All about Wisdom Teeth

A wisdom tooth, in humans, is any of the usually four third molars, including mandibular third molar and maxillary third molar. Wisdom teeth usually appear between the ages of 17 and 25. Most adults have four wisdom teeth, but it is possible to have more, in which case they are called supernumerary teeth. Wisdom teeth commonly affect other teeth as they develop, becoming impacted or "coming in sideways". They are often extracted when this occurs.

The Indonesian term of wisdom teeth is 'gigi bungsu'. 'Bungsu' means the youngest child. This represents that the teeth are 'younger' than the other teeth. Most of Indonesian does not aware of these teeth until they cause problems. This article is to show the reasons and complications of the extraction of wisdom teeth

Why are wisdom teeth extracted?

Wisdom teeth cause problems more often than other teeth. Therefore, for several reasons, it can be wise to remove them. Some of the reasons to extract the wisdom teeth:

1. acute/chronic inflammation/infection of the affected wisdomtooth (dentitio difficilis)
2. there is deep caries within the tooth (possibly with severe inflammation of the root) or the tooth is extensively damaged and can no longer be restored
3. it is probably the cause of your unexplained pain
4. in case of disease (cysts/tumour) of a tooth in the lower jaw has developed or could develop
5. it is interfering with prosthetic or orthodontal treatment or a surgical procedure
6. it could damage or cause resorption (loss of substance) of adjacent teeth
7. it could hinder successful treatment of periodontal disease
8. it is probably the cause of inflammation or a cyst in the maxillary sinus
9. transplantation of the tooth is planned
10. because of malalignment (tilting/displacement), the tooth is hindering proper chewing
11. because of its nearness to a fracture of your jaw
12. it could be a hazard (e.g. in the case chemotherapy, immunosuppression or radiation)
13. it could hinder dental treatment (fitting a prosthesis, fillings) of adjacent teeth.



How is the procedure performed?

The surgery is performed under local anaesthesia or under general anaesthesia. For extraction of a lower wisdom tooth, the local anaesthetic agent is injected into the lower inner side and possibly the outer side of the jaw and around the tooth; for extraction of an upper wisdom tooth, the anaesthetic agent is injected into the inner and outer surface of the jaw and around the tooth. To expose the tooth, an incision is made in the gum and the bony structure encasing the tooth is removed with a drill. The wisdom tooth can then be removed with an extracting forceps or an elevator. It some cases it may be necessary to cut the tooth into pieces.

Impacted wisdom tooth



The wound is either stitched or packed with gauze. In the upper jaw, the roots of the wisdom teeth often extend into the maxillary sinuses. When one of the upper wisdom teeth is removed, an open communication between the sinus and the oral cavity can arise which may lead to maxillary sinusitis. If this communication develops, it must be closed during the same procedure using a small flap of skin, which is generally removed from the cheek.

removal of upper jaw wisdom tooth with elevator

General Complications

Complications can occur during or after the procedure, which under certain circumstances may necessitate immediate treatment. How likely it is that these complications will occur depends on

the patient (e.g. whether he/she smokes). Those are:

• Generalized reactions: Changes in blood pressure, pulse, or side-effects that affect the nervous system (restlessness, seizures, breathing impairment) can develop secondary to medications that may be given (e.g. local anaesthetic agents). These symptoms usually go away by themselves without treatment; medical intervention (e.g. infus ions, medications) is sometimes necessary, however.

• Bleeding: If bleeding is severe, the wound may have to be reopened and sutured once again, packing to stop bleeding / medicated packing) may need to be applied, or medications or another operation may be necessary. If necessary a protective splint may also be placed.

• Damage to soft tissues (injection track abscess, necrosis of tissue, swelling, pain, nerve irritation) can occur before, during or after the procedure secondary to injections; this damage usually goes away by itself or it is easily treated. In an unfavourable case, long-persisting or even permanent damage (e.g. painful alteration in sensation, numbness) can develop. It is quite normal for a surgical wound to heal by forming scars. This sometimes leads to sensitivity to weather changes, a feeling of tension and pain due to irritation. Skin/mucous membrane damage is caused in very rare cases by sterilizing agents, protective materials and electrical current (redness, irritation, superficial burns). Compression damage occurs very rarely, despite employing standard techniques in positioning the patient.

• Infection (abscess, bone infection): Treatment with antibiotics, irrigation or a second operation may be necessary. In very rare case, infection leads to life threatening spread of micro organisms in the blood stream (blood poisoning; sepsis) or even to inflammation/infection of organs (e.g. the membrane lining the heart – endocarditis). Treatment with antibiotics and/or on an intensive care unit may then be necessary.

• Hypersensitivity reaction (allergy) to an anaesthetic agent or to a medication that may be given (e.g. antibiotics) can occur. Mild allergy is manifested by, e.g. itching; severe reaction even with circulatory collapse, seizures, and breathing difficulty, which can be critical or life-threatening and lead to permanent consequences (e.g. kidney or brain damage), necessitates hospitalisation in some cases.

• Thrombosis/embolus:Life-threatening problems are extremely rare and are more likely to occur in patients who are confined to bed for a prolonged period, in the case of lengthy operations, if certain medications are taken ( e.g. contraceptive medications – “the pill”) or in elderly patients. If you are at high risk for thrombosis and embolus (formation of blood clots and their movement through the blood stream), you will receive prophylactic medications (thromboembolic prophylaxis ) in order to prevent the consequences of this complication (e.g. stroke with permanent paralysis) . These measures that may be necessary to thin the blood can increase the risk of post-surgical bleeding or cause changes in the blood count.

• Breakage of the delicate ends of the root. Depending on the findings, the root ends are either removed or left in place

Complications in upper jaw:

• If a communication to the maxillary sinus is established or if the tip of the root breaks off and migrates into the maxillary sinus , inflammation/infection can occur. Treatment with antibiotics or an operation (e.g. removal of the root) may be necessary.

• Nerve injury: In very rare cases, e.g. when the anterior wall of the maxillary sinus is exposed and due to scar formation, damage occurs to the nerve of the upper jaw; consequences are alteration in sensation (e.g. numbness of the lip, painful alteration in sens a ion) in particular of the upper lip, the teeth, the mucous membranes, the cheek and possibly half of the nose (internal and external). This type of impairment of sensation can also occur secondary to injection of an anaesthetic agent in extremely rare cases.

Complications in Lower jaw:

• Nerve injury: Because the nerve is sometimes located very near the roots of the wisdom teeth, a mechanical injury can occur to the nerve when the wisdom tooth is being extracted. This injury can cause an alteration in sensation, mainly in the lower lip, the mucous membranes and the teeth. The (nerve supplying the tongue) is located in the inner side of the lower jaw, also near the

tooth to be extracted, and in very rare cases it can be bumped or bruised during the operation, which is manifested as symptoms such as numb sensation and a change in taste perception of the anterior part of the tongue on the affected side. The nerve damage des cribed above (e.g. numbness of the lower lip, painful alteration in s ensation) is usually of a temporary nature; in rare cases it can be permanent – despite subsequent surgical intervention (e.g. nerve suture). This injury will not affect the ability to move the tongue or the lower lip in any way. In extremely rare cases, these changes in sensation can also be due to an injury caused by the needle when injecting the anaesthetic agent.

• Fracture of the mandible. Since bone tissue must be removed to extract the tooth, the jaw is weakened in that area. During the operation, or even for a period as long as several weeks after the wisdom tooth has been extracted, a stress fracture of the lower jaw may occur if undue pressure is exerted. The fracture requires treatment, but usually heals without complication. If the teeth are located deep in the bone, there is a higher risk that the jaw will fracture.

• Bone infection: This can occur even at a later time (even years later) if the wound does not heal over and can lead to impaired sensation (e.g. numbness, painful alteration in sensation) and inhibit opening of the mouth. This complication occurs in particular in patients who have underlying disease such as diabetes , weakened immune response or after radiation treatment. If this complication occurs, major operations and prolonged treatment with antibiotics may be necessary to cure the infections.

Despite all the possibilities of complications, the extraction of wisdom teeth is suggested for many cases because of its many advantages compared to its disadvantages. 





Operative extraction of wisdom teeth could be done in Schön Dental only on appointment with Drg. Henri Mudjono. For free pre-consultation call 081389989122.