Wisdom Teeth, Extractions, a Bone Graft and an Infection = anxiety!

[lemonyellowkitten]

I have posted here before and I really appreciate the feedback and advice I've received - this forum in general has been really helpful. I have some upcoming dental work that is causing me a lot of anxiety and I have some questions below. Thanks in advance for any insight!

The current plan with my dentist is to have my 4 wisdom teeth removed, with PRF treatment in the sockets after extraction. At the same time I will also have my top left second molar extracted (due to advanced decay and an infection), with a bone graft and PRF treatment in that socket after extraction. In addition to extracting those 5 teeth the dentist also wants to fill a cavity on my bottom left second molar at the same time (the reasoning being I will already be numb so might as well do that too).

- Is this too much work to have done at once? My dentist said all of the above would probably take about an hour to do, but when I tell friends and family about what I am having done they all seem concerned that it's too much at once.

- My top two wisdom teeth are fully erupted, but they have decay and will probably continue to cause issues. I feel comfortable with the decision to remove them, but I am unsure about extracting the bottom two wisdom teeth. My dentist recommends removing the bottom wisdom teeth to prevent future issues. His reasoning is that they are still slightly impacted, even though the biting surface is fully erupted there is a bit of a gum flap at the back.
I am scared about removing them because my understanding is the healing is longer with extractions from the bottom jaw, there is more risk for dry socket, and potential side effects like nerve damage - at the same time I want to do what is best for my long term oral health. Would leaving them most likely cause problems in the long run? Would it be better to extract them?

- My dentist said it is up to me if I want to take antibiotics after the extractions and bone graft. I got the sense he didn’t really think I needed to - and I would prefer to not take them - but I feel uncertain if that is the best choice? The information I have found online isn’t totally solid one way or the other - some dental practices seem to prescribe antibiotics for all extractions and bone grafts, others hardly at all. Would it be safe to not take antibiotics after my extractions, a bone graft, and with the infection and corresponding sinus drainage that I have going on?

 

[Gordon]

Is this too much work to have done at once? My dentist said all of the above would probably take about an hour to do, but when I tell friends and family about what I am having done they all seem concerned that it's too much at once.

It's up to you if you feel you can cope with it or not. It's not an enormous amount of treatment but you'll be pretty numb all over for a couple of hours afterwards.

I am scared about removing them because my understanding is the healing is longer with extractions from the bottom jaw, there is more risk for dry socket, and potential side effects like nerve damage - at the same time I want to do what is best for my long term oral health. Would leaving them most likely cause problems in the long run? Would it be better to extract them?

The increased risk of dry socket is really marginal, dry socket is pretty rare anyway and the increased risk is pretty much academic really, nerve damage looks very, very unlikely from that x-ray.
Having said all that, UK guidance is not to extract 3rd molars unless actually causing problems, so if you were my patient I wouldn't suggest it. I appreciate things are different in North America but can only speak for myself.

My dentist said it is up to me if I want to take antibiotics after the extractions and bone graft. I got the sense he didn’t really think I needed to - and I would prefer to not take them - but I feel uncertain if that is the best choice?

I wouldn't prescribe them.

 

[lemonyellowkitten]

Thank you so much Gordon for your kind response and for sharing your insight, it is very appreciated!

1). You mentioned you wouldn't recommend removing 3rd molars unless they are causing problems - would the presence of decay warrant removal in your opinion? My dentist showed me the decay that is present in my top wisdom teeth, but I'm not clear on if there was any decay on the bottom wisdom teeth. Can you see any in the images I posted? I have also included some additional bite wings below. I understand you might not be able to say definitively based on just these images (and unfortunetly one wisdom tooth is not fully visible in the bite wing).

2). If I decided to remove the top wisdom teeth, but left the bottom wisdom teeth, is there any risk of that causing issues later on? Such as with my bite or supraeruption of the bottom wisdom teeth? In particular my concern for that would be with the bottom left wisdom tooth, since my top left second molar is also being removed and there wouldn't be anything left for it to bite against.

Many thanks!

 

[Gordon]

You mentioned you wouldn't recommend removing 3rd molars unless they are causing problems - would the presence of decay warrant removal in your opinion? My dentist showed me the decay that is present in my top wisdom teeth, but I'm not clear on if there was any decay on the bottom wisdom teeth. Can you see any in the images I posted? I have also included some additional bite wings below. I understand you might not be able to say definitively based on just these images (and unfortunetly one wisdom tooth is not fully visible in the bite wing).

Maybe, I can't see decay in the lowers on those films, but x-rays are rubbish for detecting decay on biting surfaces, which is likely where they're going to decay...

If I decided to remove the top wisdom teeth, but left the bottom wisdom teeth, is there any risk of that causing issues later on? Such as with my bite or supraeruption of the bottom wisdom teeth? In particular my concern for that would be with the bottom left wisdom tooth, since my top left second molar is also being removed and there wouldn't be anything left for it to bite against.

I wouldn't worry about over eruption, there just isn't space for them because of the crowding in that lower molar segment.

 

[lemonyellowkitten]

Thank you Gordon!

So to confirm it would most likely be OK if I decided to remove the top wisdom teeth (due to the presence of decay) but left the bottom wisdom teeth (as opposed to removing the bottom wisdom teeth as a preventative measure)?

 

[Gordon]

I think so. I don't think the benefits exceed the risks. You do need to commit to having them reviewed regularly though. Once a year or so is plenty.

 

[lemonyellowkitten]

Thank you very much Gordon for your insight, it is so appreciated!

All the best to you!