PROCEDURE

1. The surgeon may use one of three types of anesthesia, depending on the expected
complexity of the wisdom tooth extraction and the patient's comfort level.
● Local anesthesia. The oral surgeon administers local anesthesia with one or more
injections near the site of each extraction. Before the patient receives an injection, the
dentist or surgeon will likely apply a substance to the gums to numb them. The patient
is awake during the tooth extraction. Although it'll feel some pressure and movement,
they shouldn't experience pain.
● Sedation anesthesia. The dentist or oral surgeon gives the patient sedation anesthesia
through an intravenous (IV) line in their arm. Sedation anesthesia suppresses your
consciousness during the procedure. The patient don't feel any pain and will have
limited memory of the procedure. Also it’ll receive local anesthesia to numb your
gums.
● General anesthesia. In special situations, the patient may be offered general
anesthesia. Patient may inhale medication through its nose or have an IV line in its
arm, or both. Then it lose consciousness. The surgical team closely monitors your
medication, breathing, temperature, fluids and blood pressure. Patient will experience
no pain and have no memory of the procedure. Local anesthesia is also given to help
with postoperative discomfort.
2. Makes an incision in the gum tissue to expose the tooth and bone with scalpel.
3. Removes bone that blocks access to the tooth root with chisels.
4. Divides the tooth into sections if it's easier to remove in pieces with the turbine.
5. Removes the tooth with some extraction dissectors.
6. Cleans the site of the removed tooth of any debris from the tooth or bone with fluid.
7. Stitches the wound closed to promote healing, though this isn't always necessary.
8. Places gauze over the extraction site to control bleeding and to help a blood clot form.
9. After the procedure the patient receives sedation anesthesia or general anesthesia, it’ll
be taken to a recovery room after the procedure. If the patient have local anesthesia,
the brief recovery time is likely in the dental chair.

POSSIBLE SETBACKS IN THE PROCEDURE

1. Sinus exposure and oral-astral communication: it can occur when extracting upper
molars. The maxillary sinus is placed right above the roots of maxillary molars and pre-
molars. There is a bony floor of the sinus, dividing the tooth socket from the sinus itself. This
bone is different in each patient. In some cases it is absent and the root is the sinus itself. At
other times, this bone may be removed with the tooth, or may be perforated during surgical
extraction. The sinus cavity is next to the Sniderian membrane, which may or may not be
perforated. If this membrane is exposed after an extraction but remains intact it is called a
sinus exposed. If the membrane is perforated it is called a sinus communication.
 2. Nerve injury: it is normally related to the extraction of third molars, but it can also
occur with the extraction of any tooth when the nerve is close to the surgical site. The nerves
which are usually implicated are: the inferior alveolar nerve, which enters the mandible at the
mandibular foramen and exits the mandible at the sides of the chin from the mental foramen.,
and the lingual nerve (one right and one left), which branches off the mandibular branches of
the trigeminal nerve and courses just inside the jaw bone, entering the tongue. Such injuries
can occur while lifting teeth, but are most commonly caused by damage caused by a surgical
drill.

3. Displacement of tooth or part of the tooth into the maxillary sinus (upper teeth
only): In such cases, the tooth or tooth fragment must almost always be retrieved. In some
cases, the sinus cavity can be irrigated with saline and the tooth fragment may be brought
back to the site of the opening through which it entered the sinus, and may be retrievable. At
other times, a window must be made into the sinus in the Canine fossa, a procedure named
Caldwell-Luc.

4. Dry-socket (Alveolar osteitis): it is a phenomenon of painful inflammation within

the empty tooth socket because of the relatively poor blood supply to this area of the
mandible which usually lasts between 2 and 5 days. A dry-socket is not an infection, it is a
phenomenon of inflammation, and because of that the use of antibiotics has no effect on its
occurrence. Rinsing which chlorhexidine before or after the extraction may reduce its
probability of happening but there are mayor adverse effects in the use of chlorhexidine that
we would have to take into account.

5. Bone fragments: When extraction of molars is involved it can occur that the bones
which supported the tooth may shift and in some cases may erupt through the gums,
presenting protruding sharp edges which can irritate the tongue and cause discomfort. This is
distinguished from a similar phenomenon, where, broken fragments of bone or tooth left over
from the extraction can also protrude through the gums.

6. Trismus: Also known as lockjaw, it affects functions of the oral cavity by restricting
opening of the mouth. A double blind, clinical study was done to test the effect of two
different medications on post-extraction trismus. The patients who received a corticosteroid
by IV had a statistically significant lower level of trismus when compared to patients
receiving an NSAID by IV or no medication.

7. Loss of a tooth: If an extracted tooth slips out of the forceps, it may be swallowed
or inhaled. If it has been swallowed, no action is necessary as it usually passes through the
alimentary canal without doing any harm. But if it has been inhaled, an urgent operation is
necessary to recover it from the airway or lung before it causes serious complications such as
pneumonia or a lung abscess.
 8. Luxation of the adjacent tooth: it happens due to the application of force during the
extraction procedure.

9. Osteonecrosis: it is the slow destruction of bone in an extraction site, it happens

because of the loss of blood supply to the bones.

10. Appart from those mayor setbacks there are some other complications that may
not be related to how well the dentist did the procedure but that are related to the patient’s
immune system, such as: infection, prolonged bleeding, swelling or bruising.