OT: Wisdom Tooth Removal

[BumbleBeeDave]

Any advice from forum dentists--or even just members who play a dentist on TV--would be appreciated! :D

My left lower wisdom tooth got infected over the past month and now my dentist says the pulp has died and he advises removal, since he felt it wasn't worth it to do a root canal and crown on a tooth way at the back like that. He did all the tests--liquid nitrogen, applying an electric current to the tooth--and no feeling whatsoever, so I'm assuming he's right. He says the tooth is fully erupted and the roots are pretty straight, so he doesn't see it as a complicated procedure.

I have an appointment for a consultation with an oral surgeon in a few weeks and in the meantime my dentist gave me antibiotics--Clindamycin--to keep the infection down. The pain and, I'm assuming, the infection have eased off, though I still can't really chew on that side. But he says the infection is still inside the tooth and therefore it should come out.

Now . . . THE QUESTION. At this point I'm assuming the surgeon is going to give me an option of either just lidocaine or actually getting knocked out. Have any of you had the procedure, just gone with the lidocaine, and regretted it? While I don't usually have any queasiness with just getting cavities filled, this is certainly a bit more involved than that.

Man up and just do the needle or have the doc slip me a Mickey?

BBD

[Ken Robb]

skipping the gory details: my ex-wife went in for what appeared to be an easy extraction of her wisdoms--it was a lot more difficult than expected and would have been a real disaster under a local. I wonder if you could start with a local with the option of general if things get tricky.

[bluesea]

I had a major impacted removal, where that also took out another non-impacted wisdom at the same time. Lidocaine with epinephrine babee! Probably the closes thing to a theoretical testosterone high--pretty *edgy* experience. It killed all the pain, but he re-dosed at least twice.

Thankfully they don't use hammers anymore.

[BumbleBeeDave]

. . . this is just one tooth.

BBD

[bluesea]

. . . this is just one tooth.

BBD

A lot depends on the OR. Some don't care too much about the patients pain, others are more attentive. Mine even gave a personal call that evening to check up and answer questions. OTOH, if you've never had Nitrous Oxide, now would be the time.

But again the Lido/w epinephrine was completely sufficient, even with a procedure that left me with a chipmunk face for a few days.

[KeithS]

I got one wisdom tooth removed by my regular dentist and then a few months later had another one done by an oral surgeon. It was night and day, regular dentists (according to mine and a few other DDS friends) don't do that many extractions anymore. My regular dentist did it because "he was in there", it's a much longer even more boring story than that. The oral surgeon was done in a very short time with the minimum of discomfort. As a culture we don't eat all that much raw meat anymore so wisdom teeth have somewhat outlived their purpose anyway. The oral surgeon rides a Serotta and my regular DDS rides a Trek.

[Bruce K]

Now what does THAT tell you? :rolleyes: :D :crap:

BK

[RPS]

Man up and just do the needle or have the doc slip me a Mickey?

BBD
I'd ask the surgeon. He knows best.

I had all four of mine removed at the same time but don't recall what they used -- it was a very long time ago when they were first coming in (lack of room). I recall it didn't hurt much, or at least not until later; and that wasn't that bad. Much has advanced since then so it should be even better now. I wouldn't sweat it at all.

I'd only suggest asking your dentist if he recommends doing them all at once.

[rnhood]

I had one wisdom tooth removed a number of years ago and, it also had straight roots. So the extraction was actually easy. You only need local anesthetic. Its really no big deal. Impacted wisdoms are another story.

Having said that, I would recommend a root canal and cap. But that's just me. I have caps on two of my wisdoms and they work great. Never any trouble. Of course they did not require a root canal either. Still, I would be sure its necessary to remove the tooth, because I would much rather keep the wisdom with a cap. You don't use a lot of wisdoms eating, but you do use them some. They take a bit of the load off the molars.

[Joellogicman]

Went with local anesthesia. It was not all that painful. Two of the wisdom teeth were deeply impacted. The sound they made as being removed was pretty horrible.

The worst part by far were the next couple of days after extraction. My face was swollen like a beach ball, my mouth ached, and I couldn't eat real food for two days.

[sjbraun]

I had 4 impacted wisdom teeth removed with just novacaine, seven injections per side. I remember my dentist putting something in my mouth and instructing me to hold it just so. Whack!! It was a chisel. He needed to break the tooth so he could extract the pieces. He said he was pretty god at wisdom tooth extraction, but he still felt badly about the GIs hetrained on.

[dvs cycles]

I prefer to be knocked out with Versed or Propophol or what ever cocktail the oral surgeon is serving that day.
Had all 4 taken out in 1982 and I had bruising on my chest the next day. I imagine he had his foot up there for leverage pulling or something. :beer:

[Peter P.]

I wouldn't know anything about having wisdom teeth extracted...;-)

http://farm5.static.flickr.com/4056/4414710183_0874fe00b4.jpg

Are you nervous yet?

[palincss]

I had all four of mine removed at the same time but don't recall what they used -- it was a very long time ago when they were first coming in (lack of room). I recall it didn't hurt much, or at least not until later; and that wasn't that bad.



I had one out in 1964 that I remember to this day.

I was conscious, they used a local and I could hear all the noises they made ripping the tooth out. A while later, I'm home and when the anaesthetic wore off, I had nothing but aspirin for pain relief.

I experienced instant replay complete with sound effects for hours. It hurt so bad I couldn't stay in the house - I had to go out and run up and down the road screaming and howling at the top of my voice.

It's a good thing we lived at the end of the road that goes up Mount Beacon, and there was nobody around to notice.

[pjmsj21]

I just had my remaining two removed about ten days ago and was debating the local versus being put out. Although my initial thought was to go with the local, in the end I decided to go under and would probably do it again that way.

However I am still dealing with pain on one side of my mouth that has been quite bothersome.....not sure of the cause at this point but Ibuprofin and I have been good friends of late.

Pat Mc

[VTCaraco]

1992 I convinced my dentist, who I knew pretty well, that he could do it in office with local anesthetic. He literally had one knee on my chest as he pulled, pried and yanked. Two weeks later I had to go back for the other side. He cursed at me like a sailor on that Saturday, knowing a little better what he had gotten himself into. I had shards of tooth come out for literally years. And the dry socket (one on each side) was no treat, either.

In contrast, my wife was advised to have hers removed about 10 years ago. She consulted with a local oral surgeon who we knew vaguely (I taught his boys math). The procedure went like clockwork and was almost pain free. She developed a dry socket, too; but I don't think that either occurrence of the dry socket could be blamed on the procedure.

The dry socket IS something you'll want to look out for. For mine, they concocted some sort of homeopathic gauze that dripped clove oil, if I'm remembering correctly, down the back of my throat for hours. The relief was so profound that I didn't complain a bit about the horrible taste.

[endosch2]

Just schedule it with an oral surgeon under local and he / she will have it out in less than 10 minutes. It should be a straight forward extraction. You dont really need that tooth anyway. Local should be fine as long as you can handle some vibration, movement, noises. There is no reason to be knocked out unless you have a lot of anxiety around dental appts.

[RPS]

You guys are doing a great job scaring Dave.

I had one out in 1964 that I remember to this day. Palincss, I still remember clearly too but for a completely different reason. I was at the University of Florida in Gainesville at the time and my wife went with me to drive me home. On the way home I was hungry so we stopped for a milk shake, and recall feeling it was my lucky day because they had “Mamey” milk shakes and ice cream (my favorite tropical fruit common in Cuba). When I mumbled a Mamey milk shake the young lady looked at me puzzled, and after pointing to it, she said “you mean Mammy”?

For some weird reason it made me laugh so hard it hurt – for real.

[djg]

Had mine out about 5 years ago -- neither GA nor just local, but sedation. As to the procedure itself, you'll consult your oral surgeon and hear what he or she has to say. As for the sedation -- no regrets and no real memories either. (I mean, what do you win by being fully conscious for this?)

[huebar]

I wouldn't know anything about having wisdom teeth extracted...;-)

http://farm5.static.flickr.com/4056/4414710183_0874fe00b4.jpg

Are you nervous yet?
)))))))))
I will face it soon as well. now i am 23, it's supposed to start soon)

[Louis]

About twenty years ago I had all four of mine removed at the same time w/ local anesthetic. It took the oral surgeon about 1 hour. No big deal. The worst part was driving home with my mouth (jaw clamped down to hold the temporary packing in place) slowly filling up with blood and saliva. When I stopped off at the drugstore I had to spit about half of cup on the parking lot asphalt.

I decided to go local for the same reason I decided to do epidural instead of general when my L knee was scoped - I just wanted to know what was going on. The one time I had some cavities filled I told my dentist I didn't want any anesthetic. He was skeptical at first, but it turned out to be fine, with only minimal pain and I didn't have to go home with half my mouth feeling dead. (I don't recommend that approach for wisdom teeth.)

If you're a real man I have the tools for you right here:

http://www.solarnavigator.net/solar_cola/cola_images/chivas_regal_whisky_bottle.jpg

http://www.californiabonsai.com/shop/images/M18L.jpg

[handsomerob]

First off, there are quite a few different anesthetics they can use for a local other than Lidocaine... so don't be surprised if the Dr. has a different preference. Septocaine is a very popular anesthetic that works well for longer procedures. FYI, Novacaine is a brand name that has been discontinued for quite some time.

With a simple extraction of an erupted molar, you may be just fine with a local, but as others have said I would suggest going with your oral surgeons recommendation. How much effort a tooth requires for extraction varies per person.

[BumbleBeeDave]

. . . of having all four out. Nothing wrong with any of the others. All are fully erupted and straight and so far have not given me any trouble in 51 years.

Now what is "dry socket?" Doesn't the surgeon sew the gums together? Does the open socket where the tooth was stay there forever? Seems to me it would be a good place for things to lodge and the damn thing would just get infected again . . .

BBD

[William]

I had four pulled at one time. The Doc wanted to knock me out but didn’t like what the monitor was telling him when they started so he ended up shooting me up with Novocain and going to work. It didn’t really hurt, I just remember the tugging and one of the teeth breaking in half when he was trying to get it out. It went fine and I didn’t even need any of the fun prescription meds he prescribed for the pain.




William

[SEABREEZE]

Recently at my LBS, the mechanic just came back from having a tooth extracted, he was telling another employee, how he had it done with no pain killer.. straight up.

Could not tell you if it was a wisdom or what, as I was just listening to the story. Do recall him saying he didnt like the after affects of filling like his mouth was swollen, and wearing off of the local.


As others have posted, follow your surgeons suggestions, and best of luck to you

Rinse frequently using sea salt once procedure is done.

[ckamp]

I have had all 4 removed, it was not that bad at all. The worst part was the numbing needle on the roof of my mouth, that one hurt... for a few seconds.

[oldguy00]

Guess everyone is different...
I've had all 4 removed under normal freezing.
Three of them were not impacted and above the gum and pretty much popped out in less than 30 seconds of the dentist yanking on it. Never felt any pain and no bruising.
The one that was impacted, again, normal freezing, and the dentist sort of drilled away the part of the tooth in front of it that was sitting on top of it, put a filling in it, then yanked the wisdom tooth out....again, no pain, no after effects.

[93legendti]

I had all 4 removed years ago. One was infected. The OS used a local and it went fine.

There are risks associated with being put under.

[bluesea]

With impacted wisdom teeth, the term "pulled" is something of a misnomer. You really need to be awake to discover why. Depending on the tooth they could basically end up grinding it to pieces, while alternately manually extracting as best they can.

[VTCaraco]

. . . Now what is "dry socket?" . . .

BBD

Dry socket = no fun

I just found the following link (http://www.atlantadentist.com/Wisdom_Tooth_Dry_Socket.html) that seems to sum it all up.
Here's another one (http://www.mayoclinic.com/health/dry-socket/DS00778) from the Mayo clinic.
A professional could surely add more.

[BumbleBeeDave]

Dry socket = no fun

I just found the following link (http://www.atlantadentist.com/Wisdom_Tooth_Dry_Socket.html) that seems to sum it all up.
Here's another one (http://www.mayoclinic.com/health/dry-socket/DS00778) from the Mayo clinic.
A professional could surely add more.

I had read several places about the importance of not disturbing the formed blood clot, but I had not seen losing it called by that exact name.

Hmmm . . . Well, I guess I could just do it all myself . . . :eek:

http://www.youtube.com/watch?v=WG036wh8tkI

BBD

[John M]

Go with local. I had all 4 of mine done 12 years ago by an oral surgeon in the office under local, including two that were bony impactions requiring quite a bit of work.

From my perspective as an ICU physician, one should NEVER undergo general anesthesia or sedation unless absolutely necessary. Even though it is safe, the risks are not zero.

Good luck!

[ThomasRZ]

I had all four wisdom teeth removed last May at the age of 28.

I was knocked out and apparently they were out in 15 minutes. I was given a scrip for vicodin, but I only took one of them, as I had no major pain. I was drinking kefir and juice for the three days after the surgery, but I was eating regular food by Thursday, except for hard stuff.

I was all healed in about two weeks. I was very diligent about squirting out the holes with the little syringe and using non-alcohol mouthwash after every meal. I also avoided straws like the plague. Basically, I just followed the doctor's advice to the T.

[R3KC]

Any advice from forum dentists--or even just members who play a dentist on TV--would be appreciated! :D

My left lower wisdom tooth got infected over the past month and now my dentist says the pulp has died and he advises removal, since he felt it wasn't worth it to do a root canal and crown on a tooth way at the back like that. He did all the tests--liquid nitrogen, applying an electric current to the tooth--and no feeling whatsoever, so I'm assuming he's right. He says the tooth is fully erupted and the roots are pretty straight, so he doesn't see it as a complicated procedure.

I have an appointment for a consultation with an oral surgeon in a few weeks and in the meantime my dentist gave me antibiotics--Clindamycin--to keep the infection down. The pain and, I'm assuming, the infection have eased off, though I still can't really chew on that side. But he says the infection is still inside the tooth and therefore it should come out.

Now . . . THE QUESTION. At this point I'm assuming the surgeon is going to give me an option of either just lidocaine or actually getting knocked out. Have any of you had the procedure, just gone with the lidocaine, and regretted it? While I don't usually have any queasiness with just getting cavities filled, this is certainly a bit more involved than that.

Man up and just do the needle or have the doc slip me a Mickey?

BBD

Man up! I had 4 of mine pulled on shots only. Wasn't that big of a deal other than my entire face ended up numb.

[BumbleBeeDave]

Go with local. I had all 4 of mine done 12 years ago by an oral surgeon in the office under local, including two that were bony impactions requiring quite a bit of work.

From my perspective as an ICU physician, one should NEVER undergo general anesthesia or sedation unless absolutely necessary. Even though it is safe, the risks are not zero.

Good luck!

Not to discount what anyone else has said, but this is the kind of professional perspective that I wanted.

BBD

[djg]

Go with local. I had all 4 of mine done 12 years ago by an oral surgeon in the office under local, including two that were bony impactions requiring quite a bit of work.

From my perspective as an ICU physician, one should NEVER undergo general anesthesia or sedation unless absolutely necessary. Even though it is safe, the risks are not zero.

Good luck!

I hope this comes through as a question, rather than a challenge, because I'm really asking and really don't know: what are the risks with popular methods of sedation? I'm not asking for a definition of adverse events, or a list of possible adverse events, but a general sense of the statistical risk of a serious adverse event. I gather that the risk is not zero with oral surgery even without any meds at all -- people develop infections, the blood/brain barrier might be compromised, etc. What I don't have any rough and ready sense of is the incidence of serious problems with (a) nada, (b) local (three most popular?), (c) sedation, or (d) GA. Sorry if this is wandering off-topic, but this seems like the kind of thing folks might like to know.

[imabean]

As a general dentist, I have been doing simple, partial impaction, and full bony impaction extractions for the last 20 years. I have only used local (lidocaine with epi, septicaine with epi) with one or two cases needing nitrous due to anxiety. If you are pre-treated with antibiotics then your chances of post-op infections are low. The procedure is usually simple, if done by the right practitioner. Follow post-op instructions, continue antibiotics, soften your diet for 3-5 days, avoid smoking and straws. Anti-inflammatories, and/or short dose steroids, usually solumedrol, is helpful. Leaving the molar in place would be unwise, costly, and would probably fail in the future. You'll probably need a day off to recover and sneak in a ride.

[VTCaraco]

You'll probably need a day off to recover and sneak in a ride.

Sounds to me like imabean is the dentist we've all been looking for!!!

[John M]

I hope this comes through as a question, rather than a challenge, because I'm really asking and really don't know: what are the risks with popular methods of sedation? I'm not asking for a definition of adverse events, or a list of possible adverse events, but a general sense of the statistical risk of a serious adverse event. I gather that the risk is not zero with oral surgery even without any meds at all -- people develop infections, the blood/brain barrier might be compromised, etc. What I don't have any rough and ready sense of is the incidence of serious problems with (a) nada, (b) local (three most popular?), (c) sedation, or (d) GA. Sorry if this is wandering off-topic, but this seems like the kind of thing folks might like to know.

Each patient must discuss their procedure with their care provider to determine the best and safest strategy for analgesia/anesthesia given the individual circumstances of the procedure. In agreement with imabean's experience, I would consider removal of wisdom teeth the type of procedure that the majority of adults can safely and reasonably handle with local anesthetics.

The risk of a serious adverse event from anesthesia/sedation is quite low (but not zero). Obstetrical anesthesia is well studied, and I have seen studies that reports rates of a complication related to anesthesia of 0.25-1%. Generalizable data are hard to come by because most studies of complication rates are done with an individual procedure or specific sedation/anesthetic regimen. The definition of "complication" also varies from study to study.

I administer procedural sedation to children every day that I work in the pediatric ICU and would not do so if I did not believe that it was safe and medically necessary for those procedures. Indeed, the age range and developmental level of my patients (children) requires sedation for many procedures that adults could have done under local. That said, I stand by my original statement that nobody should undergo procedural sedation or general anesthesia unless it is necessary.

[Louis]

I've told this story before, but since the whole safety thing came up I'll repeat it:

As I said above, when they 'scoped my knee a while back I opted for an epidural so I could follow what was going on. Part of the way I suddenly started to feel very, very faint. I heard some alarms go off (I assume to plummeting blood pressure) then somebody said something about atropine. (I remember being lucid enough to think, "Hey, I know what that's for...") I don't think that I ever lost completely consciousness, but I don't know for sure.

Interestingly enough, afterward nobody mentioned anything about it to me...

[SEABREEZE]

I had all four wisdom teeth removed last May at the age of 28.

I was knocked out and apparently they were out in 15 minutes. I was given a scrip for vicodin, but I only took one of them, as I had no major pain. I was drinking kefir and juice for the three days after the surgery, but I was eating regular food by Thursday, except for hard stuff.

I was all healed in about two weeks. I was very diligent about squirting out the holes with the little syringe and using non-alcohol mouthwash after every meal. I also avoided straws like the plague. Basically, I just followed the doctor's advice to the T.

Umm kefir, smart man

[WickedWheels]

According to my wife, who's a general dentist (and does wisdom tooth extractions)...

Be put to sleep in an oral surgery office. It's not "general" as there are no tubes down your throat. It's IV sedation. As for the reasons... she said that the bone gets denser as you get older, so it could be a more difficult procedure. An oral surgeon mostly handles extractions and implants. When your career is largely based on these two procedures I would imagine that you get very good at it. You'll be more comfortable and frankly, if you're nervous enough to ask about this on a bike forum then you should go with the most comfortable option.

If you need her to establish her "bike cred" to consider her advice... she's 6 months pregnant and just got off riding her road bike on the trainer. I'd post a picture, but it's not "G" rated.