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Medical Forum / General / Dentistry / September 2007Wisdom tooth extraction: dentist or oral surgeon?
My dentist has recommended removal of a wisdom tooth because of a presently unsymptomatic crack. He thought removal made more sense than a crown. He indicated his office did this. I gathered he didn't think this removal a big deal. As far as I know, the teeth are normal, except for the crack. After reading some posts by people who have had this done, I started worrying. Somewhere I had the idea that wisdom tooth extraction fell within the purview of oral surgeons. Is that correct? If not, are there any easily stated criteria for when an oral surgeon rather than a dentist should do this procedure. I am a little uneasy just telling him I want an oral surgeon to do it. I am male, 56. You worry too much. Extractions are no big deal unless the tooth is sideways and buried under a 1/4 inch of solid bone, or wrapped around the nerves feeding the chin. The oral surgeon generally gets these cases. In my office, anyone who wants to be sedated goes to the oral surgeon. If the patient does not need to be sedated, then they get to choose between me and the OMFS. One tooth out of 2,000 (total estimation on my part) will be too difficult for a GP.  Signature/ Amatus / > My dentist has recommended removal of a wisdom tooth because of a > presently unsymptomatic crack. He thought removal made more sense [quoted text clipped - 19 lines] > > I am male, 56. > You worry too much. > [quoted text clipped - 8 lines] > One tooth out of 2,000 (total estimation on my part) will be too difficult > for a GP. Thanks Amatus for this response. I am a senior, otherwise in very good health, in a not-too-happy situation. I have 3 impacted wisdom teeth and all were found to be infected a couple of weeks ago. The other tooth was removed after an injection about 20 years ago by a dentist and there were no problems. Of the remaining 3, two are upper and one lower. The lower one appears to have some decayed bone between it and the rear tooth (which sinks a bit when chewing) and, worse still, a nerve is passing nearby. I visited a dental surgeon at a hospital and learned the following: 1 I have a lot of crowns, that might be damaged during the extractions. 2 The two upper wisdom teeth are close to the sinus cavities just above and that might "cause problems." 3 There is a nerve close to the lower wisdom tooth that could be problematic. If the nerve becomes damaged, I could have a tingling or numbness in my lower lip or mouth, that is temporary or permanent. My options: 1 Leave things as they are and monitor regularly for infections 2 Have all three done in the one session under sedation. Your opinion will be greatly appreciated TIA RF Your 3 possible complications are the standard ones we tell every patient who gets wisdom teeth removed. Without photos and x-ray images, I cannot advise you specifically. Generally, if the teeth have problems, something MUST be done. I always recommend doing all 3 (or 4) at one time. Signature/ Amatus / >> You worry too much. >> [quoted text clipped - 39 lines] > > RF > Your 3 possible complications are the standard ones we tell every patient > who gets wisdom teeth removed. Without photos and x-ray images, I cannot > advise you specifically. Generally, if the teeth have problems, something > MUST be done. > > I always recommend doing all 3 (or 4) at one time. Thanks Amatus for your response. Do you know any statistics that involve damage the nerve that is near the lower wisdom tooth? What is the worst that could happen if this nerve is damaged? Or, put it in another way, how much of my head could be permanently numb, or worse, in the worst case? Similarly what are typical statistics for breaking into a sinus cavity near the two upper wisdom teeth? There are three teeth and it makes sense to have all or none done. I live about 100 miles away from the clinic and I would have to be accompanied on every trip. Thanks again for your help. RF > Do you know any statistics that involve damage the nerve that is near the > lower wisdom tooth? Not specifically. In 23 years of practice, it has never happened on any case I did personally. The local Oral Surgeon office will get a few cases each year, but they do these all day long every day. > What is the worst that could happen if this nerve is damaged? Or, put it > in another way, how much of my head could be permanently numb, or worse, > in the worst case? Typically, it causes some numbness or tingling in the area that is numb from the anesthetic, that lasts for 2 weeks to 2 months. A few cases will last 3-6 months. More rarely, cases will be permanent. The only permanent cases I know of, personally, were cases where the jaws were sectioned and re-positiioned (a different procedure from extractions), and one or two cases where the impacted tooth was buried very deeply and had its roots wrapped around the nerve. > Similarly what are typical statistics for breaking into a sinus cavity > near the two upper wisdom teeth? I have had 3 cases in 23 years. All healed just fine after a quick treatment. It probably happens a lot, but is never noticed due to the blook clott filling the hole right away. > There are three teeth and it makes sense to have all or none done. I live > about 100 miles away from the clinic and I would have to be accompanied on > every trip. Do all three at once. >> Similarly what are typical statistics for breaking into a sinus cavity >> near the two upper wisdom teeth? > >I have had 3 cases in 23 years. All healed just fine after a quick >treatment. It probably happens a lot, but is never noticed due to the blook >clott filling the hole right away. OK, what treatment did you do ? Caldwell-Luc ? I assume the OP is referring to the complication of an oral-antral fistula. I just move a pedicle flap of gingiva over the hole and it heals up fine. I have had a root tip fall into the sinus cavity itself once and sent the patient to my local OMFS who rinsed it out of the sinus with irrigant and suction. Again the hole healed just fine. Signature/ Amatus / > >>> Similarly what are typical statistics for breaking into a sinus cavity [quoted text clipped - 7 lines] > OK, what treatment did you do ? > Caldwell-Luc ? >I assume the OP is referring to the complication of an oral-antral fistula. >I just move a pedicle flap of gingiva over the hole and it heals up fine. > >I have had a root tip fall into the sinus cavity itself once and sent the >patient to my local OMFS who rinsed it out of the sinus with irrigant and >suction. Again the hole healed just fine. Was thinking a whole tooth popped into the antrum. Have only had to surgically close one O-A fistula. Most respond well to decongestants and ABX, as long as the pt is informed about not creating a positive or negative pressure. >> Do you know any statistics that involve damage the nerve that is near the >> lower wisdom tooth? [quoted text clipped - 27 lines] > > Do all three at once. Thank you very much Amatus; that is very encouraging. Have a great week :-) RF > Somewhere I had the idea that wisdom tooth extraction fell within the > purview of oral surgeons. > > Is that correct? If the teeth are sideways and impacted, an oral surgeon, otherwise it takes like two seconds at the dentist. I had my lower wisdom teeth removed by an oral surgeon, the upper teeth at the dentist. It was no problem.
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