Lower Horizontal Wizzie Removal - Terrified...

[cj3000]

Hi everyone,

Over the past six months I've been getting occasional deep pain from my horizontal wisdom tooth on the lower right. I've been putting it off, but now I am seeing the MaxFax and have scheduled to have it removed next week. They say that if I don't have it taken out it will damage the second molar and I'll keep getting infections because I cannot properly clean between the teeth.

The thought of having this done terrifies me. I will be under GA and am seeing a highly experienced oral surgeon in the UK, but the crown of the tooth is touching the cortical wall of the IAN canal on one side and some missing lingual plate on the other. I'm worried about the procedure itself (even the risks and experience of the GA), the recovery (pain, infection, dry socket), but mostly having lasting nerve issues which either take months to recover from or don't recover at all. I had hoped my surgeon would opt for a coronectomy as I know that is lower risk, but he said that my case is not risky enough and there would be the risk of infection in the retained roots. All of this is made worse by the fact that I'm older than average (40M) and so have fully developed roots and will heal more slowly.

Any of your views would be much appreciated. Currently I'm waking up in the night in a state and in tears most days.

 

[Gordon]

I'm not sure what exactly you want to know? I'll take my best shot at answering what I think you're asking, feel free to clarify if I miss something.
1) The risk of GA is extremely, extremely low for a healthy adult. The risk %age figures are skewed a bit due to very sick people needing GAs.
2) From the x-rays then the 3rd molar needs to be gone.
3) Also from the x-rays it looks like there's a distinct space between the molar and the inferior dental canal. This should be good news from the POV of nerve damage
4) Dry socket isn't likely to be an issue after a surgical extraction. The wound is mostly closed by sutures.

 

[cj3000]

Thanks so much Gordon for your response. What you’ve given me so far has already made me feel so much better. My specific questions beyond what you’ve already covered would be: -

1. How do I know that I’m make the right decision to have it extracted? I’m following the advice of the max fax, but given that right now it’s asymptomatic, I fear that I might be taking the risks of surgery and potential permanent nerve damage when there might be more conservative alternatives (coronectomy, removal of LR7, or watchful waiting).

2. What can I do between now and the surgery on Friday to help myself? Currently the fear of everything to do with the procedure (all the things you’ve already mentioned, the breathing tube, the bite blocks, the drills, levitators and retractors, post op drugs and antibiotics) is causing me to lose weight and not sleep well. I have muscular TMD and generally just don’t have much confidence in myself that I’m going to be ok through all this.

Thanks again Gordon.

Chris

 

[Gordon]

First off, if the Max-Fac guys are happy to do the extraction then it needs done, UK guidance for 3rd molar extraction is pretty clear, only remove them if absolutely necessary. Removing LR7 won't help much, the 8 is never going to erupt into a useful position, in fact it's more likely to drift forward and start messing up the 6!

Watching and waiting has downsides, you're committed to recurring x-rays, at least twice a year, which isn't great, but given how quickly things can change then you're likely not to catch any problems in time. (Primarily the 8 munching through the back of the 7, can happen in a couple of months).
There's no way you can get a rapid appointment for a GA to remove the 8, so if you did have an issue, then you could be waiting for several months to get it sorted under GA or else have to have it done under just local...

Honestly nothing much at all that you can do. Make sure you eat well and try to get as much rest as you can.

You won't actually know anything about the actual procedure, all those things you mention may happen (not necessarily all of them!) after you're unconscious.

Post op you should take either ibuprofen or paracetamol, after you get home. Antibiotics are not routinely given and most likely won't be needed. I'd write off the weekend, just take it easy, apply regular ice packs to the TMJ areas to reduce any swelling and follow the post instructions you'll get from the hospital.