There are certain problems related to removal of wisdom teeth, which the patients who undergo the surgical extraction of wisdom tooth have to face. These problems are not complications but are general ones which almost every body has to face. However if the patient is aware of these problems before hand then it becomes easier for them to minimize their effects and also helps mentally for the patients. These problems can sometimes lead to complications if not addressed properly like severe infection in the extraction site. However one can meet all the problems effectively by carefully following the instructions of dentists.
The most important thing after the extraction of wisdom teeth is the formation of clot at the extraction site. Till then the bleeding and oozing of blood from there is common. This bleeding can occur up to 3 days after the removal of wisdom tooth; however after 3rd day its quantum goes down and should be very less or barely noticeable. Till the bleeding is continuing, one should avoid vigorous rinsing of the mouth as it can dislodge the colt formed at the extraction site. One should gently start doing warm saline rinses 2-3 times a day after 24 hours of extraction of wisdom tooth as it helps in faster healing of the wound. These should be continued till the healing is completed. This should stop the bleeding. But sometimes it does not stop. In such cases one can take sterilized gauge piece and gently bit down on it with equal pressure. This helps in stopping the bleeding. This should not be overdone as this can irritate the wound. After biting down for half an hour, when gauze piece is changed, there should be noticeable reduction in the bleeding. Another more effective way is to take iced tea bag instead of gauze piece as the tannic acid in the tea bag helps more in reducing the bleeding from wound. All the steps help in reducing the bleeding and oozing. However where in spite of all these steps it does not stop or reduce after one day then one should contact the Oral Surgeon as this is not normal and good and there can be some other reason for the same. During the period of formation of clot in the exposed extraction site of wisdom tooth and coupled with presence of bacteria in the mouth, one can have bad smell coming from there shortly after the surgery. Further this can be accompanied by bad tasting fluid seeping from extraction site. This bad smell and fluid can continue upto maximum 2 weeks after the surgery. All these increase the importance of follow up appointment with dentist within 7-10 days of surgery. During this visit if the dentist feels that the infection has set in the extraction socket then he gently uses a plastic syringe without the hypodermic needle and fills it with a mixture of equal parts of hydrogen peroxide and water or Chlorhexidine Gluconate which also comes in the form of a mouth wash, into the sockets to remove any food or bacteria that may have collected in the back of the mouth.
This is the most common complication after extraction. Our mouth is full of bacteria. One cannot sterilize it. Dentist decides whether to give antibiotics after the extraction or not. Usually for the simple extractions antibiotics may not necessary but in the case of patient having pain and swelling or pus then the dentist prescribes the antibiotics as a preventive measure. In cases where bleeding continues after 48 hours along with acute pain and swelling, there could be infection after the extraction. In such cases the patient must contact dentist to avoid further complications.
Swelling is another common problem after the extraction of wisdom tooth. Rather the painful swelling is a good sign and is indicator of normal progress of healing process of wound. There is no fixed time frame for its duration and level of severity. These can be different from person to person. To reduce the amount of swelling one can do cold fermentation with ice. It should be done for 20 minutes and then take break of 20 minutes. Do this for one hour within 12 hours of surgery. Do not do hot fermentation. The post operative instructions of the dentist explain all this including the start and reduction of swelling. Normally it takes 7 days for swelling to subside and if this does not happen within this expected time then one should call up the dentist to checkup. In cases where swelling once goes away and then sets in again, this can be due to infection in the wound.
Dry Socket is also one of the most common complications of wisdom tooth extraction. It is a very painful condition. In dry socket condition the pain is acute and it does not subside even after taking pain killer tablets and to complicate further food gets impacted in the socket. It happens when the blood clot formed over the extraction site gets dislodged or does not form or falls of prematurely. Dry Socket is not an infection rather it is a condition. This happens when the post extraction instructions given by the dentist are not followed by the patient. Smoking, drinking with straw, sucking, spitting or blowing nose dislodges the clot. Females taking contraceptives have higher risk of getting dry socket due to the high level of estrogen. Further sometimes sneezing, musical instruments played with mouth also can disturb the clot due to change in pressure in the mouth. In the cases where the patients are smokers or in the case of complicated extractions involving lot of effort on the part of dentist for cutting the bone or in the case of patients having previous history of dry socket, the chances of their having dry socket are higher than others. When all the symptoms are present and the patient suspects of having dry socket then he should contact the dentist. The dentist will clean the extraction socket and induce fresh bleeding for formation of clot. In case of infection, the antibiotics are prescribed along with pain killers.
When the wisdom tooth is extracted by the dentist/Oral Surgeon, they have to be cautious so that to avoid the injury to nerve as these can be in close proximity to the tooth being extracted. The nerves of major concern are Inferior Alveolar Nerve and Lingual Nerve. The importance of these nerves is as under:
Inferior Alveolar Nerve – This nerve enters the mandible at the mandibular foramen and exits the mandible at the sides of the chin from the mental foramen. This nerve supplies sensation to the lower teeth on the right or left half of the dental arch, as well as sense of touch to the right or left half of the chin and lower lip.
Lingual Nerve – This nerve branches off the mandibular branches of the trigeminal nerveand courses just inside the jaw bone, entering the tongue and supplying sense of touch and taste to the right and left half of the anterior 2/3 of the tongue as well as the lingual gingiva. Such injuries can occur while lifting teeth but are most commonly caused by inadvertent damage with a surgical drill. Such injuries are rare and are usually temporary. Depending on the type of injury they can be prolonged or permanent.
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