Many people wonder why it is necessary to remove your wisdom teeth if they aren’t having any problems. Wisdom teeth will likely have issues throughout life, including gum disease, infection, pain, swelling, root resorption of adjacent teeth, and cavities. To avoid these potential issues, we remove the teeth while young because the procedure is easier on both the patient and dentist while young. Waiting for a problem to arise and then having the teeth extracted is much more complicated and has worse implications. For example, the image in this section shows an infection that developed around a wisdom tooth that spread to other teeth and required other extractions. In addition, the complicated extraction had to be done with care not to break the jaw during the teeth extraction. You can see how having the wisdom teeth removal procedure while young would have benefited this patient.

The Steps of a Wisdom Teeth Removal Procedure:

1- Numb Teeth Sufficiently.
2- Release gums covering the wisdom teeth if applicable.
3- Remove bone covering wisdom teeth if applicable.
4- Create a leverage point for the tooth elevator.
5- Put pressure on the wisdom tooth until it loosens.
6- If needed, remove the tooth and bone on the distal side of the tooth so it has space to move.
7- If needed, remove the bone on the cheek side of the tooth to create space for extraction.
8- If needed, section the tooth, so the different roots are separate pieces.
9- If needed, cut off the crown of the tooth for more space.
10- Elevate and extract teeth from the socket.
11- Irrigate the socket with sterile water.
12- Place clot-promoting resorbable fabric in the socket.
13- Suture closed the loosened gums if applicable.

Click an Image of an Upper Wisdom Tooth Extraction

Wisdom Tooth Removal Procedure Upper Maxillary

Is Local Anesthesia Enough for Wisdom Teeth Extractions at a Dentist's Office?

Compared to an oral surgeon's office, the process of having wisdom teeth taken out at a dentist's office is mostly the same. However, the significant difference at some dentist offices, like ours, is that patients are awake for the procedure. The anesthesia a patient receives at a dentist’s office is called local anesthesia. Local Anesthesia means once you are numb, you will not feel any pain during the extraction procedure, but you will feel pressure and experience everything while awake. The local anesthesia is quite profound and takes a few minutes to get used to before the wisdom teeth removal.

Patients without extreme dental anxiety can handle the wisdom teeth removal procedure without being put to sleep. Patients with mild dental anxiety usually are only anxious during the first 5 to 10 minutes. At that point, they understand what to expect from the procedure and become more at ease. You can expect to feel pressure and sometimes hear small cracking noises during the removal procedure. Once again, patients get used to these after about 5 to 10 minutes.

Click for an Image of an Injection for Upper Wisdom Teeth

Numbing for wisdom tooth removal PSA

Why Do You Make An Incision For Wisdom Teeth Removal?

Depending on how impacted wisdom teeth are, they may require an incision in the gums for removal. The dentist exposes the tooth by pulling the gums back if they partially cover it or if it requires a slot in the bone. As you can see from the accompanying video to this article, not every wisdom tooth extraction will require an incision.

Click for an Image of a Wisdom Tooth Incision

making incision in gums for wisdom teeth removal procedure

Why Do You Remove Bone For a Wisdom Tooth Extraction?

Not every wisdom tooth extraction will require a small slot drilled into the jaw bone. If bone covers your wisdom tooth, you will need to remove it to create space to remove the tooth. The dentist may also need to remove bone if a tooth moves solely in a direction blocked by bone. New bone will fill in the socket as it heals.

Click for an Image of a Bone Slot around a Wisdom Tooth Extraction

Drilling a trough or slot in jaw bone for wisdom teeth removal procedure.

How Do You Extract A Wisdom Tooth?

You extract a wisdom tooth by putting pressure on it, slowly breaking the ligaments that anchor the tooth to the bone. Putting pressure in particular directions on a wisdom tooth is more beneficial to remove the tooth. For example, we commonly use an elevator, between the bone and teeth, that puts a backward and rotating pressure on the tooth. The rotating force is essential because many teeth have curved roots and create a rounded pathway out of the socket. We also use forceps that put back-and-forth pressure on the tooth. The force that goes on a tooth will eventually break all the ligaments to extract the tooth.

In the accompanying video, the third wisdom tooth is an excellent example of curved roots rotating out of the socket instead of coming straight out.

Click for an Image of an Elevator Pressing on a Wisdom Tooth Extraction 

Elevating a wisdom tooth extraction

What Are Wisdom Tooth Removal Complications During the Procedure?

While all wisdom teeth will loosen with pressure, many complications can make putting adequate pressure on a tooth much more difficult. For example, wisdom teeth will have two roots that curve in directly opposite directions to each other. The opposing root pathways make an impossible pathway out for the wisdom teeth. In this case, the dentist must drill the tooth in half to remove each root separately with its distinct path. The accompanying video of this article demonstrates the rotating extraction path on one of the wisdom teeth extractions.

Here is a brief list of other wisdom teeth removal complications: Impacted wisdom teeth, wisdom teeth in uncommon positions, brittle roots, extremely curvy roots, hard bone, small mouths, bulbous rooted teeth, and ankylosed roots. There are many other less common complications as well. Each wisdom tooth will come with its combination of these complications, making it a puzzle that the dentist must solve in real-time. However, many well-known techniques will easily solve these complications in extracting wisdom teeth.

Click for the Image of a Sectioned Tooth Piece Rotating Out and Backward.

One Piece Of Wisdom Tooth Extraction Rolling Into Another

How Do We Extract Complicated Wisdom Teeth?

We take a standard set of additional steps to make more complicated extractions easier. As noted above, we first pull back the gums and remove any bone above the wisdom tooths. Next, we drill a slot in the tooth to make space for our elevator. Then we apply pressure to loosen the tooth and determine if we need to take additional steps. Finally, with the tooth slightly loosened, we drill a slot or trough around the bone on the cheek and back side around the tooth. This slot will give the tooth space to move and loosen.

 If drilling a trough around the tooth is not enough, we then drill the tooth in half so we can remove the roots separately. As stated earlier, the roots sometimes want to rotate into the other half. Therefore, each half of the tooth will block the other from coming out. To avoid this, we move on to cutting off the tooth's crown, giving space to the other half to rotate out.

 If the wisdom tooth still does not come out, there is usually a ledge in the bone, a bulbous root, or an extremely curved root impeding the extraction. In this case, the dentist will smooth out any interfering bone until the tooth comes out of the socket.

Click for the Image of a Wisdom Tooth Drilled and Cut in Half.

Sectioning a mesio impacted wisdom tooth removal procedure cut in half

How Do We Treat The Socket After The Wisdom Tooth Extraction?

After extracting the tooth, I first check the socket for any remaining teeth pieces and sinus or nerve canal exposure. If clear, we use a small spoon instrument to remove any remaining loose tissue or infection. In our practice, we then use ozonated water to flush out the socket, which fights possible infection and reduces the possibility of a dry socket. We then place a resorbable fibrous membrane that promotes clotting and lessens post-operative pain and dry socket. Finally, if the loose gum tissue is abundant, we suture the socket closed.

Click for the Image of a Resorbable Membrane Placement in a Socket.

Putting a resorbable membrane in wisdom tooth extraction socket

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