Oral and Maxillofacial Surgeons (OMS) are the specialists for the removal of wisdom teeth, the third and final set of molars that typically emerge between the ages of 17 and 25. These teeth often require extraction because they become impacted, meaning they do not have enough room to properly erupt or develop normally within the jaw. Impacted wisdom teeth can lead to various problems, including pain, infection, damage to adjacent teeth, or the formation of cysts. While general dentists can perform straightforward extractions, an OMS is frequently recommended due to the specialized nature of the procedure, especially when the teeth are lodged within the jawbone or positioned near critical anatomical structures.
The Specialized Training of Oral Surgeons
Oral and Maxillofacial Surgeons complete a training pathway that prepares them for complex surgical procedures. Following four years of dental school, an OMS candidate undergoes a four to six-year hospital-based surgical residency program. This extended period of postgraduate education focuses on the hard and soft tissues of the mouth, jaws, and face, providing a deep understanding of facial anatomy.
During their residency, these specialists receive training alongside medical residents in areas like general surgery, internal medicine, and emergency medicine. Training also involves anesthesiology, which qualifies them to administer and monitor various levels of sedation, including intravenous (IV) sedation and general anesthesia. This comprehensive background ensures they are equipped to manage potential complications that can arise during and after surgical procedures.
Deciding Between a Specialist and a General Dentist
The choice between a general dentist and an Oral and Maxillofacial Surgeon for wisdom teeth removal hinges on the complexity of the case. A general dentist is typically well-suited to handle simple extractions where the wisdom tooth is fully erupted and easily accessible above the gum line. These straightforward procedures can often be performed using only local anesthesia for pain management.
Referral to an OMS becomes necessary when factors increase the surgical difficulty and the risk of complications. The presence of a bony impaction, where the tooth is partially or completely encased within the jawbone, requires specialized surgical techniques for removal. The tooth’s close proximity to nerves, such as the inferior alveolar nerve, also requires advanced surgical planning, sometimes utilizing 3D imaging, to avoid potential nerve injury.
If a patient requires deeper levels of sedation for comfort or to manage dental anxiety, an OMS is the appropriate provider. Oral surgeons are certified to deliver IV sedation and general anesthesia, which allows the patient to be completely unaware of the procedure. General dentists are typically limited to local anesthesia or minimal conscious sedation.
Preparation and Post-Surgery Healing
Preparing for wisdom teeth removal begins with a consultation where the surgeon reviews imaging, discusses anesthesia options, and provides detailed instructions. For procedures involving IV sedation or general anesthesia, patients are typically instructed to fast for up to eight hours before the appointment. Patients must also arrange for a responsible adult to drive them home and remain with them for several hours following the procedure, as operating a vehicle is unsafe after sedation.
Post-operative care is important for minimizing discomfort and promoting proper healing. The first 24 hours often involve managing swelling by applying an ice pack to the face, using a cycle of 20 minutes on and 20 minutes off. Pain medication should be taken as prescribed, often starting before the local anesthesia fully wears off.
Protecting the blood clot that forms in the empty socket is the foundation for healing. Patients must avoid sucking actions, such as drinking through a straw, spitting, and smoking for 72 hours to prevent the dislodgement of this clot, a painful condition known as dry socket. A soft diet, consisting of foods like yogurt, mashed potatoes, and smoothies, is recommended for the first few days, and gentle warm salt water rinses can begin the day after surgery to keep the area clean.