Conrad Masureik


Impacted Teeth
Since the removal of impacted teeth is an important matter for both the patient and the Oral surgeon, it is necessary for you to thoroughly understand the reasons for their removal and the normal side effects which may follow.

What is an Impacted tooth?
All teeth are formed deep within the jaw bones. As the roots develop the tooth travels towards its future place in the dental arch. This is called eruption. If the tooth travels in the wrong direction, or is blocked by another tooth or some dens bone it is said to be impacted. Unerrupted teeth are normal in childhood, but not in adults.  

The teeth that are the most frequently impacted are the 3rd molars or wisdom teeth that should erupt between16 and 21 years of age. There is usually not enough space for them and they can cause crowding of the other teeth within the dental arches.

The upper canine teeth or eye teeth are also frequently impacted and they erupt between 11 & 13 years of age. We can often mechanically erupt them in to the correct position with the help of orthodontic appliances.

 The premolars or any other tooth that has lost its way can also be impacted. So to, the extra or supernumerary teeth that develop from time to time can be either impacted or erupted and they very often obstruct other teeth from erupting normally.

What harm do impacted teeth do?
* They damage or cause decay of adjacent teeth-especially if they have contact with the oral environment and have broken through the gums (Partially erupted)
* Infection of surrounding gum i.e. Pericorenits.
* Crowding of erupted teeth
* Referred pain i.e. Headaches, earaches, sore throats, sinus pains Etc.
* Pathology such as cysts, abscesses and tumors (rare) may develop

Why should impacted teeth be removed?
As a basic rule all impacted teeth in patients over the age of 21 should be removed, There are however exceptions to this and they should be discussed with the doctor who is going to be treating you in consultation with the doctor who has referred you.

If a patient with an impacted tooth waits until it causes trouble, he/she may first have to be treated for the infection or other complications before the operation for removal can be done. This means additional loss of time and expense as well as some added risk.

What is it like to have an impacted tooth removed?

Many ordinary teeth can be removed using extraction forceps. This is of course not possible with impacted teeth as they are partially or completely under the surface.

We consider the removal of impacted teeth an operation in every sense of the word. This is not meant to frighten you, but to give you better understanding about certain features regarding the careful preparation, cost and the need for good after care.

The removal of impacted teeth can be compared amongst other with tonsillectomy, appendectomy, mastoidectomy or cataract operations.

The actual removal of the tooth is done in keeping with surgical principals, with meticulously sterilized instruments, good light, a dry operative field and gentle handling of the soft tissues and bone. Depending on the difficulty of the procedure it may take from ten to sixty minutes. The wound will be closed with dissolving sutures.

Most of the times impacted teeth are removed under a general anesthetic in an operating theater (you are put to sleep) and your heart rate, airway and breathing are carefully monitored by the anesthetist. It is important to note that there are very specific instructions to be followed before any general anesthetic. See the note on special Instructions before presenting yourself for an anesthetic

In certain, less severely impacted cases the removed can be done under a local anesthetic in my consulting rooms. This needs to be discussed with me or my ladies before the time. Conscious sedation for Oral surgical procedures is a very contentious issue and carries a high degree of risk so I’m not personally in favor of it out side of a fully equipped theater and then one can just as well have a full anesthetic Certain Health care funders only allow for the removal of impacted teeth under local anesthetics and I feel that it is for me to decide weather they can or can’t be removed in this way.  These matters need full clinical examination and evaluation before any decisions of this nature can be made.

Postoperative instructions for your home care comfort will be furnished (can be download from this sight).Patients are generally put on special drugs to minimize swelling, reduce discomfort, prevent infection, promote healing and aid in oral hygiene.

Are there any complications?
General Information for your Home Care Comfort Following removal of Erupted Teeth, Impacted Wisdom Teeth, and other Oral Surgical Procedures

If present remove the gauze sponges that have been placed in your mouth one hour after surgery unless told otherwise. Place fresh ones as needed - wet them in cold water first.

A certain amount of bleeding is to be expected following] surgery. It is often possible to control mild oozing bag placing a folded, wet gauze pad, the size of a thumb, over the wound. Bite down firmly, and hold for 60 minutes. Sit upright and remain quite.

If bleeding continues in spite of thee above, dip a tea bag in cold water and place this over the wound, biting firmly. It also helps to stop bleeding if you lie down, with your head raised on several pillows. Apply an icebag or cold compress to the c eek. Do not become alarmed or exited. lf unable to control excessive bleeding, call Dr. Masureik.

Upon reaching home put an icebag or cold towel to the face for the remainder of the day of surgery. Nibble on crushed ice or hold ice water in your mouth over the area of the surgery. Do this frequently. ln other words, keep the area of surgery as cold as possible as this will help to reduce the amount of swelling which you are going to have. You may even place chipped ice within the gauze packs you are biting on. Continue for at least 24 to 48 hours.

For any discomfort, use the prescription that has been given to you. Don't be afraid to use the medication as it is designed to make those first few days after surgery more comfortable for you. When taking the tablets or capsules (whichever has been prescribed) be sure to drink at least 150 - 250 ml. of either water or milk. This will ensure rapid assimilation y the body and minimise the amount of irritation to the stomach itself. This irritation may cause nausea and sometimes even vomiting, so drink plenty of liquid when taking oral medicine.

lf you have been placed on an antibiotic, please take ALL the tablets as directed. The drugs which you may have been placed on will help to a) minimise swelling, (b) reduce discomfort, (c) prevent infection, (d) promote healing, and (e) aid in oral hygiene and wound cleanliness.

Do very little rinsing until the following morning, rinsing may dislodge the blood clot and initiate bleeding. When rinsing, which you may begin the day following surgery, use ONE of the following: (a) ½ teaspoon of table salt in 250ml of warm water or (b) a mixture of one part  of white vinegar with three parts of water. If you have been given a special prescription for a mouthwash, use that as directed instead of' the above. Rinse frequently at least 8 times a day. Avoid commercial mouthwashes as they contain alcohol which may initiate bleeding and cause wound irritation.
Drink plenty of fluids such as orange juice, tomato juice, ginger ale, water, tea etc. Drink at least 8 glasses of liquids daily. Dehydration must be guarded against after oral surgery.

Follow your own inclinations as to diet, but for your own comfort stick to a soft-liquid diet. Keep taking nourishment. Try (not to skip a single meal. Begin by eating soft foods or liquids such as heavy soup, milk shakes, so boiled eggs, cereals etc. As soon as possible change o solid food. lf you are a diabetic, maintain your normal diet and take your medication as usual.

Clean your mouth thoroughly after each meal. Brush your teeth as best you can. Cleanliness is a “must ’ for a rapid and uncomplicated recovery. Food left in the wounds retards healing and invites! infection. Stitches often traps food and bacteria. Rinsing the mouth vigorously will help to keep wounds clean.

lf bowel habits are irregular, it is suggested you take a mild laxative such as milk of magnesia.