What is an Impacted Tooth?
It is a tooth that is embedded in the bone or under the gum tissue and is blocked from coming in to the mouth due to its incorrect position or the lack of space in the mouth.

Wisdom teeth are the most common impacted teeth because of their position in the back of the jaws, and the fact that they are the last to come into the mouth.

What Problems Can an Impacted Tooth Cause?
It is not normal for a tooth to remain under the gums beyond the age of 2. The following problems may develop:

Decay
Although the impacted tooth may not be visible in the mouth, food debris may reach the crown and cause decay. As this may not be fully visible in the mouth there is n o way for a dentist to fill such a cavity and severe pain could result.

Infection
When the impacted tooth is partially visible in the mouth a gum flap usually covers the back part of the tooth. Food debris may then accumulate under this gum flap resulting in a local infection. This can result in severe pain and a swollen face due to an underlying abscess. This can spread to the surrounding tissue eventually causing serious ill health.

Pressure
An impacted tooth can cause pressure on its healthy neighboring teeth, which may result in pain, destruction of adjacent teeth, or crowding of the teeth.

Cyst Formation
A cyst may form around an impacted tooth, which may slowly grow in size, causing bone destruction and damage to adjacent teeth. Subsequent removal of the tooth and cyst requires more extensive surgery with an increased chance of nerve damage and fracture of the jaw. Occasionally tumors may also develop within these cysts.

Why Should an Impacted Tooth Be Removed If It Has Not Caused Any Problems?
There is no accurate way to predict which teeth will cause problems. The vast majority if left to develop would cause some trouble. This could obviously occur unexpectedly and at inconvenient times. The removal of impacted teeth in older patients is also more difficult then it is in young patients and the incidence of complications is higher.

The surgery can be done using either

• Local anesthesia (freezing) only, or
• Local anesthesia with intravenous sedation (this is the most common method), or
• General anesthesia.

The method used in this office will be local anesthesia with intravenous sedation. This involves placing an intravenous line in the arm following which selected drugs are used to make you drowsy. Appropriate blood pressure and pulse monitors will be used while you are sedated. When you are very relaxed the local anesthesia is placed in the various sites of the mouth.

After the local anesthesia takes effect the gums and bone overlying the impacted tooth are incised. The tooth is then exposed following which some bone may be removed and /or the sectioned to facilitate its removal. The wound will then be closed with suture, which will dissolve by itself and not need removal.

This operation is performed utilizing anesthesia, sterile instruments, and will involve the surgeon and an assistant. Approximately 20 to 60 minutes may be required for the surgery depending upon the difficulty of the procedure. Great care will be taken to be as gentle as possible in handling the soft tissue and bone. Due to the sedation ­ the following is advised:

1. You should not have anything to eat or drink for at least 6 hours prior to your surgery. This is for your safety.
2. Have a friend or relative drive you home after the surgery. you will be able to walk after the surgery but due to the drugs your coordination will not be at a normal level. The surgery will NOT be performed if this condition is not met.
3. DO NOT drive an automobile, ride a bike, or operate any machinery for at least 24 hours after the surgery.
4. Do not drink any alcoholic beverages for 24 ­ 48 hours after the procedure due to the additive effect with the administered drugs. This could lead to severe problems.

No side effects or complications are expected. But nonetheless any operation carries some risk.

Swelling
This is the most frequent side effect of surgery around the jaws. This will come on very soon after the operation and may last for anywhere up to a week. You will be advised to use ice packs and the prescribed medicine to limit this swelling. As every person reacts differently to surgery it is impossible to predict just how much swelling will develop. It usually takes 4 ­ 7 days to resolve.

Pain
Severe pain is usually not a problem. Pain medicine will be prescribed for you and if taken correctly should control most pain. Occasionally pain may develop several days after the surgery and may radiate to the ear or chin. This is typically due to what is called a “dry socket” which is premature loss of the blood clot from the extraction socket. If this develops you should immediately notify the office as this can be treated by special dressings and/or pain medications.

Jaw Stiffness
Commonly some stiffness of the jaw muscles is present and may last several days. This may be helped by doing jaw opening exercises starting the day after surgery.

Bruising
Occasionally some discoloration occurs around the face and neck. This is not an important complication and fades with time. Some people bruise more easily than others do.

Nerve Damage
An impacted tooth in the lower jaw may be intimately related to the nerve, which runs in a canal in the lower jaw. While all precautions will be taken, the nerve may be damaged during removal of the impacted tooth. This could result in some numbness, pain, bruising or tingling of the lower teeth, gum tissue, chin, and lip on that side. In most cases feeling will return to those areas within a few months as the nerve repairs itself. In some cases however, the nerve damage may be permanent with no recovery of sensation in the involved areas. Also, the nerve which gives feeling and taste to the side of the tongue may be damaged during the extraction of the impacted tooth and result in numbness, pain, burning, tingling, and loss of taste on that side of the tongue. This again may be temporary lasting only months but may also be permanent.

Sinus Problems
As an upper impacted tooth is intimately associated with the sinus you may notice a small amount of blood in the nose after the surgery. This is due to slight trauma to the maxillary sinus on that side. The blood in the nose will usually clear within a few days, usually without complications. However, occasionally after removal of upper teeth ­ sinus infections or openings from the sinus into the mouth may develop. An opening like this may persist and require a secondary operation to close it. It is emphasized that these complications are unusual.

Infection
The mouth is normally full of bacteria. Infection of the gums and jaw can occur after removal of an impacted tooth. Infections of this nature usually respond to antibiotics and local therapy. Occasionally an infection may develop to such an extent that it requires surgical drainage and hospitalization.

This is difficult to predict as each person reacts different to the surgery. A general rule is about 3 ­ 4 days for the maximum swelling to develop and this will then take about 3 ­ 4 days to resolve.

You should plan to be able to have 4 ­ 5 days off work after the surgery if necessary. However, should you feel all right you may go back to work immediately afterward. This is impossible to predict and will depend on the difficulty and your reaction to the surgery.

If additional questions arise or if you do not understand the information in this pamphlet, please ask for assistance and we will be glad to answer them to the best of our abilities.

Teeth are exposed or made visible in the mouth to allow the orthodontist to pull them into proper position the mouth. Teeth will need exposure when they are aligned in the wrong position and will not come into the mouth naturally.

Exposure involves removing the overlying gum tissue and placing a packing over the site for the first 7 to 10 days. The orthodontist will then remove this packing and be able to see the tooth. Occasionally an orthodontic bracket may be bonded to the tooth during the exposure.

The most common tooth needing exposure is the upper canine or eye tooth. This surgery can be performed with local anesthetic, Intravenous sedation or full general anesthetic. Dr. McDonald will discuss these options with you during your consultation.

Techniques of Performing Oral Surgery

Local Anesthesia
This involves an injection into the gums in the area of the surgery. This will freeze or numb the area to allow the surgery to be performed without pain. You will still be awake so one will feel pressure and hear noises. This is the same as having a filling done at your dentist.

Intravenous Sedation
This involves starting an intravenous line. (needle in the arm) and injecting medication into this tubing. A combination of medications will be used to allow the surgery to be performed without the patient seeing or hearing any of the procedure.

You will be monitored by a Heart machine, blood pressure machine, oximeter (measures oxygen in your blood), and a capnograph (measures your breathing).

The outcome will be the same as general anesthesia in that you will not hear or see any of the prcedure. It is a much faster recovery than general anesthesia.

A fasting time or time without food or water of 6 hours is required prior to this procedure. This is for your safety to avoid any possible vomiting during the procedure.

General Anesthesia
This is necessary for all the major surgery cases such as orthognathic (jaw) surgery. It is not necessary for routine extractions and other office procedures. It would be performed in an anesthetic office or in the hospital. The need for this will be discussed at your consultation.