Teeth Extraction​ - Dentist Turkey

Wisdom Teeth and Tooth Extraction: Clinical Guide and Patient Care Overview

Teeth Extraction​

Understanding Wisdom Teeth

Wisdom teeth, or third molars, are the last set of permanent teeth to erupt, typically appearing between the ages of 17 and 25. Most adults have four wisdom teeth—one in each quadrant of the mouth. While some individuals experience no complications with their eruption, many develop issues due to limited space, misalignment, or partial eruption, necessitating extraction.

Why Are They Called Wisdom Teeth?

The term “wisdom teeth” stems from their typical eruption during early adulthood—a period traditionally associated with the acquisition of wisdom and maturity.


When Do Wisdom Teeth Become a Problem?

In modern humans, the jaw has evolved to become smaller, often lacking sufficient space to accommodate these molars. This leads to impaction, where the tooth cannot fully emerge or grow in its proper orientation.

Common problems include:

  • Partial Eruption: Only part of the tooth breaks through the gums, creating an opening for bacteria.

  • Horizontal Impaction: Tooth grows sideways and presses against neighboring molars.

  • Angular Impaction: Tooth grows at an angle—either toward or away from the second molar or toward the tongue/cheek.

  • Vertical Impaction: Tooth remains trapped in the jaw despite being oriented properly.


Signs and Symptoms of Impacted Wisdom Teeth

  • Swelling of the gums at the back of the mouth

  • Pain or pressure in the jaw

  • Difficulty opening the mouth

  • Foul breath or bad taste (due to trapped debris and infection)

  • Headaches or earaches (radiating pain)

  • Infection of the gum flap (pericoronitis)

  • Damage or decay in adjacent second molars


Clinical Evaluation of Wisdom Teeth

1. Dental Examination

A dentist will examine the eruption pattern and gingival tissue. Visual cues such as redness, swelling, or partially visible molar crowns are common in symptomatic cases.

2. Diagnostic Imaging

  • Panoramic X-ray (Orthopantomogram/OPG): Provides a comprehensive view of all wisdom teeth and their relation to the jaw, nerves, and adjacent teeth.

  • Cone-Beam CT Scan: Offers detailed 3D imaging when the root proximity to the mandibular nerve or sinus floor must be assessed.

3. Classification of Impaction

  • Pell and Gregory Classification: Based on the depth and relation to the ramus of the mandible

  • Winter’s Classification: Based on the angulation of the impaction (mesioangular, distoangular, horizontal, vertical)


Indications for Wisdom Tooth Extraction

The American Association of Oral and Maxillofacial Surgeons (AAOMS) recommends extraction when:

  • Teeth are impacted and symptomatic

  • Recurrent pericoronitis occurs

  • Associated with cysts or tumors (e.g., dentigerous cysts)

  • Causing resorption or decay of adjacent teeth

  • Orthodontic treatment is compromised

  • Difficult to maintain due to hygiene issues

  • Prophylactic reasons in young patients to prevent future complications


Surgical vs. Non-Surgical Extractions

Simple Extraction

  • Performed when the tooth has fully erupted.

  • Local anesthesia is usually sufficient.

  • The tooth is loosened and removed using dental elevators and forceps.

Surgical Extraction

  • Necessary for impacted or partially erupted wisdom teeth.

  • Involves incision of gum tissue, removal of bone, and possible tooth sectioning.

  • May require general anesthesia or sedation.


Pre-Operative Considerations

  • Medical History Review: Assess bleeding disorders, systemic diseases (e.g., diabetes, cardiovascular conditions), allergies, and medication use.

  • Antibiotic Prophylaxis: May be required in patients with a history of infective endocarditis or prosthetic valves.

  • Informed Consent: Discuss risks (nerve injury, dry socket, sinus involvement) and post-op expectations.


Recovery After Wisdom Tooth Extraction

Normal Healing Timeline

  • 24 Hours: Bleeding stops, clot begins to form.

  • 2–3 Days: Swelling peaks and begins to reduce.

  • 1 Week: Sutures (if non-resorbable) are removed.

  • 2 Weeks: Most soft tissue healing is complete.

  • 6 Weeks: Bone begins to fill in the socket.

Common Post-Operative Symptoms

  • Mild pain and swelling

  • Bruising along the cheek or jaw

  • Difficulty opening the mouth (trismus)

  • Slight bleeding or oozing


Post-Operative Care Instructions

  • Bite gently on gauze for 30–60 minutes after surgery.

  • Apply ice packs on the cheek intermittently for 24–48 hours.

  • Avoid spitting, rinsing, or using straws for 24 hours to prevent clot dislodgement.

  • Stick to soft foods: yogurt, soup, mashed potatoes.

  • Maintain oral hygiene without brushing the extraction site.

  • Use warm saline rinses after 24 hours to aid healing.

  • Take prescribed antibiotics and analgesics as instructed.


Potential Complications

1. Dry Socket (Alveolar Osteitis)

  • Occurs when the blood clot is lost, exposing bone.

  • Intense pain begins 2–4 days post-op.

  • Treated with medicated dressings and analgesics.

2. Nerve Damage

  • Inferior alveolar or lingual nerve injuries may cause temporary or rarely permanent numbness.

  • Risk minimized through careful radiographic planning.

3. Infection

  • Presents with fever, persistent swelling, pus discharge.

  • Requires antibiotics and possibly surgical drainage.

4. Oroantral Communication

  • Seen when upper wisdom teeth are close to the maxillary sinus.

  • Small communications often close spontaneously; larger ones may need surgical closure.


Wisdom Teeth Extraction in Turkey: A Popular Option for Medical Tourists

Turkey has emerged as a top destination for affordable, high-quality oral surgery. The country’s dental clinics are equipped with:

  • Cone-beam 3D imaging

  • Intraoral scanners

  • IV sedation options

  • Temos-accredited facilities (in select clinics)

International patients benefit from:

  • Cost-effective treatment (up to 70% lower than UK/US)

  • All-inclusive packages: accommodation, airport transfers, consultation

  • Bilingual dental professionals trained in EU/US protocols


Who Should Delay or Avoid Extraction?

  • Pregnant women (second trimester safest if urgent)

  • Patients undergoing radiotherapy or chemotherapy

  • Uncontrolled systemic illnesses (e.g., severe diabetes, coagulopathies)

  • Active infections not yet stabilized

In these cases, temporary management such as pain control and antibiotics may be initiated until definitive treatment is feasible.


Prophylactic Extraction Debate: Necessary or Not?

While many dentists advocate removing impacted wisdom teeth before problems arise (especially between ages 16–25), the decision must be individualized based on risk-benefit analysis. Some third molars remain asymptomatic for life and may not require removal.