Wisdom teeth, as the last teeth in the human mouth, often cause pain, swelling, gum inflammation and other problems because of insufficient growth space and abnormal position. When there is a problem with wisdom teeth, extraction is often a necessary treatment. Many people are full of fear and curiosity about the process of wisdom tooth removal. Here is a detailed introduction to how wisdom teeth are removed, so that you have a clear understanding of the process and eliminate unnecessary tension.
First. Preoperative preparation
(1) Examination and diagnosis
Before deciding to remove wisdom teeth, the doctor will perform a thorough examination and diagnosis. The first is the oral examination, the doctor will use oral mirrors, probes and other tools to observe the growth of the wisdom teeth, including the position of the wisdom teeth, shape, whether the eruption is complete, and whether the gums are red and inflamed. For example, if the wisdom tooth partially erupts and the gums cover the top of the wisdom tooth, forming a blind bag, it is easy to hide dirt, breed bacteria, and cause pericoronitis of the wisdom tooth.
In addition to the oral examination, X-rays are taken, commonly panoramic or cone-beam CT (CBCT). The X-ray film can clearly show the growth direction of wisdom teeth in the jaw bone, the shape and number of tooth roots, and the relationship with the surrounding important structures (such as neural tubes, adjacent teeth, etc.). For example, the roots of some wisdom teeth are curved, and the roots of some wisdom teeth are closely adjacent to the inferior alveolar neural tube, which is crucial information for doctors to make tooth extraction plans.
(2) Health assessment
Before extraction, the doctor will also assess the patient’s overall health. This is because certain systemic conditions may affect the safety of tooth extraction or increase the risk of postoperative complications. The doctor will ask the patient about their medical history, including whether they have high blood pressure, heart disease, diabetes, and blood disorders. For example, if the blood pressure control of hypertensive patients is unstable, the blood pressure may be further increased due to tension and other factors during tooth extraction, leading to cardiovascular and cerebrovascular accidents; When people with diabetes have poor blood sugar control, tooth extraction wounds are prone to infection and healing is delayed.
For some special cases, the doctor may require the patient to carry out corresponding tests, such as blood routine, coagulation function tests, etc., to understand the patient’s blood condition and determine whether there is a tendency to bleeding. If the patient is taking certain medications, such as anticoagulants (aspirin, warfarin, etc.), the doctor will decide on a case-by-case basis whether to stop the medication for a period of time before performing an extraction to reduce the risk of bleeding.
(3) Notification and communication
After completing the examination diagnosis and health assessment, the doctor will fully communicate with the patient. The doctor will explain the problems of wisdom teeth to the patient, explaining the necessity and benefits of tooth extraction, such as avoiding repeated inflammation and pain, and preventing damage to neighboring teeth. At the same time, the doctor will also inform the patient about the possible conditions during the extraction process, such as mild pain, sore feeling, etc., and possible complications after the operation, such as bleeding, swelling, pain, infection, etc.
The doctor will also introduce the patient to the precautions after the tooth extraction, including diet, oral hygiene, rest and other requirements. If the patient has any questions or concerns, it can be raised with the doctor at this time, the doctor will be patient to answer, to ensure that the patient in the full understanding of the relevant information, the decision whether to carry out the tooth extraction surgery.
Second. Anesthesia
(1) Anesthesia method selection
Local anesthesia is usually used for wisdom tooth extraction, and the common local anesthesia methods include infiltration anesthesia and block anesthesia. Infiltration anesthesia is to inject anesthetic drugs into the gingival mucosa, subperiosteal and other tissues in the surgical area, so that local nerve endings are blocked to achieve anesthetic effect. This type of anesthesia is suitable for wisdom teeth with relatively shallow location and short roots.
Block anesthesia is the injection of anesthetic drugs near the nerve stem to produce anesthetic effects in the innervated area. For wisdom teeth with deeper location, longer root and greater difficulty in removal, block anesthesia is generally used, such as alveolar nerve block anesthesia and upper posterior alveolar nerve block anesthesia. In practice, the doctor will choose the appropriate anesthesia method according to the specific situation of the wisdom tooth, and sometimes the two anesthesia methods will be combined to ensure that a good anesthetic effect is achieved.
(2) Anesthesia process
Before anesthesia, the doctor will first disinfect the injection site, usually using iodophor and other disinfectant. The doctor will then insert the anesthetic needle into the injection site, and the patient may feel a slight tingling pain during the insertion process. When the needle reaches the desired location, the doctor will slowly push the anesthetic. In the process of pushing the drug, the patient may feel the local acid swelling, which is a normal phenomenon.
With the injection of anesthetic drugs, the surgical area will gradually lose sensation. The doctor will ask the patient if he or she feels pain, or gently touch the surgical area with a probe to determine whether the anesthetic effect is as desired. In general, 3-5 minutes after the completion of anesthesia, the surgical area will be completely numb, at this time you can begin the extraction surgery.
Third, extraction operation
(1) Cut the gums
If the wisdom teeth are completely erupted, and there is no obvious adhesion of the gums, the extraction can generally be performed directly. But if a wisdom tooth partially erupts or is completely embedded in the jaw, doctors need to cut through the gums first. Using a scalpel, the doctor will make a small incision along the gum edge of the wisdom tooth to cut through the gum tissue, exposing the crown and part of the root of the wisdom tooth. During the incision of the gum, the patient generally does not feel pain due to the anesthesia that has been administered, but may feel some pulling and pressure.
(2) Separation of gums
After cutting the gums, the doctor will use a gum separator to separate the gums from the surface of the wisdom tooth crown. A gingival separator is a slender device with a wedge-shaped head that can be easily inserted into the space between the gum and the crown of the tooth. By gently prying and separating, the gum is completely separated from the wisdom tooth, which can avoid damage to the gum tissue during the extraction process and reduce postoperative bleeding and pain.
(3) Very loose wisdom teeth
After the gum separation is complete, the doctor will use a brace to loosen the wisdom teeth. A brace is a lever device with a concave head that can trap the crown or root of a wisdom tooth. The doctor inserts the teeth into the gap between the wisdom tooth and the alveolar bone, and gradually loosens the wisdom tooth by rotating, prying and other actions. During the process of loosening the wisdom tooth, the patient may feel greater force and vibration, but there will be no obvious pain.
(4) Removal of wisdom teeth
When the wisdom tooth is loosened enough, the doctor will use dental forceps to remove the wisdom tooth. The beak of the forceps comes in different shapes and sizes, and the doctor will choose the right forceps based on the shape of the wisdom teeth. The doctor accurately clamps the crown or root of the wisdom tooth with the beak of the forceps, and then pulls the wisdom tooth out of the alveolar socket by buccolingual, proximal and distal shaking, and pulling in the direction of the joint surface. The moment the wisdom teeth are removed, the patient may feel the force and slight tug of the tooth being pulled out.
(5) Treatment of alveolar cavities
After the wisdom tooth is removed, the doctor will check the alveolar socket for any remaining roots, tooth debris, or inflammatory tissue. If there is, the doctor will clean it up with an instrument such as a curette. The doctor will then trim the socket properly to smooth the edges of the socket and reduce the risk of postoperative pain and infection. Finally, the doctor will apply pressure to the alveolar cavity to stop bleeding, generally using cotton balls or gauze to press on the alveolar cavity for 15-30 minutes until the bleeding stops.
Four. Postoperative treatment
(1) Wound suture
If the extraction wound is large or there is a significant tear in the gum, the doctor will sew the wound. The suture uses absorbable or non-absorbable sutures, which absorb themselves after a period of time without the need to remove stitches. Non-absorbable sutures should be removed 5 to 7 days after surgery. Suturing the wound reduces bleeding and promotes healing while also helping to keep the extraction wound clean.
(2) Hemostasis and observation
After the tooth extraction, the patient needs to bite a cotton ball or gauze placed by the doctor at the tooth extraction wound to stop the bleeding through pressure. In the process of biting the cotton ball or gauze, do not spit frequently, so as not to increase the negative pressure in the mouth, resulting in the loss of blood clots at the tooth extraction wound, causing rebleeding. Generally bite the cotton ball or gauze 30-40 minutes later, you can gently spit out.
After spitting out the cotton ball or gauze, the patient needs to be observed in the hospital for a period of time, usually 30 minutes to 1 hour, to see if there is no bleeding. If there is still obvious bleeding in the tooth extraction wound, the doctor will take corresponding treatment measures in time, such as re-pressure hemostasis, the use of hemostatic drugs.
(3) Notice of postoperative matters
Before the patient leaves the hospital, the doctor will again explain the postoperative precautions to the patient in detail. Do not eat within 2 hours after surgery, after 2 hours you can eat some warm, soft food, such as rice porridge, noodles, ice cream, etc. Avoid eating spicy, irritating food and overheated food, so as not to stimulate the tooth extraction wound, causing bleeding and pain.
Do not brush your teeth and gargle within 24 hours after surgery to avoid destroying the blood clot formed by the tooth extraction wound, resulting in bleeding. After 24 hours, you can brush your teeth gently, but avoid tooth extraction wounds. After surgery, pay attention to rest, avoid strenuous exercise and overwork, and ensure adequate sleep, which is conducive to physical recovery.
If there is mild pain and swelling after surgery, this is normal and can be relieved by cold compresses for 15-20 minutes at a time, with an interval of 1-2 hours. If the pain, swelling is severe, or there are symptoms such as fever, limited opening of the mouth, you should seek medical attention in time, may be postoperative infection and other complications, need to be treated accordingly.
Five. Postoperative recovery
(1) Healing process
The healing of an extraction wound is a gradual process. After extraction, a blood clot will form inside the wound, which is the beginning of healing. Over the next few days, the blood clot gradually mechanizes and forms granulation tissue. About 1 week or so, the gingival epithelium begins to grow into the wound and cover the wound. After 2-3 weeks, the surface of the tooth extraction wound is basically healed, but the bone repair in the alveolar fossa takes a longer time, generally taking 3-6 months to fully heal.
(2) Return visit and removal of stitches
If sutures were performed during tooth extraction, the patient should follow the doctor’s instructions to return to the doctor for stitches. Stitches are usually removed 5 to 7 days after surgery, when the doctor will use tweezers and scissors to gently remove the suture. The procedure is generally simple and quick, and the patient does not feel significant pain.
In the process of postoperative recovery, if the patient finds that the tooth extraction wound has abnormal conditions, such as bleeding, severe pain, swelling, wound odor, etc., he should return to the doctor in time, so that the doctor can deal with it in time to ensure the smooth healing of the tooth extraction wound.
Conclusion
Although wisdom tooth extraction is a relatively common oral surgery, the whole process requires the doctor to have rich experience and professional technology, but also needs the patient’s active cooperation. Understanding the whole process of wisdom tooth extraction is helpful for patients to make full preparation before surgery, reduce tension and fear, and better cope with tooth extraction surgery and postoperative recovery. Hopefully, this article will give you a more comprehensive and in-depth understanding of wisdom tooth extraction.
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