Part 1 can be found here

How difficult will the wisdom tooth be to remove?

The difficulty depends on the number of observations all taken together for the dentist to analyze. Generally speaking, wisdom teeth are more difficult to take out than other normal teeth – however this is not always the case.

Some wisdom teeth can be taken out in a number of seconds, whereas others can take more than an hour to take out. Having said that, other teeth which are not wisdom teeth sometimes also take a few seconds to take out, but also can take an hour to take out. It all really depends on a number of observations all taken together for the dentist to analyze.

There is a massive difference between whether the wisdom tooth is an upper one or a lower one, which dictates how difficult wisdom teeth are to remove. Upper wisdom teeth cause less problems to extract than lower teeth. Even after the extractions have been done, upper wisdom teeth give you far less post-operative complications than lower wisdom teeth which have been taken out.

There are a number of reasons why upper wisdom teeth are easier to extract then lower wisdom teeth. One such factor, which makes upper wisdom teeth easier to take out than lower wisdom teeth, is the root anatomy of wisdom teeth.

Upper wisdom teeth tend to have a more simple route anatomy than lower wisdom teeth. Our wisdom teeth often will just have one small conical root, which will come out very easily, whereas lower wisdom teeth tend to have multiple roots which are curved in different directions.

So to answer the question , how difficult will the wisdom tooth be to remove, depends on a number of observations all taken together for the dentist to analyze and these observations relate to the oral examination common findings of the radiographs, the classification of the impaction, overall medical health, and how nervous you are.

Let’s take all these factors in turn.

1. The oral examination.

When a dentist looks at your wisdom tooth in your mouth, the dentist will have a very good idea then of how difficult that wisdom tooth will be to take out. The oral exam, however, can be deceptive as well. A wisdom tooth might look very difficult to take out but on the day of the extraction, it can come out very quickly and very simply without much problem afterwards.

1. Findings of the radiographs.

A good set of dental x-rays is absolutely critical in ascertaining the difficulty level of a particular wisdom tooth. The X-ray tells the Dentist a number of things, such as how close the roots are to the nerve, the angulation and the density of the surrounding alveolar bone.

1. The classification.

As mentioned above, the impacted wisdom tooth can be classified so that the dentist knows the relationship of the wisdom tooth to the other teeth in the mouth and the position in the jaw bone. Disto alveolar impaction is much more difficult than a wisdom tooth which is upright. The dental classification takes into account mainly the position in relation to the surrounding structures, such as the inferior alveolar dental nerve.

1. Overall medical and general health.

Your overall medical and general health is an important factor which must be taken into account in order to work out how difficult the wisdom tooth will be to remove. If for example you have diabetes, it could be that special precautions have to be taken so that you do not have a situation where your blood sugar dips during a wisdom tooth extraction, hence complicating things. Your overall medical health is also very important, and if you are fit and healthy it does make sure that there are going to be fewer complications afterwards.

1. How nervous you are.

One of the more important factors is how nervous you are as a patient. There is a saying in surgery which states that it is easier to carry out a difficult procedure on the co-operative patient rather than an easy procedure on a difficult patient.

Do I need to be put to sleep for my wisdom teeth extractions?

The three choices you normally have for the removal of your wisdom teeth are: 1) local anaesthetic, 2) sedation, 3) general anaesthetic.

There is in fact a fourth option, which is not to have anything at all! At our practice, we have had a few patients who have been brave enough not to have any anaesthetic whatsoever. You may think, how is this even possible? One of these patients was a hypnotherapist by profession, and he hypnotized himself not to feel any pain. Another patient was a monk, who could go into such deep levels of relaxation that he could blank out any form of pain. However, most people are not hypnotherapists or monks (!), so it is usually recommended that they have one of the three forms of anaesthesia.

1. Local anaesthetic

If at all possible, it is preferable to have your wisdom teeth out by a normal dental injection in the same way as you would have a filling done. For simple to moderate levels of difficulty, a local anaesthetic is the best way to have your wisdom teeth out. It is best, because you don’t need to go into hospital, you don’t need to bring anyone with you, and once the extraction has been done, you can go home and the numbness will wear off in a few hours.

1. Sedation

Sedation is a little bit in between a local anaesthetic and a general anaesthetic. Dental sedation can even be done at your dental practice rather than hospital. Dental sedation will wear off a lot quicker than a general anaesthetic, but at the same time you will be more comfortable than with a local.

1. General anaesthetic

The general anaesthetic needs to be done in hospital. Afterwards it will take several hours for the full effects of the general anaesthetic to wear off.

So I started by saying that not all wisdom teeth need to be taken out whilst you are asleep. It depends on the level of difficulty of the wisdom teeth, the number of teeth you are having out, and how nervous you are. It’s perfectly fine for a relaxed patient to have all four wisdom teeth taken out which are of simple nature, at your normal dentist in the dental chair. On the other hand, just one wisdom tooth which is going to be very difficult and close to the nerve, will be better taken out in hospital.

Packing

An important reason for taking out wisdom tooth or wisdom teeth is because of food packing.

Food packing is problematic both in the short term and long term. In the short term, food packing causes bad breath and a bad taste in the patient’s mouth. In the long term the food packing causes pain, infection, inflammation, and infection.

If the patient cannot keep the food out, then it is always best to have the wisdom tooth or teeth removed.

Gum Disease

When a wisdom tooth has been causing problems for a long time, gum disease around it is always going to be a problem. Gum disease around the wisdom tooth is no different to gum disease around any other teeth in your mouth. Gum disease is caused by the accumulation of plaque, which if not removed, causes the gums to become inflamed and infected.

Often with wisdom teeth, it is not easy to treat the gum disease because it becomes impossible or at least very difficult to keep the gum around the wisdom teeth clean enough.