The wisdom teeth, or third molars, are the last set of teeth to develop, typically erupting in the late teens or early twenties. Because the jaw often lacks the necessary space for these late arrivals, their emergence can lead to various complications requiring professional removal. The prospect of having a tooth extracted often causes concern, and one of the first questions people ask is which type of dental professional is qualified to perform the procedure. Answering this depends on the specific nature and complexity of the tooth’s position.
Identifying the Right Specialist for Extraction
The professional who removes a wisdom tooth is determined by the difficulty of the case. For a fully erupted tooth that is straightforward to remove, a general dentist is often qualified to perform the extraction. General dentists receive training in simple extractions and can manage uncomplicated cases using local anesthesia to numb the area.
However, more complex cases are typically referred to an Oral and Maxillofacial Surgeon (OMS). An OMS is a dentist who has completed four to six years of additional surgical residency training in a hospital setting. This advanced training focuses on procedures involving the mouth, jaws, and facial structures, making the OMS the specialist for complicated extractions.
An OMS is required for teeth that are impacted, meaning they are trapped beneath the gum line or bone, or when the tooth’s roots are positioned close to a major nerve, such as the inferior alveolar nerve in the lower jaw. Oral surgeons offer a full range of sedation options, including intravenous (IV) sedation and general anesthesia, which are necessary for longer or more involved procedures. The general dentist serves as the initial point of contact, and if diagnostic images reveal a difficult surgical scenario, they will initiate a referral to the specialist.
Common Reasons for Wisdom Tooth Removal
Wisdom teeth are generally removed due to pathology or to prevent future damage to adjacent teeth and bone. One of the most common issues is impaction, where the tooth is blocked from fully erupting by the jawbone, gum tissue, or another tooth. Impaction is often classified by the tooth’s angle, such as mesioangular (angled forward), vertical (straight but trapped), or horizontal (lying on its side).
A partially erupted wisdom tooth creates a flap of gum tissue, called an operculum, which easily traps food debris and bacteria. This can lead to a localized gum infection known as pericoronitis, which causes pain, swelling, and sometimes difficulty swallowing. Additionally, an impacted tooth can cause the adjacent second molar to develop decay or periodontal disease because it is impossible to clean the area effectively.
In some instances, the sac surrounding the unerupted tooth can fill with fluid, forming a cyst within the jawbone. These cysts slowly expand, potentially destroying the surrounding bone structure and damaging other teeth if they are not removed. The need for extraction is often driven by a desire to prevent these long-term issues, especially in younger patients where the roots are not fully developed.
The Consultation and Diagnostic Process
Before any procedure, a consultation is performed to determine the best approach for removal. This assessment begins with a thorough clinical examination and a review of the patient’s medical history. Dental imaging is an indispensable part of this planning process, as it reveals information that a visual exam cannot.
A panoramic X-ray is typically the first imaging tool used, providing a single, comprehensive two-dimensional image of all the teeth, the jawbones, and associated structures. This image helps to determine the exact position of the wisdom tooth and the extent of any impaction. In cases where the tooth appears to be very close to the mandibular canal, which houses the inferior alveolar nerve, a Cone Beam Computed Tomography (CBCT) scan may be ordered.
The CBCT provides a three-dimensional view, allowing the surgeon to precisely map the tooth’s root structure in relation to the nerve to minimize the risk of nerve damage. The specialist will also discuss anesthesia options based on the complexity of the surgery and the patient’s level of anxiety.
Managing Post-Operative Healing
Immediately following the surgery, the patient is instructed to maintain gentle pressure on gauze pads placed over the extraction sites to encourage the formation of a blood clot, which is the foundation of the healing process. Swelling and discomfort are expected, and applying ice packs to the cheek in 15-minute intervals during the first 24 to 48 hours helps to reduce inflammation.
Pain is managed with prescription or over-the-counter medication as directed by the surgeon. A major concern during the healing period is the prevention of alveolar osteitis, commonly known as dry socket, a painful condition that occurs when the protective blood clot is dislodged or dissolves prematurely, exposing the underlying bone. To protect the clot, patients must avoid any action that creates suction in the mouth, such as using a straw, spitting, or smoking, for at least 48 to 72 hours.
Dietary restrictions require the consumption of soft, cool, or lukewarm foods like yogurt and mashed potatoes, while avoiding crunchy or hard items that could irritate the surgical site. After the initial 24 hours, gentle rinsing with warm salt water several times a day can help keep the area clean without disturbing the healing tissue. Patients should also avoid vigorous physical activity for several days to allow the body to focus its energy on recovery.