time to remove wisdom teeth?
The answer to this is simple.
If your wisdom teeth are impacted, and never likely to erupt or be healthy, then seek a specialist opinion to assess whether to have your wisdom teeth removed before you have any problems.
Remember that everyone is different, and that your body and any problems you may have with it, are unique to you.
Don’t ask your next door neighbor for their opinion over the fence. They are at one end of a spectrum of expertise.
The highest level of advice comes from an experienced, registered and trained specialist in wisdom teeth surgery. Wisdom tooth specialists lie at the other end of the spectrum of useful advice.
Everyone else... your teachers, your neighbors, even your famiy dentist, lie somewhere else along the rest of that spectral line.
Where can I get treated?
Oral & Maxillofacial Surgical specialists in Australia can be found in all major cities. The major referral centers are located in Sydney, Newcastle, Melbourne, Brisbane, Gold Coast, Canberra, Brisbane, Perth, Adelaide, and Hobart, and in most large regional centres.
Always ask for an oral & maxillofacial surgeon if you want a surgical specialist to advise upon or directly treat your wisdom teeth. Most major country centers also have visiting wisdom teeth specialists. But check the credentials and registrations of your treating specialist before you accept your referral to visit them.
All referrals in Australia carry a Medicare benefit rebate when visiting your oral & maxillofacial surgeon with a referral.