The Cosmetic Dentistry Blog

I know smoking is bad but I had all 4 Wisdom teeth removed 2 days ago and the healing process has been smooth. Very little pain and no bleeding after 5 hours of the teeth being removed. How long should you wait to smoke again to prevent dry sockets because I have had friends who smoke the same day and did not get them and friends who waited 3 days after and got them.
- Jason from Wisconsin

Jason,
Dry socket is an infection of the socket and isn’t related to how soon after surgery you smoke. Smokers tend to get more dry sockets than non-smokers, but it isn’t caused by the physical act of smoking, as many dental assistants, and even some dentists, believe.

Dry socket occurs after about 15% of the extractions of lower wisdom teeth, and it is characterized by a dramatic increase of pain about two or three days after the surgery. When the socket is examined, it doesn’t have a blood clot. Seeing that, dentists many years ago thought that the blood clot must be missing because the patient “sucked it out,” and that this was the cause of the problem. From this erroneous idea come all the instructions to not suck through a straw or smoke, because smoking requires sucking. But scientific studies do not confirm this. The loss of the blood clot is an effect of the infection, not a cause.

The incidence of dry socket increases with increasing trauma to the socket that occurs during the surgery. An oral surgeon, with careful and gentle surgical technique and placing an antibiotic dressing of clindamycin in the socket right after removing the tooth, can nearly completely eliminate dry socket as a surgical complication. I know, because I did that and went for over ten years and hundreds of wisdom teeth extractions without a single incidence of dry socket.

I don’t smoke, and I would love to be able to tell you not to smoke. You’d be much better off to kick that self-destructive habit. But the truth is that you will not cause dry socket by smoking too soon after your surgery.

Dr. Hall

I am 35 yrs old and recently started having pain in my lower right wisdom tooth. It is fully impacted. The pain comes and goes within a couple of hours. This has happened 3 times in the last couple of months. My dentist referred me to an oral surgeon who recommends the tooth be extracted. He says the risk of parethesis is about 8-15%. Is that true and should I proceed with the surgery?
- Bridget from Texas

Bridget,

Your oral surgeon is warning you about possible paresthesia, which comes from damage to one of the nerves that go through the wisdom tooth area. There is the lingual nerve that goes to the side of the tongue, and the inferior alveolar nerve that goes to the lip. If this nerve is damaged, you could have anything from a transitory altered sensation in that nerve that lasts a few weeks to a permanent loss of sensation. Temporary damage is far more common. Permanent loss of sensation is a result of severing or totally crushing the nerve, which happens very infrequently.

You need to know that when a dentist gives you warnings about the risks from a procedure, the object they have in mind is to protect themselves against lawsuits. So there is a tendency, especially among specialists such as oral surgeons, to overstate the risks. Without an x-ray of your tooth, I couldn’t tell you if the percentage they gave you is right or wrong. It is high if there are no complicating factors in your surgery.

But you have to have the tooth out. The risk of doing nothing is far greater. The tooth could easily be infected, and a wisdom tooth infection can become life-threatening. And the longer you put this off, the more difficult the surgery will become and the greater the risks of complications.

And I would strongly recommend having ALL of your wisdom teeth out at this time. If you’re having trouble with one wisdom tooth, you will very possibly have trouble with the corresponding one on the other side soon. And the uppers are simpler to remove. The healing time and discomfort are only a little greater in having four wisdom teeth out as opposed to having one. A dentist who really cares about his or her patient will recommend that.

And for others reading this posting, this is an excellent illustration about the wisdom of having your wisdom teeth extracted when you are 25 or younger, if they are impacted. At that age, your bone is quite pliable and the risks of complications are very low. Having wisdom teeth removed at, say, age 20, has about 1/4 the risk of difficulty as having them out when you’re 35. Dentists who would advise otherwise are almost never dentists who have first-hand experience taking out impacted wisdom teeth.

Dr. Hall

Read more about tooth extractions.

Dr. Hall,
Hello. I had a wisdom tooth partially removed with the roots still intact. The dentist could not pull out my tooth. It was pretty excruciating. I sat for four and a half hours before he called it quits. He partially removed some bone to try to extract it the tooth but it didn’t work. He broke the tooth and took out what he could and cleaned up the bone as much as possible before sewing me up. He stated that he cut down the tooth enough for the bone to grow back over the roots that was left and that tissue will heal and start to grow back over the wound. My question to you sir is it ok for the roots to still be there. Am I still prone to serious infection if the bone grows over the roots, and will tissue grow back over some of my exposed jaw bone? I appreciate the help.

Thank you
-  Darian from Belgium

Darian,
I was surprised to read what had happened to you. I have heard of general dentists attempting wisdom teeth extractions and other difficult extractions, and finally giving up because they became too difficult. But in the situations I have heard of, the dentist then referred the patient to an oral surgeon to complete the work.

I don’t know how much of the tooth was left in your jaw, but the larger the piece, the greater the risk of subsequent infection, or cyst formation, or other complication. In some cases, it is wise to leave a root tip in the jaw when it is in a risky position such as near a nerve or near the sinus. But that doesn’t seem to be the case here – it just seems like it is a matter of the tooth being beyond the difficulty of your dentist. Yes, bone will probably grow over the roots, and it is possible that you will have no further trouble with this. But it is also possible that you will.

I would suggest going to an oral surgeon in the next couple of days and having him or her x-ray this tooth and examine you, and see what they think should be done.

Dr. Hall

PS – The following was not part of my e-mail to Darian:

I get frustrated when I hear Americans complain about health care in the United States. There are a number of stories I have heard from people in Europe and Asia that are like this and reveal a much lower standard of dental care than would be considered acceptable in the United States. This corroborates what I saw in my practice when I had to re-do foreign dental work. I guess it is just a human tendency to not fully appreciate the good things we have.

Link: Check Naperville emergency dentist Dr. David Newkirk

My son had 4 wisdom teeth removed two days ago, and from the removal his face is severely swollen on the left including his eye. I am seriously concerned could he possibly have nerve damage that is affecting his eye and! jaw which would require additional surgery? Or will anti-inflammatory medication, time, washing with warm salt water and penicillin help decrease the swelling? Thank you From Mother with frustrated son
Angela in Maryland

Angela,
You’re e-mailing me two days after this surgery, which is typically the worst day for the swelling, and then it tends to go down after that. I’m not hearing anything from you suggesting any nerve damage. The swelling comes from the surgery and always happens when you have impacted wisdom teeth removed. If the upper left wisdom tooth was a little difficult and required removing bone to get it out, as they often do, that tooth is very near the eye and the swelling will be up in the eye area. Now I can’t examine him, so I’m just going by what you are telling me. But you’re not telling me anything unexpected, really.

I would just follow the instructions of the dentist who took them out, and I would expect steady improvement. If at any time his situation gets worse – the swelling increases instead of decreasing, or there is an increase of pain from one day to another, then you should tell your dentist, and your son may need additional help.

You may give some feedback to the dentist that took them out. We always tried to brace our patients for the worst, and we described a worst-case scenario of what they would experience afterwards, so they didn’t worry if that happened. It’s not smart to paint too rosy a scenario for the patient – I would put my optimistic outlook aside and describe the worst I thought could reasonably be expected. If you weren’t expecting this, maybe your dentist could use a little lesson in post-operative instructions.

Related link: read about tooth infection.

Dr. Hall,
I was wondering if you could help me. I am a 50 year old woman whose dentist wants to take out her wisdom tooth (not impacted) but they say has a big cavity. Do you recommend  extraction for my age group? Is there any other treatment for this?

It doesnt give me any problems (no pain).

Thank you for your time!
Trisha from Florida

Trisha,
Ordinarily, you want to save a tooth if possible. But if this wisdom tooth has a large cavity in it, extraction may be the best thing, because wisdom teeth are sometimes very difficult to restore well. There is no age limit on extractions.

If you wait until the tooth hurts, the extraction could become very difficult because the tooth will crumble when they try to take it out. It would not be a pretty picture. And if a wisdom tooth isn’t impacted, you don’t have all of the complications that I list on the website for extractions of impacted wisdom teeth.

There has to be a certain amount of trust between a dental patient and a dentist. 90% of what the dentist does will be for things that you can’t tell are wrong. As dentists we try to get to cavities and other problems before they start hurting. Otherwise we’d be doing root canal treatments and crowns on every tooth.

If the tooth has a large cavity, then your choices are either extraction on the one hand or restoring the tooth on the other. The restoration could be a large filling or a crown, possibly including root canal treatment, depending on how large the decay is. But sometimes on wisdom teeth there are special complications in trying to restore them, because access is limited that far back in the mouth. A crown is a lot of money to spend if the result is questionable and you end up needing to replace the crown every two or three years, say. Hopefully you can trust the recommendations of your dentist.

Dr. Hall

Dr. Hall, I was searching online with the statement “wisdom teeth piece left in gumline” and I found a post of yours. You stated that the dentist makes a choice of whether or not he should leave the piece left in the gum. What are the actions that can occur if something does go wrong later on. I am asking because I had this happen to me and I am trying to figure out what I should do. I have seen two other dentists and they said they will not do the surgery to go in and remove the piece because they are scared of nerve damage in my face. Is there any legal responsibilites by my old dentist? I appreciate you time and any information you can give me.
- Chris from Virginia

Chris,
You didn’t say whether or not you are having trouble with this piece of tooth left in your jaw. If you aren’t having any trouble, then that is the end of the issue.

Even if you are, though, I don’t think the dentist is responsible for anything. And here is the reason: It seems to me that if you have two other dentists who are afraid to go after this piece for fear they will damage your nerve, then the dentist was reasonable to leave it in. If the piece is bothering you a great deal, then you can make a decision that you will take the risk of damage to your nerve, absolve the dentist or oral surgeon of any responsibility, and have it taken care of. But you will need to sign away your rights to complain later.

If your inferior alveolar nerve is severed in the process of getting this piece out, then your lower lip on that side will be permanently numb. While it feels weird for several months, eventually people get used to this and forget that it’s numb. You do have to be forever careful, though, because you can’t feel it if you bite your lip or burn it. I think you need to decide whether or not you want to take that risk.

Dr. Hall

Related links:
Read about the post-operative complications possible with wisdom tooth removal.