Pain Free keyhole Surgical Removal Of Wisdom Tooth

Pain Free Keyhole removal of Wisdom Teeth.

Dr Seow Onn Choong

Last week a young lady walked into my clinic. Both sides of her face was swollen. She was obviously in a lot of pain. She was crying when she told me she had surgical removal of her wisdom teeth just 4 days ago.

Her left face was really swollen with an obvious haematoma. She told me that she had been not eating properly since she could not open her mouth and asked me to be very gentle. I reassured her that i will be very gentle as I have managed many of such conditions before.

On examination it was obvious the surgeon had made very large incisions to remove the wisdom teeth. To make matters worse there were many ulcers on her lips and her cheek. This is an indication the surgeon was very rough in handling the procedure.
As can be seen on photo lots of ulcers.

Why is there  a need to remove wisdom teeth.

The majority of people are born with the curse of the Wisdom tooth. There are usually 4 wisdom teeth in the mouth and they are the last molars to erupt right at the back of the mouth. There is a lot of variation in the numbers. Very few people are lucky not to have any wisdom teeth. Some have anything from 1 to 3 but 4 wisdom teeth is definitely the most common.

Not all wisdom teeth give rise to problems. Those who give problems are always associated with lack of space for proper eruption and thus the teeth are stuck. This is known as impacted wisdom teeth. Food gets stuck in the gap causing not only frequent swelling of the gums but also cavities. The most damaging consequence is when the tooth in front gets a bad decay resulting lots of work to save it. More often than not root canal treatment is required but the results may not be good and the tooth is eventually extracted.

Types of impaction.

Gum impaction.

These teeth are usually partially or fully blocked by the gums. Their removal is usually easy.

Bony impaction.

In this situation the tooth maybe partially or fully covered by bone. Those teeth that is lying horizontally poses the most difficulty as a gum flap is usually necessary followed by bone removal.

What is the possible reason why wisdom teeth cannot erupt normally?

Nobody really knows why the wisdom cannot erupt out normally. Maybe is an evolutionary problem. Why do I come to this conclusion?

The wisdom tooth usually erupts only after 18 years old. If one looks at history, dentistry as a profession did not exist about 100 years ago. So dental care was absent, not even tooth brushing. Dental decay was very common and most people would have lost some teeth before they reach adulthood. This is especially so for the first molars that erupt out when one is 6 years of age. Thus by the age of 18 the first molars would have broken down. Since the wisdom tooth comes out then, it can restore back the bite. Thus the last molar is known as the wisdom tooth because it comes out at the age when one is wise enough.

In the modern world this seems ludicrous. However if you know that more than 100 years ago the  life expectancy of most people were no more than 45 years you would be able to appreciate the importance of 4 more teeth.

My learning curve in pain free wisdom tooth removal.

Most dental students perform only a handful of cases during their student days. Even these few cases are selected ones so that no problem arises. As a young dentist I had my fair share of  my problems especially when along time is required. This usually ends up with a lot of trauma and unnecessary pain.

I found it extremely stressful and unrewarding in the struggle during the surgery. Thus I approached what was then the most famous oral surgeon in Singapore to teach me the art. He was known as the King Dentist because he drives a Rolls Royce then. He was very kind. He wanted me to spend some time assisting him so that I can see and learn. It proved to be a most invaluable lesson and since then i have little difficulty in the surgical procedure. Later I experimented further with different instruments and techniques so much so i can achieve literally pain and swelling free removal.

Pain Free Experiences.

My own daughter’s experience is a good example. On her second time of removal she was dressed up for sports. I asked her what she planned to do. She said she was going to play football after the operation. Wow I asked? She said after the last operation she rested at home and she was bored cos nothing happened. So this time she is very confident nothing will come about.

Another friend’s son came on Christmas eve. He was a university student. He was taking advantage of the long Christmas break. His story is worth listening. He had a dental student friend who persuaded him to be a demo patient by an oral surgery professor. To him it was a big mistake cos he said he suffered a lot during and after the operation.

That evening i sms his dad. The reply was “He is eating like a pig, absolutely no pain and he does not even feel that he had a wisdom tooth operation” How wonderful to hear such news.

Last year my ophthalmologist friend’s son was going to UK to study medicine. He needed a second wisdom to be removed. I had removed his one side and now it was the next side. She was so impressed by the first time she told me to document it and present it to my profession. I told her I doubt the profession will believe me cos i am just a gp dentist without the titles.

This is the latest feedback from one happy person

Hi Doctor Seow,

sorry this is so late, been rather busy. Anyway here's my experience on my operation.
It is my first time plucking out my wisdom tooth, i heard of many experiences where, people have to stay at home for 1 week because it is very painful, some of my friends, cant even take solid food, they just want to sleep the pain away. During the second day of work, my friend asked, "wow you pluck out your wisdom tooth and still able to eat?" and another friend asked my during supper asked "are you sure you can eat?" I told them, "i felt no pain after the operation." I believe they were surprised

Anyway do look at the pictures and see for yourself.

Before surgery

On recall 5 days later

Her xray

Before operation

Can't see the tooth in the mouth, buried tooth

On recall no swelling at all

His xray

The ideal age group to remove your wisdom tooth.

The wisdom tooth usually erupts at around 19 years old. This is also the best time to remove them. At this age the roots have not fully formed and thus not hardened. The bone socket they are in is still soft. This is to allow the roots to grow fully.  These are important factors that contribute to the easy  removal with much less risk of root fractures or damage to the inferior dental nerve.
As the site has not been affected by chronic infection or accumulation of bacteria colonies, healing is usually very swift and good. Infection usually cause further pain.. Without infections, antibiotics are not necessary at all.
A lot of people refuse to remove their wisdom tooth at this age usually due to ignorance. As a result with chronic food trap and inability to clean the site the neighbouring tooth develops a deep decay. By the time pain shows up the decay has affected the nerves.This  tooth needs root canal treatment followed by a crown. This is a troublesome and costly problem. As this is a difficult tooth to perform root canal treatment, most cases end up in failure and have to be extracted. All these suffering could have been prevented if the wisdom tooth is removed early.