Impacted wisdom tooth age 35 - Pill sedation / extraction questions

[the34guy2024]

Hello I have a bottom right impacted wisdom tooth growing in mesioangular (or kind of sideways) . The tooth itself is decaying/decayed and has a piece that broke off about 2 - 3 weeks ago. It is not causing any pain right now or any swelling on my external cheek but inside my cheek i feel abrasion or a hard surface but not much more symptoms. I am 35 year old male and I have had a few consults. I have a dentist that is willing to do it with Oral Pill sedation (two halcion pills i believe) and another that is trying to do a potential coronectomy / extraction with deep IV sedation. I dont think the coronectomy is possible because its decayed. And the coronectomy surgeon didnt see the CBCT scan only did a pano .

The CT scan revealed that the tooths roots are NOT entangled with the nerve but that there is a 5-10% chance of nerve damage due to its proximity. I trust the dentist that did the CT because he was thorough in going through the images with me. The fact that the I mainly have been putting this off because I am nervous with respect to the thought of being overly sedated with my mouth open because I have trouble sleeping on my back to where i wake up due to my anatomy or nose structure....and also have had allergies that cause an uncontrollable cough and even tightness in throat like a laryngospasm (more so during the day or in the morning ...not in sleep) . I have a fear one of these will happen during the procedure is why I want to tell my surgeon that I want to just take (1) single pill and just do the numbing shots. I feel as if i am overly / moderately sedated I may have a bad experience. Of course this is rooted in anxiety and may very well be unreasonable.

I also understand that I cant just leave it be because I will subject myself to a bigger more serious problem. Let me know if you have any comments and i can be more thorough. Ive been put under GA before like 10 years ago...went well overall but i did break out in hives is what my mom said they told her but the report doesnt show what it was from.

From what I have detailed - everything going normal ...How long do you think it would take to extract this (1) tooth ?

 

[Gordon]

.How long do you think it would take to extract this (1) tooth ?

Sorry, it's not really possible to say how long a totally different person from me will take to do something If you want a guess, then actually extracting the tooth would take me about 5 minutes or thereabouts. Not including sedation time, local anaesthetic administration, stopping bleeding etc etc.

If it's a question about sedation, then personally I would vastly prefer to use IV over oral, far better control of the sedation level and able to quickly reverse it if there was a problem.

 

[the34guy2024]

@Gordon Thank you. I also received a elevated cholesterol report ....total choleseterol is 205 and triglycerides are high ....I will let my dentist know but are there any patients that youve seen with very high cholesterol numbers and still get the wisdom teeth extracted? Thank you

 

[robertsonic]

the fact the crown has fractured could make extraction of rest easier. the root part can be elevated into space where crown was. it would take me 10 minutes to remove. high cholestrol is a different issue and does not have any effect. you could be at risk of a so called dry socket if blood clot lost and food goes into space. lots of hot salt mouthbaths starting following day

 

[the34guy2024]

@robertsonic Thank you very much for the reply and information. I am glad to hear that the estimated timeframe possible to take it out can range from 5 - 10 min to extract on my bottom right impacted tooth.
I was wondering since I am 35 years old...is it possible it could actually be more difficult to take out ? Or the possibility of something where upon extracting something just prevents the tooth/pieces/rootsfrom coming out (digging around for pieces etc.) and it takes way longer than the 5-10 mins? Or do these usually come out regardless with fairly no complications ? I figure it will likely be routine since professionals do literally thousands of these. I ask out of true ignorance here.

Thanks much!

 

[Gordon]

I am 35 years old...is it possible it could actually be more difficult to take out ?

No.

Or the possibility of something where upon extracting something just prevents the tooth/pieces/rootsfrom coming out (digging around for pieces etc.) and it takes way longer than the 5-10 mins? Or do these usually come out regardless with fairly no complications ?

As they say in the US, sh*t happens. It's unlikely though, 99% come out as expected.

 

[robertsonic]

@the34guy2024
although now retired, I have 50 years of experience in such matters and although cannot guarantee things the infection does loosen the remaining roots which facilitates their removal. have to follow post extraction advice carefully as at risk and liable to get a dry socket infection

 

[the34guy2024]

@robertsonic Thanks to the both of you. In terms of Dry Socket is this due to my specific situation ( age , location of tooth ) or just in general ? As you mentioned , i will make sure to do warm salt water rinse starting the next day after the surgery. I will also follow my surgeons instructions. Is there any further advice or pro tips you have regarding preventing dry socket or anything to help if i in fact do get it ? thanks much

Also , even though i am doing a full regular extraction did you ever treat or refer out with coronectomy where just leaving the roots intact ? this does appear to cause more of a concern down the line should the roots need to be removed anyway. I may not be eligible anyways since my tooth already has a cavity / decay. i ultimately feel the extraction is best suited for my case but was just wondering

 

[Gordon]

Healing after Tooth Removal

What should you do following tooth extractions? Find out about the healing process, and the do's and don'ts for a speedy recovery.

www.dentalfearcentral.org

I wouldn't worry over much about dry socket, they are fairly rare events.

Coronectomy has advantages and disadvantages, I did a few but generally went for straight extractions if possible.

 

[the34guy2024]

@Gordon Thanks. I spoke with the DDS/ Surgeon today and he said it could take 5 mins or could take longer up to an hour for the one tooth depending on difficulty. (Hoping for a very quick process) Also he mentioned he said he might put some sort of graft/membrane/bone to aid the healing process. Do you have any experience with this type of thing that aids in the healing process...and what it entails perhaps? Is this a normal procedure that some surgeons do and are there any risks with this part of the extraction as well?

Thanks

 

[Gordon]

Do you have any experience with this type of thing that aids in the healing process...and what it entails perhaps? Is this a normal procedure that some surgeons do and are there any risks with this part of the extraction as well?

Not really, grafts are normally used for implant cases and I didn't do any.

You need to discuss this directly with your surgeon, you're not clear as to what is being proposed so I can't really answer you. They should make you aware of any specific risks as part of the treatment plan.

 

[the34guy2024]

@Gordon Thank you. Yes, i called them today and the assistant told me its a PRF ..where they take blood and spin it etc....seems like a decent option...do you have any experience with the PRF? If so is this somewhat routine or more of a added feature. Thanks again. I will continue to search the forums as well.

 

[Gordon]

Nope, never heard of it, sorry.

 

[the34guy2024]

@Gordon thank you. I was going to ask…as my current DDS has already seen my cbct scan and says he could do the extraction. I did have another dds / OS tell me over a quick consult after seeing my pano he suggests I go to a DDS with a MD just in case my jaw breaks during the surgery since the roots are “bulbous”. And he recommended a certain doctor. From looking at my pano do my roots look larger or harder to get out ? Or should the DDS that saw my CBCT scan have more of an accurate depiction ? he feels confident to do it but i feel a tad bit conflicted cause I haven’t heard about this til when I spoke with this OS and it seemed like news to me.

 

[Gordon]

I did have another dds / OS tell me over a quick consult after seeing my pano he suggests I go to a DDS with a MD just in case my jaw breaks during the surgery since the roots are “bulbous”.

ROFL. Who's doing the extraction in his mind, Conan the Barbarian???

Or should the DDS that saw my CBCT scan have more of an accurate depiction ?

Yes.

 

[the34guy2024]

@Gordon I know right LOL. Thank you. I really appreciate that. I feel like i am very easy to convince in this high stress / anxiety state Im in. I just dont want to get it done where im going to have post-op complications cause i didnt go to a board certified oms specialist etc. I am being overly negative about the fact that I am 36 y. old and that I have a impacted side ways tooth that needs to come out and that theres gonna be something happening during procedure... My DDS said he feels confident but that I have a small chance of temporary nerve damage. But I also just am trying to buy time and hope it doesnt get infected until i get the courage up to go and do this.. Currently just need reassurance that the odds everything in terms of extraction will go okay is what I am trying to affirm to my self but it feels increasingly hard when you read over the Consent forms and risks etc. I guess i am fixated on negatives but i should be trusting the professionals. Any encouraging words you can further extend i am also grateful for.

This link also is kind of what i am talking about when they talk about a "failed" attempt at extracting...

https://www.reddit.com/r/Dentistry/comments/2mbvy7/failed_impacted_wisdom_tooth_removal

 

[Gordon]

I'm not seeing a question, sorry if I'm being a bit dense.

 

[the34guy2024]

@Gordon its okay. Forgive me for my run on sentences as I am just in an anxious state that has carried on through the holidays from this whole situation. My last reply was just me trying to get your thoughts on what i was sort of ranting about. Also, i was wondering about Tooth Fracture during extraction or if there can be small fragmets break off during the extraction process. Since my crown has already a chipped piece off and has some decay. Is it possible that during the extraction, the tooth may fracture, particularly at the root or parts of the root etc? and therefore the remaining fragment of the root may be left in place causing me more problems down the line?

The dentist saw the CBCT and didnt mention this but when you read the extraction Consent forms it sort of says these type of things on there as assumed risks. Is this something that can be predicted or is something that does not commonly happen with respect to the extraction process? As well as if there is potential for Jaw fracture, injury during healing or during the procedure? I know this may be overkill but I sincerely appreciate your time as I am daily trying to muster up the strength to go and get this done and prove I can do this .

Thanks much.

 

[Gordon]

Tooth fracture during extraction is not unusual and easily managed, teeth don't tend to shatter into tiny pieces, the broken bits are large enough to be seen easily and removed. If the tooth does shatter then washing out the socket with some sterile saline will clear them out. I think I've felt the need to do it about twice in over 40 years and several thousands of extractions (I used to extract about 500 teeth a month...)

The other stuff is the usual US "informed consent" stuff, i.e. every possible complication needs spelling out to head off a lawsuit.

 

[the34guy2024]

@Gordon Okay thank you. For the meantime., before i get the extraction... Is there anything to look out for while i have this tooth that is cracked? Such as sepsis or infection likelihood? What symptoms are more alarming? Shooting pain or fever? Thanks much.