What are the Risk and Potential Complications of having your Wisdom Teeth Out?

Before having your wisdom teeth out it is important you understand not just the benefits of treatment- e.g. teeth will be easier to clean but also the risks and the other treatment options such as trying to fill the tooth or simply doing nothing.

The risks and complications of an extraction all apply and are covered in detail, in the dental extraction series.

As with any extraction, these will vary from case to case. If your wisdom tooth is fully through (or nearly) and needs to be extracted, then it is just like taking a normal tooth out, only a little further back.

Remember a ‘wisdom tooth’ simply means a third molar tooth.

Surgical wisdom tooth extractions are a different matter. The more impacted and more bone removal needed the greater side effects, potential complications and the longer recovery will take.

You should expect:

• Pain

• Swelling

• Bruising

• Difficulty opening your mouth

• Social and lifestyle consequences– You may need time off work, to eat a soft diet for week and be out of normal routine- not exercising or socializing. As mentioned above, this totally depends on the difficulty of the extraction. Patients who have a simple upper wisdom tooth extraction sometimes complain of not really even noticing any soreness or problems whatsoever and are back to normal later that day or the next. A surgical impacted wisdom tooth will knock you about a little more, so expect it.

And there is a risk of:

• Dry socket -This affects 1-35% lower wisdom teeth extractions but will depend on the difficulty and technique used.

• Nerve problems- See ‘What about possible nerve damage’ below for more details.

Are you having the Procedure Under General Anaesthetic?

This comes with its own set of risks and specific routine. It tends to be reserved for cases that are expected to be particularly difficult, uncomfortable or long and you are probably going to have all four teeth out at the same time. Thus you should expect the recovery period to be that bit worse and the side effects more severe.

Plan accordingly with a few days- up to a week of rest following surgery to allow the bulk of the swelling to go down and pain to subside. Having a general anaesthetic in its self knocks you about a bit.

Mortality from general anaesthetic is anticipated to be about 1 in 200,000 and those patients with complicated medical problems are more of a concern.

What about Possible Nerve Damage?

How close or involved the roots of your wisdom teeth are to the nerve canal, the depth of impaction and the type of procedure carried out for its removal, will all affect the risk of this complication. Thus a detailed assessment of your wisdom tooth must be made of this before hand.

Both your Lingual and Inferior Dental (ID) nerve supplying the tongue and teeth/lower lip respectively are at risk from stretching or bruising during the removal of lower wisdom teeth.

A simple fully erupted tooth is unlikely to have any involvement, particularly if a clear gap exists between the nerve canal and the roots of the wisdom tooth. A deep impaction requiring extensive bone removal in the region of the nerve carries a somewhat higher risk.

All dentists must warn you that nerve damage, though rare, is a possibility and you need to be aware of this. If some persisting numbness does occur most of the time this will heal spontaneously over the course of a few weeks; this may even take months. During this time you will start to feel the sensation slowly coming back while total numbness may change to a tingling as the nerve fibres regenerate.

If after 6 months there has been no improvement then it is likely that some permanent damage has been sustained; this occurs in about 0.5% of cases. A consultation with a neuro- surgeon to discuss the possibilities of surgery and regeneration should be considered.

Nerve damage is actually a risk any time an injection is given. It is very very rare that it happens, but it can and has been known to. It most often happens when an ID block is being given in the lower jaw and happens from the needle hitting and damaging the nerve while the injection is given.

If the dentist hits the nerve (which by the way we are aiming for) a sharp ‘electric shock’ will be felt. When this happens the nerve goes numb very rapidly. Nearly all the time, when this happens the anaesthetic will just wear off as normal without any lasting damage. The aim of the local anaesthetic injection is to place anaesthetic near the nerve. The chance of actually hitting it is incredibly small because the nerve is tiny. I give injections all day everyday and for me it may happen a couple of times a year.