Wisdom Teeth in McLean, VA

Reasons to Remove Wisdom Teeth

Throughout human evolution and development, the upper and lower jaws got smaller as the skull and brain got bigger. The good news: we got smarter. However, we also ran out of space for the 3rd molars (wisdom teeth) in each corner. The lack of space and capacity to erupt in a normal location has several negative consequences
The majority of Wisdom teeth should be removed to avoid common complications such as:
1) Soft Tissue Infection, Bone Loss, and Pain
The lack of space leads to abnormal angulation and position, thus resulting in
2 ) Second Molars: Cavities, Bone Loss, and Premature Loss
The second molars are the teeth immediately in front of the wisdom teeth. Just like the first molars in front of them, they play a critical role in chewing food, as well as protecting the front teeth from being damaged by the strong chewing forces. Due to the impacted wisdom teeth behind them, the second molars tend to be at a higher risk for cavities leading to root canal therapy as well as bone loss, all leading to premature loss of these important teeth.
3 ) Cysts and Other Benign Tumors
Impacted teeth are often associated with different types of pathologies. Although these are very rarely malignant, benign tumors like cysts can be locally destructive. These lesions continue to grow, unless they are removed by a surgeon. Surgery to remove these tumors and the surgeries to reconstruct the area can be disruptive to one’s life.
4 ) Orthodontic Treatment and Future Teeth Alignment
Many orthodontists ask for wisdom teeth removal to create space for orthodontic alignment. This is true for teenagers. In addition, with the rising popularity of Invisalign, many adults chose to align their teeth later in life. Since removing wisdom teeth is associated with less complications when we are young, removing them sooner affords us less complications and more options for future orthodontic treatment.

Timing of Removal

The ideal time for removal of wisdom teeth is simple: the younger, the better! Patients that are in their teens, 20’s and 30s, and even 40’s can avoid having the mentioned complications. it is best to take care of this when we are young and able.

Safety

One of the traditional complications during wisdom teeth removal is injuring the nerves that give us sensation to the lower lip and chin (called Inferior Alveolar Nerve, IAN). Luckily, thanks to modern technology like 3D Imaging (Cone Beam CT, CBCT), we can see the exact anatomic relationship between the root tips of the wisdom teeth and the IANs. This allows us to modify the procedure in order to keep the IAN safe. At Elevation Center, the chance of injuring that nerve in a permanent fashion is extremely small (near 0%).

Comfort - Sedation/Exparel

Removal of wisdom teeth is usually a one hour appointment. It is done under Intravenous Sedation, so you are sleeping for the entire surgery. Prophylactic Antibiotics, Anti-swelling, and Anti-pain medicines are all administered intravenously. In addition, Exparel Injection at the end of the procedure will greatly reduce your post-procedure pain (thus greatly reducing the need for Opioids after the procedure).

After care : Wisdom Teeth

Bleeding
Intermittent bleeding or oozing during the first few hours/days is normal for many people. Bleeding may be controlled by placing fresh gauze over the area and biting on the gauze for 30-45 minutes. The bite must exert pressure on the area. Try to make a Golf ball size and shaped gauze out of 2-3 pieces of gauze. You must feel actual pressure on the surgical site. Loose, flat gauze will not help control the bleeding. Gauze can be changed every 10-45 minutes depending on how much bleeding is occurring. It is best to moisten the gauze with a slight amount of tap water and loosely fluff (this ensures the gauze does not stick to your cheeks.
Site Management
Swishing and tooth brushing after surgery should be done in a gentle fashion. Flossing in the areas that you see or feel stitches should be avoided the first 5 days after surgery.
Post-op Site Visualization and Complications
Please avoid analyzing the surgical sites in the first few days after any procedure. It is normal to see sutures, gaps, defects, floppy tissue, white tissue, yellow tissue, etc. Complications after surgery involve a new swelling/pain that begins at least several days after the procedure. Pain and swelling is normal, at least to some degree, in the first 2-4 days after any procedure. Also, asymmetry in pain and/or swelling is 100% normal! One side can have more pain and swelling and that is normal!! (Bone Graft Patients: It is normal to see little pieces (salt-grain size) leak out after the procedure.)
Post-op Stitches
Stitches after surgery are self-dissolving and you do not need a post-operative visit unless you are told otherwise. As stitches get loose and noodle-like, you can snip them with a small pair of scissors near the gum line. If they are not bothersome, wait a few more hours/days, they will fall off.
Follow Up
For Dental Implant patients, follow up and next step visits will be outlined to you verbally and the office will always call you when you are due for your next step.
Smokers
Please eliminate or at least minimize smoking for for at least 2 WEEKS prior to and especially after any procedure. Smoking is is very detrimental to healing and may cause complications like dry socket after teeth removal (extreme pain after extraction), infection, or implants not to integrate with the bone (if applicable).
Swelling
Swelling is often normal and reaches its maximum around 2-3 days after any procedure. Therefore, do not be alarmed if you are more swollen on the 3rd day than on the first day after surgery. It is NOT normal, however, for the swelling to decrease, then increase again on the 5th day and beyond. Swelling can be minimized by the Ibuprofen (Advil, Motrin, 800 mg, if you can take it, every 8 hours) and applying an ice pack to the area (applied twenty minutes on and forty minutes off during the first 24-48 hours after surgery. Do not use ice beyond the first 48 hours.
Starting the 2nd day after surgery, you may apply warm compresses to the skin over the areas of swelling (hot water bottle, hot moist towels, heating pad) for 20 minutes on and 20 minutes off to help soothe the tender areas. This will also help decrease stiffness and speed up the healing process.
Pain
You will usually have a prescription for pain medication. If you take the first pill before the anesthetic has worn off, you should be able to better manage the discomfort.
Follow this Regimen: ( Unless contraindicated ), use Advil/Motrin/Ibuprofen 800 mg every 8 hours x2-3 days with food for baseline pain control. If you need more, you can add Over the Counter Tylenol: TWO of the 500 mg pills for a total of 1000mg, every 6-8 hours. If you are still in pain, you can keep the Ibuprofen, but replace the Over the Counter Tyleonol with the prescribed Opioid (ie. Vicodin/Norco (Hydrocodone), Percocet (Oxycodone) …etc), One pill every 6 hours.
Caution: Do not take BOTH Tylenol and Opioids, as most Opioids contain Tylenol. When supplementing the Ibuprofen, use EITHER Over the counter Tylenol OR Opioids, but not both at the same time. Tylenol toxicity causes liver damage. Also, remember that Opioids cause nausea and/or constipation. and resultant dehydration.
Typical usage involves taking Advil/Motrin/Ibuprofen around the clock for 2-3 days every 8 hours. Tylenol 1000 mg every 8 hours can be taken at the same time as Ibupfrofen, or you can stagger them (so that every 4 hours, you are taking either the Advil/Motrin/Ibuprofen or the Tylenol.
Nausea
Nausea is not uncommon after surgery if you received intravenous/general anesthesia. In addition, pain medications may be the cause, as discussed above. You can limit the nausea by preceding each pain pill with a small amount of soft food and by taking the pill with a large volume of water. Try to keep taking clear fluids and minimize dosing of narcotic pain medications. Limiting narcotics use by taking Ibuprofen and over the counter tylenol is the best thing you can do to minimize nausea. Also, remember that a little bit of blood in the stomach can cause nausea, so please ensure proper pressure on the surgical site in the event of increased bleeding.
Diet
You can eat soft foods in the first 2-4 days. It is NOT required to switch to a liquid-only diet. If your jaw is sore, soft foods are gentle. If you are not too sore to chew, feel free to do so. Choosing soft food vs harder food is related to your comfort level/soreness when you chew. There are no contraindications from a surgical standpoint. straw usage is permitted but GENTLY. Avoid extremely hot foods or drinks. The only exceptions are patients who just had Corrective Jaw Surgery or Full Mouth Reconstruction (full mouth extractions/implants). If so, please ask your doctors for how your diet will be managed.
For all patients, it is best to avoid foods like nuts, seeds, popcorn, spinach, etc., which may get lodged in surgical areas. Please note that Proteins (Beans, Meats…etc) and Fats (avocados, Peanut butter with the oil on top, meats, etc), Vitamims are more important than Sugars for recovery.
Irrigation Syringe
If you had an extraction without bone grafting (e.g. Wisdom teeth), you can flush the extraction site with water using the irrigation syringe provided in your post op bag. This is especially true for lower molars. You must wait exactly ONE WEEK after your surgery to start using this syringe. This should be done after eating or at least once before going to sleep.
Sharp Edges
If you feel any bumpy or sharp edges, it is likely you are feeling the bony walls that support the jaw in the area of the procedure. In addition, small slivers of bone may work themselves out during the following week or so. If these cause discomfort, please call us.
Overall Healing Trend
The first three days after surgery are generally the most uncomfortable and there is usually some swelling. On the fourth day, you should be more comfortable and, although still swollen, you can usually begin a more substantial diet. The remainder of the post-operative course should be gradual, steady improvement. Soreness to touch is normal for the first few days despite everything else being much improved.
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