Patients consistently underestimate the amount of time it takes to recover from having all four wisdom teeth extracted. In one study involving 266 adult patients having all four wisdom teeth extracted, patients estimated they would miss just two days or less of work. However, following surgery patients in this study missed an average of 4.7 days of work with over 42% requiring one or more unplanned post op visit due to high levels of pain arising and other complications.27
When wisdom teeth (aka “3rd molars”) form we had only two choices before Zero3 TBA (3rd molar Tooth Bud Ablation): either prophylactically extract these teeth in late teens or early 20’s – before roots fully form – or monitor and treat them as pathology develops later in life. If the decision is made to prophylactically extract wisdom teeth there are numerous videos online that show the surgical process of removing these troublesome teeth. Consider the following video to see how surgical extraction of wisdom teeth is performed. Please be advised that surgical extraction of wisdom teeth is highly invasive and not a simple, blood-free process.
Surgically extracting wisdom teeth is not risk free. Consider the following risks and complications, many of which are listed on oral surgeon’s patient informed consent forms. Based upon multiple animal studies conducted to date, none of the following risks or complications are known to exist using Zero3 3TBA technology.
- Opiod Abuse Opiod abuse and addiction has become a nationwide issue. In two independent studies researchers determined that persistent opiod use and abuse in adolescents and young adults increased 2.7 fold 13 with an overall rate of abuse of 5.8% 14 when an opiod prescription for post op pain medication was given following wisdom tooth extractions.
- Recovery Time Healing from impacted 3rd molar extractions generally takes 3 to 5 days for teens and 5 to 7 days for adults. Gum tissue generally heals back to normal levels in 4 to 6 weeks. However, if extensive bone was removed to complete the extraction procedure, then full healing may take up to 6 months.
- Post Operative Pain Pain following 3rd molar extractions is an expected consequence and is considered normal when the effect of local anesthesia wears off. The level of pain reported varies widely with 37% reporting mild pain, over 50% reporting moderate to severe pain. This is followed by nearly 50% reporting no pain 7 days following their surgery.13
- Accidental Damage to Adjacent Teeth Because of the physical pressure placed on teeth to remove them during extraction there can be minor chipping or cracking of an adjacent tooth. While rare, the entire crown of adjacent teeth can be fractured off.
- Swelling (Edema) Post-extraction facial swelling (edema) is considered a normal consequence to having 3rd molars removed, especially when they are fully impacted. Swelling can be immediate and generally reaches its maximum 2 days following surgery. Reversal of swelling is expected in 4 days and complete resolution 7 days following surgery. Note that while the application of ice packs may help with pain management, it has no significant effect on reducing or controlling swelling. Use of steroids (injection) and NSAIDs (ibuprofen) can reduce the magnitude of swelling, but will not eliminate facial swelling potential. 14
- Facial Bruising Bleeding into the soft tissues after 3rd molar extractions is considered normal. Some of this residual blood can be pushed directly under the skin and cause an extensive “bruising” appearance as this blood is removed by the body as part of the healing process. Sometimes this bruising discoloration can extend around the eyes and down the neck and – in extreme instances – take several weeks to finally disappear.
- Residual Periodontal Infections Incomplete healing bony and soft tissue healing can occur following extraction of 3rd molars, including failure to grow new bone on the posterior surfaces of adjacent second molars. While this is a generally pain free condition for many years, the formation of long-term periodontal pockets can occur that later becomes chronically infected on 2nd molars. To mitigate this risk of longer term periodontal pocketing and infection, bone grafting may additionally be planned as part of the 3rd molar extraction process. This is especially true when significant bone loss is present at the time of extraction because the 3rd molar is impacted directly against the 2nd molar.
- Incomplete Tooth Removal When a tooth is not completely removed, a portion of the root may remain permanently in the jaw bone. While every attempt will be made to remove the entire root to prevent future infection, it may be less invasive and lower risk to leave a small portion of a root tip behind or perform a coronectomy (i.e., remove only the crown of the tooth) and leave the entire root behind.
- Dislocation of 3rd Molar into the Maxillary Sinus While rare, it is possible that when applying pressure to release upper 3rd molars from the bone that it can be accidentally pushed into the maxillary sinus. When this happens then more extensive surgery is necessary to remove the mobile tooth from the sinus cavity.
- Bone Sequestras When 3rd molars are extracted residual bone fragments (sequestra) can become mobile and float into the extraction site where they will be temporarily held in place during healing. While most bone fragments are resorbed by the body, these bone fragments can slowly migrate and eventually push through the gum tissue where they become exposed. When this happens these bone fragments can feel sharp, are painful when touching them because of the gum inflammation they cause, and can easily be removed.
- Temporo-Mandibular Joint (TMJ) Damage TMJ pain may occur as a result of hyper extending the mandible to gain surgical access to upper and lower teeth during 3rd molar extraction. It was recently documented in a longitudinal study that nearly 23% of all patients with long-term TMJ dysfunction and chronic pain joint can be directly attributed to 3rd molar extraction surgeries, making 3rd molar extraction a significant risk factor for developing TMJ pain later in life.15
- Post Op Tooth Alignment Problems Tooth alignment problems can occur that adversely affect chewing ability or jaw joint function. Misaligned teeth may cause pain, teeth grinding (bruxism) and cracking or splintering of teeth withstanding the force of the jaw.
- Fractured Tuberosity When extracting upper 3rd molars the posterior bone (maxillary tuberosity) can be fractured and become mobile. Because the maxillary tuberosity contains blood vessels and forms the posterior aspect of the maxillary sinus, a fracture of this bone is considered serious. In rare instances massive bleeding can occur that must be considered life threatening until the bleeding is stopped. Stabilizing the bone or stopping the bleeding may require additional extensive surgery.16
- Aspiration of the tooth It is possible that an extracted tooth can be accidentally aspirated (i.e., inhaled and become lodged in the trachea or a bronchial tube). If a tooth is accidentally swallowed during surgery then it must be assumed that it has been aspirated. Chest x-rays will be necessary to identify the location of the missing tooth and then it must be removed from the trachea or bronchial tube.
- Bleeding There is always some bleeding following extraction of 3rd molars and is considered normal. Frank hemorrhaging as a complication can generally be stopped by applying compression using a gauze pack. In some instance, topical thrombin or other clotting agents may need to be applied along with suturing. While the incidence of serious hemorrhaging is relatively rare, excessive bleeding following 3rd molar extractions has been reported to be over 5%.17
- Jaw Fracture A fractured jaw (especially in older people with osteoporosis of the jaw) is caused by the pressure put on the jaw during extraction or by the creation of a weak area following surgery. While rare, this is a serious event when it does occur and may require hospitalization and additional surgery to stabilize the fractured jaw.18
- Trismus After 3rd molar extraction it is considered normal to have trismus, which is spasms of the jaw muscles. The most common presentation of trismus is a limited ability to open partially or completely without significant pain in doing so. In extreme cases, muscle spasms can cause the mouth to remain tightly closed. Trismus tends to peak around 2-3 days following surgery and can last a week. The prevalence of trismus is reported to be nearly 40% when completely impacted 3rd molars have been removed.19
- Exposure of the Maxillary Sinus If an upper tooth has been extracted, a hole may have been made into one of the adjacent sinuses. If this hole does not heal normally patients may need to return for further treatment to close the opening into the sinus cavity. While a normally erupted maxillary 3rd molar has a very low risk of this occurring, a full bony impacted extraction has been reported to result in exposure of the maxillary sinus in over 20% of these difficult extractions.20
- Post Operative Infections Every extraction site comes in contact with saliva and food, which contain bacteria. Post op infections that spread beyond the extraction site is generally related to patients failing to remove impacted food down from the extraction site or when more than normal levels of bone need to be removed before being able to extract the 3rd molar. Infections that spread laterally into normal or undisturbed soft tissue that are “abscess like” in description generally appear from 1 to 3 weeks after the surgery with a reported incidence of nearly 6%.21
- Dry Socket (Alveolar Osteitis) A common complication after extraction, dry socket (alveolar osteitis) occurs when a blood clot fails to form in the socket (or the blood clot that did form has been dislodged), thus disrupting the normal sequence of healing. When the clot is disrupted it leaves the underlying bone and nerves exposed to air and food, which results in painfully inflamed bone tissue. Dry socket typically appears two to five days after extraction, usually has a bad odor or taste with it, and generally requires extended healing time of up to two weeks. Dry socket is most frequently associated with difficult or traumatic extractions (especially the lower wisdom teeth) and occurs more often with people over the age of 30, smokers, those with poor oral hygiene habits and women. When dry socket occurs a dentist will need to place a medicated dressing into the socket to soothe the pain and encourage normal healing. The dressing must be replaced every 24 hours until the symptoms of dry socket lessen (about five to seven days). The incidence of dry socket is generally reported to be between 5% and 10%.22
- Nerve Damage While primarily an issue with extractions of lower wisdom teeth, nerve damage can occur with the removal of any tooth if the nerve is near the extraction site. Typically caused by damage from a surgical drill, permanent nerve injuries are not common and generally occur only when the nerve has been cut or torn. Numbness of the lip, tongue and cheek can occur and is reported in 5% to 8% of mandibular extractions with over 95% of initial complaints of numbness resolving completely within 4-8 weeks after surgery.23
- Osteonecrosis of the Jaw Bisphosphonates — drugs used to treat osteoporosis, multiple myeloma, bone cancer and bone metastasis from other cancers — put patients who undergo tooth extractions at higher risk for developing osteonecrosis of the jaw (a rotting of the jaw bones) in both the upper and lower arches. If patients are taking conventional osteoporosis medication (such as Fosamax, Boniva, Actonel and Reclast) to treat osteoporosis then they should avoid extractions whenever possible even though the risk of ONJ is rare for these medications. For those patient that have taken IV bisphosphonates as part of a cancer-treatment regimen, the rates are significantly higher with a rate of nearly 9% when having teeth extracted.24 It is routine to consider recommending extraction of marginal teeth – including wisdom teeth – before patients undergo treatment for cancer.
- Jaw Dislocation It is possible that the mandible can become dislocated during removal of 3rd molars if the jaw is hyper-extended during surgery. While rare, this can lead to damage of the cartilage in the TMJ and require later surgery.
- Hyper-eruption of Opposing Teeth Without an opposing tooth, the tooth above or below the extraction socket can, over time, move out of its socket, likely exposing its roots and becoming sensitive to temperature changes.
- Post Extraction Granuloma A chronically infected post-extraction granuloma can form after the extraction of 3rd molars. This altered tissue response and is the result of the presence of a foreign body (i.e., dental filling remnants, bone chips, small tooth fragments, tartar or calculus etc.). These residual foreign bodies result in the formation of a highly focal post-extraction infection that triggers the formation of the granuloma, which is unable to resolve until the foreign body is physically removed.
- Surgically-induced Subcutaneous Emphysema While rare, air can be pushed into the 3rd molar extraction site and become trapped under the gum tissue and facial tissues. This can lead to swelling, especially around the eyes or over the cheeks that lasts several days.
- Sharp Bone Irregularities Sharp bone irregularities – especially in the mandible – may occur following 3rd molar extraction when bone has been cut away to remove the tooth. The lateral aspect of the tongue may abrade the gum tissue away, causing the sharp bone to become exposed. The sharp edge of the bone will need to be surgically removed. Sharp bone irregularities have been reported occur with less than 1% frequency.25
- Ludwig’s Angina Due to the physical position of 3rd molars at the junction of a number of different facial spaces and tissue planes in the neck, an infection in this area must be taken seriously because this can block the airway and cause death. This condition is called Ludwig’s angina and must be acted on immediately.
- Adverse Reactions to Anesthesia While very rare, a number of deaths have occurred as a result of adverse reactions to the anesthetic agents used while undergoing 3rd molar extractions.