Disclosing your medical history
Do all wisdom teeth need to be removed?
Do you need a 3D image?
Do wisdom teeth cause crowding?
There is a no definitive answer in the literature to support or refute this claim. However, general consensus is that the evidence is more suggestive that retention does not cause crowding. As we age our teeth tend to drift forwards physiologically. Additionally, this drift still occurs in those whose wisdom teeth did not develop or were removed. Special warning should be emphasised on patients who have had orthodontics. Unless permanent retention or retainers are worn, teeth crowding will relapse regardless of wisdom teeth presence. There may still be other indications for the removal of your wisdom teeth; however, the decision will always be based on weighing up the risks and benefits of the surgery. If dental crowding is a chief concern of yours, please discuss this will your Oral Surgeon, Orthodontist or dental practitioner.
Do missing teeth need to be replaced?
Teeth can be lost for various reasons including deep dental decay, periodontal disease, infection, cracks or trauma. Not every missing
tooth needs to be replaced, but sometimes it may be recommended due to aesthetics or increasing function
within your mouth. There are different treatment options for replacing teeth
including removable dentures, bridges or dental implants. Every patient is unique and priorities
for everyone differ. If you would like some options to replace teeth that you have lost, please discuss this with your Oral Surgeon or dental practitioner.
How long is the recovery after surgery?
Post-operative recovery is based on three factors:
1. Health status of patient
2. The type of surgery carried out
3. Compliance with post-operative instructions
For minor surgery in an otherwise healthy person, recovery is short. Mild tenderness and swelling for a few days. This may include removal of one or two teeth or a biopsy. For more involved surgery, such as removal of four deeply impacted wisdom teeth, recovery will be one to two weeks. This does not mean you will be bed bound for two weeks. However, it is advisable to not have any rigorous activities or important events on during this time. For case specifics, discuss this with your Oral Surgeon.
What to do if you are anxious about having surgery
It is completely normal to have some nerves when it comes to having surgery especially in your mouth. However, many horror experiences and myths do circulate that do not reflect what should occur. Some anxiety may stem from treatment being carried out in an inappropriate setting. If you are anxious, it is advisable to book for a consult first and talk through your concerns with the surgeon. Other alternatives may be more feasible such as treatment under nitrous oxide, oral anxiolysis, IV sedation or general anaesthetic. This will be safer for all involved. Other horror stories have arisen by treatment being carried out by those with lack of experience. For an experienced surgeon, predictable timings for the procedure can be given. Oral surgery procedures are normally less than 60 minutes and this includes removal of four impacted wisdom teeth. Oral Surgeons are Specialists who have had years of rigorous formal surgery training after their primary dental qualification. It is guaranteed that knees will be nowhere near your chest!
Do you require antibiotics?
Antibiotic prophylaxis is a broad term used to describe the administration of antibiotics (drugs that target bacteria) to patients who do not have an active infection. It is used to prevent an infection from occurring both at the surgical site or at a distant site in the body. They may be taken at the time of surgery or a course afterwards.
There are specific medical conditions where this has been indicated in the past including certain cardiac conditions or patients with joint prostheses. The guidelines behind these have changed over the years and it is best to discuss this with your surgeon, or medical specialist. Other times may be due to patients with a compromised immune system (for example; poorly controlled diabetics, patients undergoing chemotherapy, patients taking immuno-suppressant drugs such as prednisone or methotrexate).
Most fit, healthy patients do not require antibiotics after surgery as long as other oral hygiene instructions are carried out. Your surgeon should not prescribe antibiotics after surgery unless it is absolutely necessary. Inappropriate prescription can lead to an increase in microbial resistance, but more immediately the risk of allergy or gastro-intestinal upset. What is better practice is to have an appropriately timed review appointment and if there are any signs of infection, to then commence antibiotics. This will be dependent on many factors including your medical history, surgery carried out and oral hygiene. Discuss this with your Oral Surgeon if you have any concerns.
What pain relief will you be prescribed after surgery?
A common question with surgery is, “How much pain will I be in afterwards?” Pain itself can be quite subjective but surgery anywhere on your body will have post-operative tenderness and limitation of function as you heal. This is a protective measure from your body against further injury. You will be prescribed appropriate analgesics (pain killers) after surgery. This will be dependent on many factors including your medical history and the surgery carried out. Appropriate pain relief will be prescribed.
What makes surgery in your mouth unique in comparison to other parts of your body (for example your foot) is that it is very difficult to rest your mouth. You need to eat, speak, and show emotions such as smile. You are normally more conscious of discomfort in your facial region because it is so personal. But, it is advised to go about your routine as best as you can. This puts the discomfort at the back of your mind. It is recommended to restrict yourself a little in some activities such as eating softer foods and no intense exercise for a week.
The World Health Organisation pain ladder advises the use of paracetamol with a non-steroidal anti-inflammatory drug as first line therapy for pain relief. Many patients think that this will not be enough and request ‘something stronger’ to begin with. The WHO outlines that as you climb the ladder to a higher rung, stronger drugs are then implemented, not as first line therapy.
There have been many randomised controlled studies (highest evidence) looking at the addition of opioids (for example; codeine, oxycodone) to the post-operative regime after oral surgery procedures. The findings have revealed that in most cases this is not necessary and in fact does not improve the analgesic effect. Opioids themselves have many issues with use including addiction and side effects such as drowsiness, constipation, nausea and vomiting. In a reasonable percentage of the population opioids have no effect at all, and some people are more susceptible to the side effects. This is another reason why safer drugs are usually prescribed first. Best practice is to have an appropriately timed review appointment and monitor the pain, and commence stronger drugs if necessary. Discuss this with your surgeon if you have any concerns.
What is a biopsy?
The Pathologist will use particular chemical tests and look at the sample under a microscope to finalise their diagnosis. They will then write a report and return this to the surgeon. Your surgeon will discuss the Pathologist’s findings and whether any further treatment is necessary.
Your surgeon will take your Medicare details for submission of the sample and the Pathologist will bill you directly. You may receive some monies back from Medicare for their report.