Wisdom teeth avulsion
Wisdom teeth avulsion is a common surgical procedure. The operation is performed under local or general anesthesia. If your case requires general anesthesia, your ENT and cervicofacial surgeon can perform the procedure on an outpatient basis, like his or her stomatologist or maxillofacial colleagues. A stomatologist, oral surgeon, maxillofacial surgeon or certain dentists can perform the removal under local anaesthetic whenever possible.
Find out more about wisdom teeth surgery from Dr. Delagranda, ENT and cervico-facial surgeon.
Objectives of wisdom tooth avulsion
- Reduce the risk of posterior caries on the second molar.
- Eliminate the pain associated with wisdom tooth eruption.
- Facilitate and/or stabilize the work of orthodontists.
Wisdom teeth
Wisdom teeth, or third molars (called “germs” when the roots are absent or incomplete), are the last teeth to build up and erupt. They generally appear in the mouth between 17 and 20 years of age, provided there are no obstacles to their eruption, or morphological defects preventing their normal development.
It is not uncommon to find one or more wisdom tooth agenesis (lack of development), which can be diagnosed on X-ray.
Their avulsion is indicated in cases of malpositioning, lack of space, painful inflammatory or infectious accidents, or tumoral accidents (dentigerous/follicular cysts, etc.).
Inflammatory or infectious accidents, known as “pericoronaritis”, can evolve into a more extensive infection known as “cellulitis”, requiring rapid and appropriate treatment. The result is limited mouth opening, swelling of the cheek, stabbing pain radiating into the ear, and a bitter, salty taste indicating the presence of pus in the oral cavity. If the infection progresses to the stage of cellulitis, it is important to look for signs of “severity”: an altered general condition (fever, nausea, severe fatigue, etc.), limited mouth opening of less than a fingerbreadth, difficulty breathing or real difficulty swallowing solid foods. The infection could evolve and spread, so it’s important to consult a healthcare professional.
Indications for wisdom teeth avulsion
Adolescents from the age of 12 and all adults can be concerned.
Wisdom teeth are best avulsed when they have not yet completed root formation. In fact, the length and divergence of the roots can make the procedure more difficult, increasing postoperative symptoms.
Main cause of wisdom teeth avulsion indications for adolescents:
- Anticipation of lack of space available for eruption of wisdom teeth without anomaly (jaw too small).
- For orthodontic purposes: eruption of wisdom teeth can cause tooth displacement when there is insufficient space available, so it’s preferable to remove them once orthodontic treatment has stabilized.
- Infectious episode: an inflammatory or infectious outbreak during eruption, marking an abnormal eruption. This is more common in young adults.
- Benign tumor: follicular cyst / dentigerous.
Main cause of wisdom teeth avulsion indications for adults:
- Infectious episode.
- Decay of the second molar at the posterior contact with the wisdom tooth.
- Benign cystic tumour.
The different stages of the intervention
The surgical procedure
ENT-cervicofacial wisdom teeth surgery is performed under general anesthesia, depending on the invasiveness of the procedure (number of teeth, depth of inclusion, abnormal situation, etc.) and the patient’s medical status: medical pathology, cooperation, psychological state….
Under general anaesthesia: The procedure is performed on an outpatient basis, meaning that the patient comes in on the morning of the procedure fasting since midnight the night before (no food, drink or tobacco), and leaves on the day of the procedure. The procedure lasts 20-30 minutes. Teeth are removed in one piece, if possible, using special instruments called forceps, and the dental root cavities, called alveoli, are cleaned. When the wisdom teeth are in the germ stage, it is necessary to open the mucous membrane of the mouth, fracture the jawbone to free the wisdom teeth, and book the removal of the pericoronal cyst.
Post-operative recovery period
After surgery, we recommend you to rest at home for 4-5 days. Unsuitable activity promotes post-operative swelling, pain and bleeding.
Post-operative pain is often considerable, and is controlled by class II analgesics.
The surgeon will issue a certificate and a medical sick leave report.
Post-operative instructions are :
- Cold, soft food for 3 to 5 days: cold food limits bleeding and edema. Hard food should be avoided, as postoperative mouth opening can be limited for up to 10 days after surgery.
- Apply ice packs to jugal edema.
- Resume impeccable oral hygiene on the evening of the operation, brushing the operated areas with a soft toothbrush.
- Sport is not recommended for the first 15 days, and should be resumed gradually.
- Follow the post-op prescription.
- Post-operative care at home: mouthwash, brushing, analgesics, possible antibiotic therapy.
- Scarring: no visible scarring.
- Stitches may be present in the surgical area. These are resorbable and will disappear on their own, sometimes within several weeks.
Complications associated with wisdom teeth surgery
In addition to the risks inherent in any surgery involving general anaesthesia, wisdom teeth avulsion presents a number of complications:
- Persistent hematoma and bleeding.
- Alveolitis: inflammation or infection of the tooth socket.
- Damage to a neighboring tooth, loosening of a crown, fracture of a dental restoration, bridge or tooth.
- Loss or reduction of sensitivity of the lip and/or tongue, usually transient (a few weeks to a few months) and exceptionally permanent.
- Bone fracture (mandibular angle in particular) during surgery or during the consolidation phase.
- Communication between mouth and maxillary sinus usually closes on its own (4 to 8 weeks). If it persists, further surgery is required to close it.
- Projection of an upper wisdom tooth or fragment into the sinus, behind the sinus or into the cheek, which may require further surgery.
Frequently asked questions
Here is a selection of questions frequently asked by Dr Delagranda’s patients during consultations for wisdom teeth avulsion in La Roche-sur-Yon.
How long will I be swollen?
Post-operative swelling can last up to 10 days. Contact your surgeon if it lasts longer. An inflammatory peak with increased swelling frequently occurs on the 3rd day.
Do I have to have them removed?
No. However, the earlier the teeth are removed, the easier they are to manage and the less unpleasant the after-effects. What’s more, it’s best to remove them before complications (see above) arise.
How is wisdom teeth surgery performed?
Wisdom teeth surgery is performed under general anaesthetic, with tracheal intubation taking 20-30 minutes.
When can I eat after wisdom teeth avulsion?
Eating can be resumed on the first day. However, food should be cold and soft for the first few days, as heat promotes edema, bleeding and pain.
What should I eat after wisdom teeth removal?
Food should be cold and blended for at least 3 to 5 days, to limit the risk of bleeding. Ice cream is permitted and recommended.
How long before I can resume sport?
Ideally, avoid sport for at least 7 days. Physical activity causes inflammation, bleeding and pain. Resumption of physical activity should be gradual.
Can I smoke afterwards?
No. Smoking must be stopped 3 days before the operation (to facilitate anesthesia) and at least 15 days afterwards. Smoking exposes you to alveolitis, and even more serious infections such as cellulitis.
What to do if bleeding resumes?
The first thing to do is rinse your mouth with ice-cold water, without gargling (very gentle mouthwash). If that doesn’t do the trick, wrap a wet compress or handkerchief around the bleeding area and hold STRONGLY for 15 minutes, watch in hand. Repeat these two steps until the bleeding stops. If bleeding persists, contact your surgeon.
Fees and coverage of the procedure
Wisdom teeth surgery is covered by health insurance. Contact your health insurance company to find out whether any extra fees will be covered.
Do you have a question? Need more information?
Dr Antoine Delagranda will be happy to answer any questions you may have about wisdom teeth surgery. Dr Delagranda is a specialist in ENT surgery at the Clinique Saint Charles in La Roche-sur-Yon in the Vendée.
ENT consultation for wisdom teeth avulsion in Vendée
Dr Antoine Delagranda will be happy to answer any questions you may have about wisdom teeth surgery. Dr Delagranda is a specialist in ENT surgery at the Clinique Saint Charles in La Roche-sur-Yon in the Vendée.