Be wise on why, when and how: Self-care tips for wisdom teeth extraction help with healing

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Nov. 11—Consider it a wise move. More than 5 million young Americans will have their wisdom teeth removed this year.

The preventive surgery is common for a reason. Modern mouths are smaller than those of our ancestors, so, typically, there isn't room for a third set of molars. The name comes from how these molars form later in life by around age 18, when a youth has a bit more wisdom.

Dentists recommend about 85% of people have their wisdom teeth removed by late adolescence — or typically between ages 17 to 25 — to prevent health issues such as infections, pain from crowded teeth and decay.

While the surgery is straightforward, patients need to be mindful of several self-care recovery tips, said Dr. Kyle Dosch, Spokane-based dental director for Delta Dental of Washington. But first, there's why it shouldn't be delayed.

Earlier the better if issues are likely

Removal is typically done for these reasons: The third molars aren't aligned and don't have enough room, crowding the teeth, causing pain and potentially damaging adjacent teeth. Decay and infection can occur in the bone and gums. Few people have enough room, but if wisdom teeth come in at least partially, they're often difficult to keep clean.

With X-rays, dentists typically can tell before the wisdom teeth erupt about any issues. Earlier surgery often is better, before roots are fully formed and the wisdom teeth still are developing in the jaw prior to pushing through the gums, Dosch said.

"If it appears most likely that the wisdom teeth are going to cause any one or more of the problems, the surgery actually can be easier and less complicated when the tooth is smaller, when it doesn't have all the root development," he said. Early timing also is good because younger patients typically heal faster.

If you're already experiencing pain and problems because of wisdom teeth, also don't delay "because just the same as with other dental treatments such as cavities, the longer you delay, the more the issue can become compounded and more severe, which can make the treatment be more extensive.

"Even though we're still in this pandemic, patients should feel safe going to see their dentist, and they shouldn't delay care, including this type of surgery."

Dentist or oral surgeon may do surgery

It really depends on individual dentists and what that practice offers. "Every dentist in practice has the education and experience for extracting teeth," Dosch said. "Extracting wisdom teeth can be more complicated. A lot of times, the recommended timeframe for removing these teeth is when the roots aren't completely developed and the tooth actually isn't visible in the mouth, which means the surgery involves removing some bone to uncover the tooth to access and extract it."

"Not every dentist will do that as a regular part of a practice, or it might be that the tooth is so far back in the back of the mouth that the surgery might require anesthesia beyond just local anesthesia. Referrals to oral surgeons are a very common thing."

Tips for recovery can make it smoother

—Rest. You've just had surgery. If your job requires strenuous activity or lifting, take a couple of days off after the extraction, Dosch said. "You want to allow healing without disrupting the blood clots forming in your mouth. Eventually, that blood clot will be replaced with bone and gum tissue."

Lifting something heavy or overdoing it at the gym for about two weeks afterward might dislodge a blood clot and create a dry socket, a condition when the protective blood clot is disturbed and exposes the bone to air, food and bacteria, which is painful and can cause infection. "It can require additional treatment."

—Avoid using straws, smoking and vigorously rinsing the mouth for the first two weeks. Such suction in the mouth can dislodge a blood clot and cause a dry socket problem. Brush gently near the extraction site. After the first 24 hours, a gentle rinse with antiseptic mouthwash is OK.

—Go with a soft diet and avoid crunchy foods for at least a week. Foods such as seeds, rice, chips and other hard foods can form into hard little bits that get stuck in the socket and can irritate the wound. Instead, try options such as smoothies (no straw), yogurt, protein drinks, pudding, mashed potatoes and eggs.

—Try a ice pack on the cheek and elevate your head slightly if there's swelling, which should reduce after two days. "You can use an ice pack or bag of frozen veggies for about 10 minutes, then rest for maybe 15 to 20 minutes, then apply for another 10 minutes," Dosch said. "That in combo with ibuprofen will help keep the swelling down."

—Use pressure and gauze at first. "You'll go home and usually you're biting down on gauze, and that's helping to form those blood clots and applying pressure to stop the bleeding."

You'll likely get some additional gauze when sent home. As you change gauze, "You'll want to get it a little bit wet under the sink, so you're not putting on something dry that can stick to your gums, then bite down for every 35 to 40 minutes." You might think you're bleeding more than reality because a bit of blood can make saliva look pink, he said. If it's dark red, apply more direct pressure and sit up.

By two weeks, you probably won't notice the extractions. "Our body does a very good job of healing, especially in the mouth where there is lots of blood supply."

Pain isn't always a given

You should expect some discomfort for about two to three days, but the level of pain varies widely, Dosch said. Many patients have only a little discomfort and sometimes soreness at the jaw because the mouth had to be open wider than normal during the surgery. Most people will recover with ibuprofen or acetaminophen and ice the cheek.

Complications are rare, but watch for fever, difficulty swallowing or breathing, persistent numbness or oozing from the socket. Call your dentist if there are any issues.

Check in with insurance beforehand

The cost of wisdom extractions varies. Dosch said most dental benefit plans cover at least part of the cost of having your wisdom teeth extracted, as a common dental procedure, but you can check ahead with your carrier.