Wisdom teeth are the final set of teeth to develop, typically emerging in the late teens or early twenties. These teeth often pose a problem because the jaw has insufficient space to accommodate them, leading to impaction where the tooth is blocked from erupting fully. Impaction can cause pain, infection, crowding of adjacent teeth, and other issues, making removal a necessary procedure for many people. The extraction of these third molars is a common surgical procedure performed by one of two types of dental professionals.
The Oral and Maxillofacial Surgeon
The Oral and Maxillofacial Surgeon (OMS) is the specialist who most frequently handles wisdom teeth removal, especially when the procedure is complicated. An OMS completes four years of dental school, followed by a rigorous four to six-year hospital-based surgical residency program. This extensive training provides experience across a wide range of surgical procedures involving the mouth, face, and jaw, including anesthesiology, internal medicine, and emergency medicine.
The core of an OMS’s practice involves managing complex extractions, which often includes fully impacted wisdom teeth lodged beneath the gum line or jawbone. These specialists possess the expertise to perform the surgical removal of teeth that require sectioning or significant bone removal. Their training also focuses heavily on the safe administration of various levels of sedation, from intravenous (IV) sedation to general anesthesia.
Many patients requiring the removal of four impacted wisdom teeth, or those with significant anxiety, are referred to an OMS because of this specialized training. The OMS is equipped to handle cases where the tooth roots are unusually close to delicate anatomical structures, such as the inferior alveolar nerve, which runs through the lower jaw.
When a General Dentist Performs Removal
A General Dentist (GD) is the primary care provider for oral health and is fully qualified to perform certain types of extractions, including simple wisdom tooth removal. This type of extraction is generally considered “simple” if the third molar has fully erupted into the mouth and is easily accessible. The tooth must not be significantly impacted or pose a high risk of complications upon removal.
In these straightforward cases, the dentist can remove the tooth using standard extraction techniques, often involving instruments that loosen the tooth before removal. The procedure is typically performed in the dental office using only local anesthesia, which numbs the tooth and surrounding tissues. A GD will often choose to refer a patient to a specialist if they anticipate a need for complex surgical techniques or if the patient prefers deep sedation for the procedure. This decision is based on the dentist’s comfort level, the complexity revealed on X-rays, and the equipment available in their practice.
Factors Guiding Your Specialist Referral
The determination of whether a GD or an OMS performs the extraction depends on the clinical assessment of the tooth’s position and the patient’s needs. The degree of impaction is a primary factor, with teeth categorized by whether they are covered by soft tissue, partially encased in bone, or fully submerged (full bony impaction). The more bone surrounding the tooth, the more complex the surgery, making a referral to an OMS more likely.
High-Risk Factors for Referral
Specialist referral is necessary when complex factors are present.
- Proximity to adjacent structures, such as the inferior alveolar nerve in the lower jaw or the maxillary sinus. Radiographic imaging, such as a Cone Beam Computed Tomography (CBCT) scan, helps determine if roots are dangerously close.
- Complex anatomy or multiple teeth requiring surgical removal.
- Patients with complicating medical conditions.
- A patient’s preference for sedation beyond local numbing, such as IV sedation or general anesthesia.
What to Expect During Removal and Recovery
The process begins with an initial consultation, where the provider reviews X-rays to assess the tooth’s position and discuss anesthesia options. The procedure itself usually takes between 30 minutes to an hour for all four teeth, depending on the complexity of the impactions. You will likely be given gauze to bite down on to control bleeding immediately following the extraction.
Post-operative care is crucial for proper healing and begins immediately after the surgery. To minimize swelling, you should apply ice packs to the cheeks for the first 24 hours, typically in 20-minute intervals. Pain is managed with prescribed medication, often in combination with over-the-counter anti-inflammatory drugs like ibuprofen, and should be taken with food.
For the first week, your diet must consist of soft foods, such as yogurt, mashed potatoes, and smoothies, and you must avoid using straws. The sucking motion created by a straw can dislodge the blood clot protecting the surgical site, leading to a painful complication called a dry socket. You should avoid vigorous rinsing or spitting for the first 24 hours, but after that, gently rinsing with warm salt water can help keep the area clean. Strenuous activity should be avoided for at least three to five days, as it can increase blood pressure and lead to increased bleeding or swelling at the surgical sites.