The third molars, commonly known as wisdom teeth, are the last set of teeth to develop, typically emerging in the late teenage years or early twenties. Often, the jaw lacks sufficient space, causing them to grow at an angle or remain trapped beneath the gum line, a condition called impaction. Wisdom teeth often require removal to prevent pain, infection, or damage to adjacent teeth. The choice of professional to perform the extraction—either a general dentist or an oral and maxillofacial surgeon—depends on the complexity of the specific case.
The Role of the General Dentist
A general dentist is typically the first professional to evaluate the position and development of the third molars during routine checkups. They rely on dental X-rays to monitor the teeth, often recommending removal before the roots are fully formed to simplify the procedure and recovery. General dentists are qualified to perform a simple extraction, which involves a tooth that has completely erupted and is visible in the mouth.
A simple extraction is a straightforward procedure that uses instruments to grasp the tooth and remove it without the need for an incision or bone removal. This extraction is usually completed quickly in the dental office using a local anesthetic. If X-rays reveal impaction, a complex root structure, or proximity to nerves or sinuses, the general dentist will initiate a referral. The dentist’s primary responsibility is to ensure the patient receives the safest and most appropriate care.
When to See an Oral Surgeon
An Oral and Maxillofacial Surgeon (OMS) is a dental specialist who completes four to six years of additional hospital-based surgical and anesthesia training after dental school. This extensive training equips them to handle complex surgical procedures, making them the preferred choice for most wisdom teeth removals. Their expertise is needed when a tooth is impacted, meaning it is stuck beneath the gum or jawbone and cannot erupt normally.
Impaction can range from soft tissue impaction, where the tooth is covered only by gum tissue, to partial or full bony impaction, where the tooth is encased in the jawbone. These surgical extractions require the surgeon to make an incision in the gum, sometimes remove bone, and often divide the tooth into sections for easier removal. The specialized skill of the OMS is important for managing cases where the tooth is close to the inferior alveolar nerve, which provides sensation to the lip and chin.
A primary distinction of the OMS is their training and certification to administer a full spectrum of anesthesia options. While general dentists typically offer local anesthesia and sometimes nitrous oxide, an OMS can provide intravenous (IV) sedation or general anesthesia, allowing the patient to sleep through the procedure. IV sedation is often preferred for complex extractions because it ensures the patient is deeply relaxed and has little to no memory of the surgery, benefiting those with dental anxiety. The ability to administer deeper levels of sedation safely is a primary reason patients are referred to a specialist.
Preparing for and Recovering From Surgery
Preparation for the procedure often begins with specific instructions from the surgeon, especially regarding sedation or general anesthesia. Patients receiving IV sedation or general anesthesia must not eat or drink anything for six to eight hours before the procedure to avoid complications. It is necessary to arrange for a responsible adult to drive the patient home and remain with them for several hours following the surgery.
The recovery phase requires careful adherence to post-operative instructions to encourage healing. Swelling is common and can be managed by applying ice packs to the cheeks for 15 to 20 minutes at a time during the first 24 to 48 hours. Pain medication should be taken as directed, and the diet must be limited to soft foods like yogurt, mashed potatoes, and smoothies for the first few days.
Preventing a dry socket is a major focus of post-operative care, as this painful condition occurs when the blood clot dislodges from the extraction site. Patients must avoid any sucking motion for at least a week, meaning they cannot use straws, smoke, or forcefully spit. Gentle rinsing with warm salt water can begin after the first 24 hours to keep the area clean and promote healing.