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11.07.10 | Having A Wisdom Tooth Removed
Filed under: Medicine — Tags: , , — Dr. Ivan @ 23:33 — Comments (0)

Long story short, I have recently had my one and only wisdom tooth removed surgically. Being a medical student myself, this was actually one of the more interesting experiences I have had in the past six months.

Truth be told, I have witnessed quite a few surgical procedures and have of course done dissection myself (as any medical student should). I do not have any fobias concerning neither needles, blood nor internal organs. However, this new experience has been somewhat surprising and definitely thought-provoking.


I was aware of the fact that I had one wisdom tooth, but it has been entirely asymptomatic and the condition which is described below was diagnosed on one of the regular checkups at the dentists’ some weeks prior. Subsequently a panoramic x-ray of my jaws (aka an orthopantomogram) had shown a horizontally positioned mandibular third molar on the right side. It appeared to impact the second molar’s posterior surface thus creating a small pocket which could potentially communicate with the oral cavity. This was considered a warning sign by my private dentist who immediately recommended surgical removal. Strictly speaking removal of wisdom teeth is somewhat controversial as a prophylactic measure (f.ex. see here and here). However considering my young age, complications were not of primary concern. The worst case scenario would have certainly been that the small pocket created by the third molar impacting the second one could potentially lead to a bacterial infection, empyema and so on. Such a development is of course not probable until much later in life – however when finally occuring it may have rather ominous results. At that stage extraction is much more difficult since the wisdom tooth would have developed longer roots.

Before my scheduled appointment, I had looked up the general procedure I was about to undergo online. Several illustrative videos and helpful sites later I had a more or less firm grasp of the process: First, an incision is made so that the third molar becomes visible (this of course implies that the wisdom tooth is still beneath the surface of oral mucosa). Then, its top part is removed to make extraction of the rest easier. The major part of the tooth was then to be removed and any remaining roots were to be extracted. The incision site was then sutured. Despite the rather straight forward-sounding procedure this is actually the most invasive surgery I have had of any kind in my life (up until now at least).

The procedure itself

Now thinking back at it, I am far from sure that the thorough knowledge of the procedure was to my advantage. Despite the fact that I knew precisely the advantages, the dangers and every step surgeon was going through, my heart raced at an abominable speed and I hyperventilated as I lay on the surgical table. My first thought was that of utter embarrassment – this was certainly not the way a medical student should react to a mundane surgical procedure. However this just goes on to prove that being a witness in the surgical theater or even performing any procedures yourself is a very different experience than being the patient – no matter how much you do or do not know.

The procedure happened to be slightly longer than planned. Pain was certainly an issue, so much so that several additional injections of Xylocaine (lidocaine and adrenaline) were required. As far as I could count there were 10 injections of various volume. As the surgeon noted in my journal later, the extraction was complicated by roots (five in total) being small and crooked and the fact that the patient (i.e. me) was not lying still due to pain. Apparently the roots passed very closely to the inferior alveolar nerve. This again was used by the surgeon as an excuse to basically double the price – a fact that I was not too happy about (the procedure already being rather costly). There was only minimal bleeding peroperatively.

Nonetheless, she did her job well and after ten minutes of paying the bills and receiving some very poorly articulated and very rushed instructions on how to administer the drugs I was prescribed, I was sent home. I do have to take some time to comment on the poor information given me however. We are time and again taught that communicating important information is key and often neglected – as it was indeed in this case. The surgeon took about 15 seconds of her time to explain how the prescribed medications should be taken (all 4 of them) and whether they mix well with alcohol or not. This was done in such a hurry that, if I haven’t known much of what she had to say beforehand, I would have been utterly confused about the medicines prescribed – especially since I was out of the operation room for about a minute and was still dizzy. How I should spend the first few post-surgical days was not even mentioned. Fortunately they did give me an sheet describing the latter (well, at least that was done right). Please also note that she was unaware of the fact that I am a medical student – which goes on to prove that this is the way any regular patient would have been treated.

Early post-procedural period

I was given prescription to 4 medicines: Paralgin Forte and ibuprofen (both for relieving pain after local anesthesia), chlorhexidine (disinfection of cavum oris until I could properly brush my teeth) and, finally, clindamycin (systemic antibiotic prophylaxis).

To begin with I managed to totally miss on my pain medication. I took a dose of Ibu right after I came home, however not knowing how long the effect would last, I just thought I would wait until the pain would set in. Additionally I wanted to minimize the intake of painkillers, so I assumed that it was best to further wait until the pain becomes a bother (there is of course no need to suffer needlessly either – any kind of additional stress, be it pain OR the painkillers, have negative effects on health; so balance is the key). The intent behind the latter might have been good, but in reality it all went wrong.

Neither, by the way, did I realize that the difference in effect of the two pain relief medications. My understanding was that taking Paralgin was a last resort since it contains an opiate (codeine, to be more precise) and thus may have some unfortunate side effects along with a possibility for development of physical dependence. The problem was that due to the extent of the procedure I’ve just been through, ibuprofen (despite being taken in a quite large dose) was far from enough.

I took my second dose of ibuprofen some 5 hours after completed surgery and was at that point in some pain. The problem was that the systemic effect of the painkiller takes some time to develop, and after half an hour, minimal drug effect and escalating pain I had to resort to codeine. Despite its potency and the “Forte” addition to the drug name, Paralgin also takes some time to work – peaking at about 1 hour after intake (perhaps later if administered after food intake). All of this amounted to rather painful 1.5 hours. Once this newly acquired knowledge had sunken in, I continued to take Paralgin that day as well next morning after which I was comfortable with just Ibuprofen.

Further healing, stitch removal

Besides the aforementioned debacle with painkillers, the first days of the postoperative period went reasonably well. There was only marginal blood loss the first day, and none at all after that. Swelling was very marked – despite using ice after the surgery. Jaw movement was severely constricted for at least 3 days, but became gradually better. Food is of course a huge problem in such circumstances. I thought I would rely on something drinkable and very soft, like milk, tomato juice and yoghurts. The latter was unfortunately a no-go until day 3 because I could not eat yoghurt with a spoon (I couldn’t open my mouth wide enough).

My huge concern during this period was the fact that I was supposed to attend the EACR21 conference just two days after surgery. This implied eating whatever you are given (usually bagels which is far from ideal for the sensitive suture) and having to talk extensively. The latter was somewhat problematic since mobility of my jaw was still restricted. Despite my fears, it all went very well – except for slight worsening after the first day at the conference.

The suture itself was looking fine most of the time, although some local redness could be seen around it and the neighboring second molar. This resolved after I was finally able to brush my teeth properly. Probably the most annoying were the stitches (all four of them) since they had a tendency to poke the tongue and get in between teeth when I ate. It was thus a great relief to have them removed ten days after surgery. Since nothing was holding the suture together, a small hole (approximately 2mm in diameter) developed some distance posterior from the second molar. I was slightly worried since it indeed looked rather deep, but it resolved after a week or so – I guess the regeneration of oral mucosa is really unrivaled, being used to tolerate great many insults of our everyday eating habits.


Painkillers were unnecessary after the fifth day. Furter, I concluded my antibiotic prophylaxis and chlorhexidine mouth washes one week after the procedure. There was a slight discoloration of the tongue – as to be expected after chlorhexidine – which disappeared gradually over a week. Further course of recovery was uncomplicated.

Disclaimer: Please realize that medical contents provided in this blog post is for informational purposes only. I do not provide medical advice, diagnosis or treatment. Despite careful proofreading, I cannot be held responsible for correctness of names of substances, dosage or indications for use. If you have any concerns about your health, please contact your doctor. You might also want to read this.

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