Oral and maxillofacial surgeons (OMS) are the recognized specialists who perform wisdom teeth removal, especially complex procedures. While a general dentist may handle a straightforward extraction of a fully erupted tooth, an OMS is the expert for challenging cases involving impacted teeth and deep sedation. This specialization ensures patients receive the highest level of surgical care for their third molars.
Defining the Oral and Maxillofacial Surgeon
An Oral and Maxillofacial Surgeon (OMS) is a highly trained specialist whose education extends beyond the four years of dental school. After receiving their dental degree, these practitioners complete an additional four to six years of a hospital-based surgical residency program. This intensive training focuses on the hard and soft tissues of the mouth, jaw, and facial skeleton, preparing them for a wide scope of procedures, including complex extractions.
The residency involves rotations in medical fields such as general surgery, internal medicine, and anesthesiology. This multi-disciplinary exposure uniquely qualifies an OMS to manage surgical complications and administer various levels of in-office sedation, including deep intravenous (IV) sedation. Their extensive experience makes them the primary choice for removing wisdom teeth trapped within the jawbone or positioned close to nerves.
Clinical Necessity for Wisdom Tooth Removal
Wisdom teeth, or third molars, are the last teeth to emerge, typically appearing between the late teens and early twenties. If the jaw lacks sufficient space, the teeth become impacted, meaning they fail to fully erupt through the gum line. Impaction occurs when the tooth is obstructed by bone, gum tissue, or another tooth.
Impaction is classified by the tooth’s angle: mesial (angled forward), distal (angled backward), vertical (stuck but correctly positioned), or horizontal (lying sideways). A horizontally impacted tooth can press against the roots of the adjacent second molar, potentially causing damage or pain. Even if not immediately painful, impaction can create significant problems over time.
One common issue is pericoronitis, an infection of the gum tissue that partially covers the wisdom tooth, trapping food and bacteria. Impacted teeth are also prone to decay because they are difficult to clean, and they may contribute to the development of cysts or tumors in the jawbone. Removal is frequently recommended as a preventative measure to avoid these complications, especially in younger patients.
Anesthesia and the Surgical Process
The surgical removal of wisdom teeth, especially impacted ones, is routinely performed in the OMS office under various forms of anesthesia to ensure patient comfort. The choice of sedation depends on the extraction’s complexity and the patient’s anxiety level. Local anesthesia is always used to numb the surgical area, which can be supplemented with other options.
Patients may choose nitrous oxide (laughing gas) for minimal relaxation, or IV sedation, which produces deep relaxation and amnesia during the procedure. Oral and maxillofacial surgeons are trained in the safe administration and monitoring of IV sedation in an outpatient setting. This capability is preferred for impacted teeth, allowing the patient to remain still and unaware during the 30 to 60-minute procedure.
The surgical process begins with the surgeon making a small incision in the gum tissue to expose the impacted tooth and surrounding bone. If the tooth is covered by bone, a small amount may need to be removed (ostectomy). To minimize bone removal, the surgeon often sections the tooth, cutting it into smaller pieces so each fragment can be removed through a smaller opening.
After extraction, the surgical site is cleaned, and the gum tissue is typically closed with dissolvable stitches. Gauze is placed over the site, and the patient maintains firm biting pressure to encourage the formation of a blood clot. Post-operative care includes managing swelling with ice packs, taking prescribed pain medication, and adhering to a soft-food diet. Patients must avoid smoking or using straws, which can dislodge the blood clot and lead to dry socket.