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Complications of wisdom teeth extraction

While we hope and expect normal healing for all of our patients, it is good to be informed about possible complications.  I want my patients to have the most accurate information, so I’ll tell it to you like it is.

A normal part of the healing process for everyone is some bleeding, swelling, and soreness.  Click here for tips on how to aid healing and have the best recovery after wisdom teeth removal possible.

Keep in mind that the complications listed here do not happen to everyone who has wisdom teeth removed.  This information is provided to help manage complications if they happen to you.

Trismus, or muscle stiffness
The most common complication after wisdom tooth extraction is trismus, or tightness in the jaw muscles.  It may feel difficult to open wide enough to bite into a sandwich.  This tightness can last several days to one week.  Three things will help loosen up the jaw muscles as quickly as possible: heat, stretching, and massage.

Heat
During the first two days of healing it is best to apply ice packs to limit swelling.  Starting on the third day, switch to heat in the form of warm compresses.  Use a heating pad or a damp wash cloth heated in the microwave for about 15 seconds.  Apply the warm compresses to the stiff jaw muscle in the cheeks, the neck, and the temples.

Stretching
Use your fingers to push your teeth apart.  This will stretch the tight jaw muscles.  Use slow steady pressure to stretch the jaw.

Stretching is most effective immediately after warming the muscles with heat.

Once you’ve loosened up enough to open more than halfway, use a yawning motion to stretch passively.

Massage
Use your fingers to find tender spots, knots, or bumps in the jaw muscles.  Press on these areas using a circular motion, like flattening out bread dough.  Massage several times a day.

masseter massage

Using heat, stretching, and massage several times a day will relax stiff muscles and return you to normal talking, laughing, and eating within a few days.

Dry socket
What is a dry socket?  When a wisdom tooth is removed, normal healing will fill the socket with a clot that stays in place until it replaced by gum tissue and bone.  A dry socket happens when the clot comes out before healing is completed.  The boney socket is exposed to saliva and air, causing irritation and aching in the socket.  Dry socket happens about 10% of the time after wisdom teeth removal.

How will I know if I have dry socket?  Normally healing soreness lasts a few days, and diminishes each day.  Normal healing soreness is also easily managed with pain medication.  If soreness is the same intensity after four or five days, you may have a dry socket.  If pain medication doesn’t help reduce pain, you may have a dry socket.

What should I do if I have a dry socket?  There are two answers to this question.  First, the best thing to do is to prevent a dry socket in the first place.  Second, I’ll answer how we manage a dry socket if it does happen.

You’re more at risk for dry socket with a low-density blood clot, vigorous mouth rinsing, smoking, or changes in pressure of the mouth.  For the first two days it is recommended not to suck through a straw, spit, blow up balloons, or do anything that changes the pressure in your mouth, as this may draw the blood clot out of the socket.  Do not exercise for two days as a rise in blood pressure may cause the blood clot to come out.  By the third day of the healing process you may resume these activities.

If you do get a dry socket, there is a treatment.  The area is packed with a sterile gauze dressing soaked in soothing medicine (mainly eugenol).  This gauze dressing will keep the pain to a minimum while healing progresses.  After 48 hours the gauze dressing is removed.  Continue to take pain medication as prescribed.

A dry socket takes longer to heal than without a dry socket, but in the end the healing result is the same.

Antibiotics do not help prevent a dry socket or cause it to heal faster.

Infection
Symptoms of infection include swelling, pus, fever, and malaise (a general sick feeling).  Some swelling is part of the normal healing process for the first few days after wisdom teeth removal.  If swelling lasts longer than three days, or is getting worse after the third day, you may have an infection.  If you haven’t already been prescribed an antibiotic, please call the office for an antibiotic prescription.

Sinus opening
Upper wisdom teeth can be near the sinus.  There is always a layer of bone separating the tooth from the sinus.  If the bone is thin and comes out with the tooth, an opening between the sinus and mouth occurs.  This happens with about 1% of upper wisdom teeth extractions.

How will I know if I’m having this problem?  If there is an opening in the sinus, you may feel stuffy and congested in the area of your cheeks.  You may notice water coming through your nose when you drink.

What should I do about it?  Usually this opening will heal closed without any additional treatment.  If the opening is still present after two weeks, the area should be numbed and sutured closed.

Nerve injury
Lower wisdom teeth may be near a nerve.  If the nerve is injured during wisdom tooth removal, this may cause the lower lip on the same side to feel tingly or itchy.  This happens with fewer than 1% of lower wisdom teeth removals.  When you have a consult about the procedure, your dentist can show you on your x-ray if you are at risk of nerve injury.  The risk varies from person to person and can only be evaluated with x-ray examination.

What should I do about it?  Your mouth will be numb from anesthetic for a few hours after your wisdom tooth removal.  This is normal.  If numbness persists the next day, call the office and report this to your dentist.

 

 

Most patients will experience some bleeding, swelling and soreness as a part of the normal healing process.  While the complications described here are unlikely, it is important to be informed.  At Wisdom Teeth Littleton, it is our highest priority to make your wisdom teeth removal as easy as possible.