TOOTH REMOVAL

An impacted tooth refers to a tooth that is stuck inside the jawbone and is unable to move into its proper place in the mouth due to blockage by another tooth, dense bone, thick tissue or inadequate room in the mouth.

If left in place, impacted teeth can cause a variety of problems including:

1. Impacted teeth press against adjacent teeth possibly causing injury or contributing to crowding of nearby teeth.
2. A cyst (fluid-filled entity) may surround an impacted tooth, causing destruction of surrounding bone as it grows. A cyst can cause movement of adjacent teeth and structures causing further damage.
3. If saliva is able to reach an impacted tooth, decay may result, and subsequently causing an infection with a severe toothache. These deep cavities are not accessible and therefore cannot be filled.
4. Germs in saliva may cause an infection around an impacted tooth. This infection may potentially spread to the cheek, throat or neck, causing severe pain, stiffness of the jaw and general body illness.
5. Impacted teeth have been implicated in causing headaches, earaches and may be the source of severe pain to nearby teeth or the opposing jaw (referred pain).
6. If not removed, an impacted tooth could cause concern in the future, requiring removal at a later date and increasing the risks of surgical complications at that time.
7. If you choose not to have an impacted tooth removed, ensure that your dentist takes specific x-rays to monitor the tooth every 1 to 2 years.

The Tooth Extraction Experience

An impacted tooth usually resides beneath the gum tissue surface and it may or may not be covered by bone. Due to its position, its removal requires a surgical procedure. Local anesthesia is administered to the site, rendering the affected area numb. During the procedure, no pain should be experienced, however a sense of pushing and pulling may still be felt. 

The entire procedure may range anywhere from 30 minutes to a few hours depending on the number of teeth requiring removal and their complications.

During tooth removal, it may be necessary to cut into the gum tissue and possibly remove the supporting bone.

At the end of the surgical procedure, stitches may be placed to help control bleeding as well as reapproximate the gum tissues.

It is important that you fill the prescribed medications and follow the post-procedure home care instructions given to you by your dentist. It may take 1 to 2 weeks for your mouth to feel comfortable and another 2 to 4 weeks for the tissue to completely heal.

Risks & Complications

There is a risk, however small or rare, associated with even the most careful tooth extractions. The following is an explanation of some (but not necessarily all) of these possible risks and complications.

After tooth removal, there may be a large defect in the jawbone that will take time to heal. Sometimes, infection may occur, even several weeks later and additional treatment may be necessary, such as drainage of an abscess. There may also be little bone or tooth fragments that may slowly extravasate over several weeks causing some discomfort.

Like any other surgery, there is risk of bleeding. Bleeding is controlled once you leave the clinic; however, minimal bleeding at home is normal. If you bleed excessively, it is important to seek the help of an ER physician or contact your dentist.

In addition, there may be pain, swelling and tenderness after the surgery. These symptoms are usually the worst in the first 2-3 days, however they may persist for a couple of weeks. There may also be tenderness at the injection site.

Lower impacted teeth usually rest close to the main nerve of the lower jaw and tongue. Sometimes during the procedure, these nerves may be bruised or injured. This may result in altered sensation with partial or rarely complete numbness. Less commonly, one may experience a burning, tingling or pain of the lower lip, inside the cheek, gum tissues and all the teeth on one side or the tip of the tongue. Taste sensation may also be reduced or rarely lost entirely. In most cases (approximately 95% of the time), altered sensations do not last more than a few weeks as the nerve repairs itself. In rare cases, the altered sensation may last several months or years and it may be permanent. Altered sensation does not affect your appearance.

Upper impacted teeth may lie against the walls of the sinus cavity or at the base of the nose. Their removal may occasionally cause an opening leading to seepage of blood into the nose or sinus. A prescription decongestant often remedies this situation but rare cases may require further surgery. Extraction sometimes results in displacement of the tooth into the adjacent sinus cavity or anatomic space requiring further surgery for its removal.

During extraction, adjacent teeth may become weakened or injured. Sometimes adjacent teeth are already affected prior to extraction, and only after extraction does this become evident. Adjacent teeth may require subsequent treatment and may not feel comfortable for weeks following the procedure. Large fillings or crowns on adjacent teeth may become dislodged inadvertently during the procedure.

With difficult extractions, the roots of a tooth may be left in place if the dentist determines that the surgery necessary for their removal may damage adjacent nerves or teeth. Rarely, these tooth remnants may cause concern in the future, requiring their surgical removal.

Stiffness of the jaw is common after surgery and may last several weeks. Limited mouth opening and pain on wide opening may result and will heal with time. Occasionally the jaw joints themselves will be particularly sore or stiff or there may be exacerbation of a pre-existing condition, including jaw locking, clicking or other symptoms. This may require further treatment.

In extremely rare circumstances, removal of lower teeth results in jaw fracture. This may occur during the procedure or several days after the surgery due to weakened bone structure.

Medications prescribed for surgery may interfere with your currently prescribed medications. Ask your dentist and pharmacist for more information regarding your medications.