Why wisdom teeth should be removed

• Due to difficult tooth eruption: The most frequent causes here are lack of space, primarily in the lower jaw. In the case of partially erupted wisdom teeth, an acute infection very often occurs. A pocket is formed under the gum cap where bacteria multiply. This infection often leads to severe pain, reddening and swelling of the surrounding soft tissue, problems in swallowing and even difficulty in opening the mouth, as well as to the formation of abscesses.
• Due to displacement of the wisdom tooth: Lack of space in the jaw often leads to axial inclination of the tooth. Horizontally lying wisdom teeth can press on neighbouring dental roots and cause the tooth to die. A vertically lying wisdom tooth can cause sensitivity problems.
• Due to tooth decay or pulpitis in the wisdom tooth, as it is often difficult to clean.
• If the wisdom tooth is located in the fracture gap, in the case of lower jaw fracture.
• For orthodontic requirements.
• For prosthetic requirements before a complex cleaning process.
• Before organ transplants, as impacted wisdom teeth can be regarded as foci.

Operative removals in the lower jaw are often linked to complications

It is important to bear in mind that the bone density in the lower jaw is more pronounced than in the upper jaw. It is therefore to be expected that operative removals in the lower jaw are more often linked to complications. The wisdom tooth has many variations, both in its anatomic form and in the number of roots. The extraction of the teeth is therefore generally more difficult.

Before the operation, a long-lasting painkiller (e.g. Ibuprofen 600) can be administered, or an analgosedation (medicinal anaesthetisation with simultaneous sedation). If all four wisdom teeth are to be removed in one session, general anaesthetic is often used. 

The tooth is often anchored in the jaw. If access to the other molar teeth is limited and the jaw angle is too small, or if the tooth lies horizontally in the jaw, the tooth must be severed. In the lower jaw we usually perform an open treatment with a iodoform tamponade for 1 week, in the upper jaw we close the wound with stitches.

The following procedures aid wound healing after the operation

Cool packs help in the first 48 hours. Oral hygiene can take place as usual. If intense pain occurs, then teeth brushing should be temporarily avoided and instead a medicinal mouthwash (0.1% chlorhexidine) should be used. Violent nose-blowing and sneezing should be avoided, especially after removal of the upper wisdom teeth.

The following should also be avoided:

• Milk products
• Coffee, black tea, energy drinks
• Alcohol, cigarettes
• Wholemeal products, rice
• Sport, sauna, solarium, exposure to the sun

Normally, good wound healing takes place and the procedure is free of complications. After 3 weeks the oral mucosa is completely healed.

The most common causes of infected dental pulp are

• Tooth decay
• Incorrect use, extensive teeth clenching or grinding
• Trauma
• Orthodontic treatment
• Parodontitis (deep pockets)
• Exposed tooth neck

The infected tissues within the root swell and expand but they cannot do this in the root canal however, as it is surrounded by the tooth structure. The infection therefore spreads via the foramen apicale in the bones, i.e. the connection between the tooth and the bones where nerves and blood vessels stream into the bone. If the infection reaches the jaw bone, we refer to this as periapical disease. The tooth pain becomes jaw pain. Cleaning the root canal system followed by root filling serves to preserve the tooth and stops the pain. The root canals are disinfected using laser treatment.