Wisdom tooth extraction

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Feb 12, 2023
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Can anyone give me some advice on wisdom tooth extraction. What happens to the area were the tooth roots where?
 
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Yes, it should've been removed well before the decay started; this was an inevitable result. It will be a surgical extraction requiring lifting up of the gum, then severing the tooth in 2 planes - first light green to remove the crown part, and then possibly dark green to divide the roots. For a competent general dentist, that is quite achievable; for an oral surgeon it'll be easy.
There are a few risks, as with any procedure:
  1. the filling in the 2nd molar may be damaged and need repair at another appointment. My first step before raising the gum would be to slice off the back edge of that lumpy amalgam (yellow line) to minimise this issue, and make the extraction easier.
  2. The red lines show a major nerve bundle (the IAN) under...

Dr M

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What exactly do you mean?
In very basic terms,the socket in general firstly fills up with blood, that co-coagulates to form a blood clot. This clot, gradually transitions into scar tissue and then into woven bone, which is immature bone. The woven bone gradually mineralizes and becomes normal bone
 

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MattKW

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Put up an OPG. Quality needs to be at least 350kB, or better 500kB.
What is your age? How many are being removed?
 

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I will post the xrays. The wisdom tooth grow in at an angle and caused decay in the 2nd molar. This was filled 10 years ago. When I was 25. I kind of think the wisdom tooth should of been removed then when I was younger. I'm now 35.
 

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That's the x-ray from a month ago.
 

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And that's the area from 2019. I have had the filling since around 2012/13. I'm not sure why wasn't removed when caused the original decay.
 

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MattKW

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Yes, it should've been removed well before the decay started; this was an inevitable result. It will be a surgical extraction requiring lifting up of the gum, then severing the tooth in 2 planes - first light green to remove the crown part, and then possibly dark green to divide the roots. For a competent general dentist, that is quite achievable; for an oral surgeon it'll be easy.
There are a few risks, as with any procedure:
  1. the filling in the 2nd molar may be damaged and need repair at another appointment. My first step before raising the gum would be to slice off the back edge of that lumpy amalgam (yellow line) to minimise this issue, and make the extraction easier.
  2. The red lines show a major nerve bundle (the IAN) under the root tips. There's always a risk of damaging it, particularly if there has to be any digging around deep in the socket to chase broken roots. I see it as really unlikely.
  3. If a root tip DID break during the extraction, it is reasonable to sometimes leave it in place and let the bone heal over.
  4. There is another nerve just on the inner side of the wisdom tooth - the lingual nerve. Again, very small risk of damage in your case in hands of competent dentist.
  5. Then there's the usual issues - pain, bleeding, bruising, possible "dry socket".
I'm guessing you're in early 30s? The bone where the wisdom tooth comes up will fill in with new bone over several months. Because this extraction has been delayed, the bone at the back of the filled tooth (blue arrows) will NOT fill up. You will have to work extra hard to keep the back surface of that clean for the rest of your life.
Screenshot 2023-03-10 215440.jpg
 

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Thanks previous dentists have never mentioned removal not sure why. Thought it has already caused damage. I should still be definitely looking at getting it done? Thanks for such a detailed response
 

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MattKW

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Yes, still get out ASAP. And any other potentially damaging or redundant wisdom teeth. You don't want to develop problems in your 70s, 80s, or 90s when you might be in Aged Care, plus have other medical conditions to juggle.
 

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Thanks again. The filling was done 10 years ago now. I have only this last week started flossing in the area between the wisdom tooth and the second molar and alot of food gets stuck in there that the floss seems to get out. I'm happy to get it done but I'm in no pain at the moment with it or ever have, but am worried about it. Is it going to be better for my oral health with removal? As said earlier I wish I was advised to get it removed 10 years ago before it lead to the filling. That is the only filling I have in my mouth. Thanks for any more advice and all the advice you have given in the first message with the diagram.
 

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I occasionally get a creaking sound which I think is maybe coming from the filling when chewing this is not all the time but does it from time to time.
 

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Sorry, one dentist said yes to taking it out another said it's borderline so I am unsure. What causes the bone loss if it has caused it? They said the bone loss looked pretty stable between the x-ray from 4 years ago.
 

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