Any operation carries some degree of risk. This risk is minimized by careful preparative assessment of your physical condition, by careful preparation of instruments and all facilities, and by the performance of the surgery to the best of the surgeon’s ability. The most commonly encountered complications are discussed below.
Excessive Bleeding and or Bruising
Postoperative bleeding is uncommon and usually is encountered when the patient has not placed the gauze pack DIRECTLY over the surgical site. Pressure over the site for forty-five to sixty minutes will control most post-operative bleeding. If you are still concerned call the office and the problem will be dealt with promptly.
A condition known as “dry socket” occurs in approximately 5 to 10 percent of patients. It is more common in smokers and female patients taking oral contraceptives. It is manifest by a dull throbbing pain which starts within three to five days after the operation and is accompanied by a bad taste and odour in the mouth. The treatment is simple and consists of cleansing the area and the placement of the dressing which protects the area and has medication in it which relieves the pain. Healing is slightly slower than normal and a depression or hole may exist, where things will get caught. If this occurs you will be given a special irrigating syringe to use on a daily basis to keep this area clean until the hole fills in.
Infections after the removal of wisdom teeth are not common. The most common one is under the gum tissue that was pushed back in order to get at the tooth. This is called a “subperiosteal abscess”, and occurs in 1.5 - 3% of patients. Redness, increasing swelling and pain after an initial decrease, foul tasting discharge into the mouth, fever, chills, and enlarged glands are all sign of this infection. If these should appear call the office and you will be attended to promptly. This is usually treated with antibiotics. Occasionally a hole in the gum tissue must be made to allow the infection a way to get out. In some circumstances the infection tends to reoccur, and if this is the case, the surgeon may have to clean the area.
Upper impacted third molars lie against the wall of the sinus. Great care is taken to insure that no injury occurs to this structure. Occasionally the thin bony wall of the sinus cracks and fluids seep into the sinus resulting in an infection (sinusitis). This is so rare the true incidence is really not known. If it were to occur, it is usually treated with antibiotics. Occasionally a communication between the sinus and the mouth may be formed. If your surgeon suspects this to be the case you will be informed and additional medication will be prescribed.
This is also quite rare but important, because if the communication does not close liquids in your mouth can go up into the sinus, then out the nose, and there can be reoccurrence of the sinusitis. The closure of this hole would require additional surgery during which the gum tissue is stretched across the opening in order to close it.
The roots of the lower impacted teeth very often rest on and around the main nerve of the lower jaw. Very rarely, in spite of all precautions, during the removal of lower third molars this nerve is bruised, or cut. The result will be numbness of the lower lip, and chin, teeth on the involved side and/ or the tongue.
This effect does not last longer than a few weeks. In most cases, it improves as the nerve repairs and regenerates itself. Occasionally the numbness may last as long as two years and even more rarely it may be permanent. Also in the region of the lower third molar is the nerve which supplies sensation to the side part of the tongue. It may on occasion be stretched with a resultant numb tongue. This problem usually resolves within several weeks or months. The incidence of permanent numbness is in the area of 0.5 – 1.0%.
Damage to adjacent teeth, fillings or crowns
Occasionally a large filling in, or a crown of, and adjacent tooth may be loosened or cracked or dislodged during the removal of the wisdom teeth, in spite of immaculate care and skill. If the possibility of this exits prior to surgery you will likely be informed. The root of an adjacent tooth may also be damaged or fractured. This happens infrequently, and is not always predictable in advance.
On removing any tooth a portion of its root may fracture off. The surgeon will make a decision as to whether it will be necessary to remove it. In some circumstances it is best to leave it there. The body will just heal over it and seldom, if ever, will it cause a problem.
Another very rare complication is cracked or fractured lower jaw. This occurs when the wisdom tooth is very severely impacted. If your surgeon is concerned about this possibility, you will be informed.
IN CONSENTING TO HAVE THEIR IMPACTED TEETH REMOVED ALL PATIENTS SHOULD INDICATE THAT THEY CLEARLY UNDERSTAND THE RISKS THAT HAVE BEEN DESCRIBED.