Wisdom Tooth Consent

  • Wisdom Tooth Consent

  • Informed Consent: Patient Information

  • This information page answers frequently asked questions about removal of wisdom teeth. It has been developed to be used in discussion with your general dentist so you are adequately informed about the benefits and risks of the proposed procedure.
  • 1. Why do wisdom teeth need removing?

    When a wisdom tooth has been damaged either by infection (from severe tooth decay or gum disease) or impaction (from lack of room for the wisdom teeth), the dentist will provide advice as to the best treatment for the tooth. If the damage to the tooth is too severe, the best option may be for your dentist to remove the wisdom tooth (tooth extraction). If the wisdom teeth is left untreated, it may eventually cause severe pain, systemic infection, development of dental cysts, and potentially tumors of the jawbone.
  • 2. How is a wisdom tooth removed?

    The dentist will first need x-rays to assess the tooth, bone, nerves and blood vessels around the tooth. Adequate numbing is then given via a local anaesthetic. Once the area around the tooth is numb, the tooth is painlessly loosened with precise movements and pressure. The loosened tooth is then removed. You will then be asked to bite down on a piece of sterile gauze to help stop the bleeding and encourage blood clot formation to begin the wound healing process. Stitches may be required depending on the circumstances.

    There may be cases where a ‘surgical extraction’ is required. When a tooth is still under the gum or is very broken down, the tooth may need to be divided into sections and bone may need to be removed to allow the tooth to be loosened with minimal force, and therefore removed safely.
  • 3. What are the benefits to removing a wisdom tooth?

    If the tooth is already painful from severe decay or gum infection, removing the tooth is generally the only way for this pain and infection to go away. Some patients mistakenly think that by taking antibiotics it will clear an infection, however in reality, antibiotics are extremely ineffective as a definitive treatment and therefore cannot clear dental infections properly.

    Pain is present because bacteria from the decay or gum infection causes pressure and inflammation build up in the tissues within and surrounding the wisdom tooth. In some cases, the bacteria can spread to the major blood vessels and carry the bacteria to the neck, which can cause a life-threatening breathing problem. Rare cases of death have been reported as a result of airway breathing difficulties, all stemming from a badly infected wisdom tooth being left untreated.

    If the tooth is not painful but is impacted, removing the wisdom tooth will reduce the risk of development of certain rare dental cysts and dental tumors. Odontogenic Keratocyst and Dentigerous cysts are often associated with impacted wisdom teeth. Both are destructive to the surrounding jawbone and can make the lower jaw fragile and at risk of fracture if the cyst is left to grow to a significant size. In addition, wisdom teeth are often very difficult to clean and so commonly food is left behind around wisdom teeth and thus the neighbouring second molar. Removal of the wisdom teeth reduces the chance of food trapping in this region and thus reduces the risk of decay in the second last tooth.
  • 4. What are the risks and complications of wisdom tooth extraction?

    Although every medical procedure has a risk of side effects and complications, removing a wisdom tooth is generally very safe. The benefits greatly outweigh the rare risks of complications. Nonetheless, even with best-practice techniques to reduce adverse outcomes as much as possible, it is important you understand the following side effects, complications and risks.

    Common side effects, risks and complications include:

    • self-inflicted injury to lips, tongue, cheeks and other soft tissues: you may bite or rub the numbed area without realising the damage you may be causing; children may need to be supervised until the numbness has worn off
    • short term (7-10 days) mild to moderate pain, including but not limited to gum/jawbone/joint pain, due to the irritation of the nerves and the movement of the jaw during the extraction
    • short term swelling (3-10 days) and possibly mild cheek bruising
    • bleeding
    • infection of the extraction socket, known as a dry socket: occurs when a blood clot does not form in the hole where the tooth was or the blood clot is disrupted by smoking, food debris, or by chance (2% of all extractions get dry socket due to no definitive cause):
    – the extracted tooth bone socket will be exposed to air and food
    – this can be very painful and can cause a bad taste and/or foul mouth odour
    – this is 10x more likely to occur if you smoke within 7 days of surgery
    – Treatment is usually strong painkillers to ease the discomfort while the body naturally cures the dry socket, which can take up to 14 days.
    – pain or difficulty opening your mouth wide, lasting 10-14 days.

    Uncommon risks and complications include:

    • Temporary altered nerve sensation and function (less than 1% chance):

    – a small percentage of people may, in spite of all precautions, experience partial and temporary loss of feeling in the areas served by the inferior alveolar and lingual nerves, as these nerves are located in close proximity to the extraction site. This can last from 3 months to 18 months.
    – The clinical signs and symptoms of this include altered taste and mouth sensation, tingling/weakness and/or numbness of the tongue & lips, and increased saliva flow.
    – Bone and root fragments remain in your gum, which may require subsequent follow up removal. Occasionally, if the fragment is less than 2mm and is deemed too risky to retrieve, the dentist may decide to leave them where they are if there is an unfavourable chance that nerves or other structures may be damaged in trying to retrieve the root fragment.

    If the upper wisdom teeth are close to the maxillary sinuses, removal of wisdom tooth may result in a communication (hole between the mouth and the sinus). This may require further surgery by an oral and maxillofacial specialist surgeon if the hole does not self-heal.

    Rare risks and complications include:

    • Permanent altered nerve sensation and function (less than 0.5% chance):
    – an extremely small percentage of people may, in spite of all precautions, experience permanent and potentially total loss of feeling in the areas served by the inferior alveolar and lingual nerves, as these nerves are located in close proximity to the extraction site.
    – The clinical signs and symptoms of this include altered taste and mouth sensation, tingling/weakness and/or numbness of the tongue & lips, and increased saliva flow.

    • Mandible fracture during the procedure, or shortly after the procedure, due to the bone being removed to create space to extract the wisdom tooth
  • 5. Who will remove my wisdom tooth?

    Your wisdom tooth will be removed by a Choice Dental general dentist who has been adequately trained to undertake the procedure, and has assessed your case to be suitable for their level of experience. You are advised that Oral and Maxillofacial surgeons do exist who are dental specialists in wisdom tooth oral surgery, and perform wisdom teeth extractions more frequently than general dentists. You are advised that a referral to such specialists can be given to you at your request at any time. By signing this form, you acknowledge that you do not wish to be referred to an oral and maxillofacial surgeon and that your decision is for the Choice Dental general dentist to perform this wisdom tooth extraction for you instead.
  • 6. What happens following removal of my tooth?

    Post-op Pain:
    Post-op pain following wisdom tooth removal is normal and expected. You can expect the discomfort to last a minimum of 5 days and up to 14days. The pain is generally tolerable with the help of painkiller medications such as Panadol, Nurofen/ibuprofen, or as prescribed by your dentist. Ensure you check with your GP/pharmacist if you are medically allowed Nurofen/ibuprofen.

    Time off Work:
    Following the day of surgery, you may need to take 1-3 days off work if you find the pain is too uncomfortable and you need to rest at home. This recommendation varies between people and usually the patient will self-assess if time off is required or not based on the severity of their pain symptoms.

    Wound healing time:
    The wound normally takes 2-3 weeks for the gum area to heal and to look normal again. Minor problems with healing occasionally may arise because the mouth must be used for eating and speaking. The mouth also naturally contains many bacteria which may increase the risk of infection in the wound. Fortunately, these issues are mild and very manageable. You will be given advice to prevent the risk of these after your procedure is complete.

    Numbness duration:
    Following removal of your tooth, the anaesthetic effect may continue for 6-8 hours. Occasionally, it can last 24 hours. Your mouth may feel swollen and uncomfortable during this period.
  • 7. What can I do to help prevent complications following removal of my tooth?

    You can help prevent complications such as pain, swelling, infection and bleeding by following a few simple points.

    Do not:
    • bite or suck a numb lip, cheek or tongue, as you may injure yourself
    • smoke or drink alcohol for at least 7 days as it will delay proper healing
    • lie down flat: you can relax but keep the head elevated to decrease the risk of bleeding
    • be too active for about 24 hours
    • rinse your mouth for about 4 hours:

    More detailed information will be provided by your dental practitioner following your procedure.
  • 8. What if I choose to not remove my wisdom tooth?

    If the wisdom tooth has been planned for extraction, it means your dentist has assessed your case and believes it is in your best health to have the wisdom tooth removed. If you decide to not remove the wisdom tooth, you may experience certain consequences.

    If the wisdom tooth is already painful (e.g. from decay or gum infection), you can expect to experience:

    • Increasing pain in the wisdom tooth area, to the point where it may be excruciating
    • Pus and infection formation in the jawbone
    • Rare risk of pus and infection spreading to the neck causing potentially life-threatening breathing difficulties
    • Rare risk of pus and infection spreading to the head and brain blood vessels, causing potentially life-threatening brain infections.

    If the wisdom tooth is not yet painful (e.g. from impaction or being non-functional), you can expect to experience:
    • Risk of future formation of dental cysts and tumors (i.e Dentigerous Cysts and Odontogenic tumors)
    • Risk of decay around second molars due to innate difficulty of cleaning the wisdom teeth region in certain people
    • Risk of future gum inflammation and gum pain from partially erupted wisdom teeth.
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