Even with proper care, all operations carry some degree of risk that complications may occur. The most commonly occurring complications will be outlined. The size of the wound remaining after an impacted tooth is removed is variable. In the upper jaw, healing of the surgical site generally proceeds quickly. In the lower jaw, however, healing takes longer. After surgery, meticulous oral hygiene is extremely important, and will speed up the rate of healing. If food debris or germs cling to the stitches, gum tissue, or are allowed to collect in the extraction sites, dry socket, infection and delayed healing may result. Dry socket occurs when the protective blood clot inside the healing extraction socket disappears.  It occurs in approximately five percent of patients.  It is more common in smokers, female patients taking the birth control pill, and in areas that were infected before surgery.  A dry socket is characterized by a dull, throbbing pain which may start five to seven days after surgery, that does not go away by taking your prescribed pain medications.  Fortunately, it is easily treated by placing a medicated dressing into the extraction socket.  Several dressing changes may be required.  Infection after the removal of wisdom teeth is rare.  Redness, increasing swelling after an initial decrease in swelling, discharge of pus into the mouth, fever, and chills, are all signs of infection. If these signs appear, call the office and you will be assessed and treated, as required.  To prevent infection, you may be prescribed an antibiotic after surgery.  You will also be provided with an irrigating tool or cleaning syringe to use for four to six times daily,  four to six weeks after surgery, to clean the lower extraction sockets. 

Lower impacted wisdom teeth can lie close to the main feeling or sensory nerve to the lower jaw. This nerve is called the inferior alveolar nerve. The main nerve to the tongue, the lingual nerve, also can lie very close to the site of surgery. Sometimes, despite all precautions, these nerves may be unintentionally bruised, stretched, or traumatized during surgery. This may result in an altered sensation, characterized by a loss of, painful, warm, or heightened sensation, numbness or paraesthesia involving the lower lip, chin, inside of the cheek, gum tissue, the teeth on the involved side, or the side, top, tip or under surface of the tongue. The altered sensation is usually temporary but may remain for weeks, months, or even years. Sensation to the affected areas improves as the nerve repairs itself or slowly “regenerates.”  Since nerve tissue heals very slowly, the return of nerve function may take up to two years.  In rare cases, altered sensation may be permanent. Altered sensation does not affect appearance as the inferior alveolar nerve is a sensory nerve, not a nerve responsible for movement. 

When impacted wisdom teeth are being removed, it is possible for very small root tips to break. They are most commonly retrieved during initial surgery. However, the decision may be made to leave them in your jaw, if their removal poses, for example, a risk to the underlying inferior alveolar nerve in the lower jaw or to the overlying sinus cavity in the upper jaw. These residual fractured root tips may require removal in the future should they become infected and are start to shift positions, or the body naturally tries to extrude them.  For this reason, radiographs and regular follow- up appointments may be required, in order to monitor the status of your retained root tips.  You will be informed if this occurs.

Upper impacted third molars can lie against the wall of or within the maxillary sinus cavity inside the upper jaw bone. Occasionally, an opening can occur between the tooth socket and the maxillary sinus cavity. This opening is called an oro-antral communication. If this occurs, blood may seep from the sinus and into the nose, causing a mild nosebleed following surgery. In most cases, this opening heals spontaneously. In rare very cases, this opening may not heal properly, and it is then called an oro-antral fistula. If this occurs, additional surgery may be required to close this fistula.

Adjacent teeth may have been weakened or injured by the presence of an adjacent impacted tooth. This type of injury may not become apparent until the impacted tooth is removed. This often means that an adjacent toth may be sensitive or slightly loose, and could require additional treatment by your dentist after surgery.  An adjacent tooth must therefore be considered "on probation" for three to six months following removal of an impacted tooth. Dental fillings, caps, or orthodontic brackets and hardware next to an impacted tooth may be unintentionally dislodged at surgery. If necessary, a temporary filling will be placed. If required, you may need to return to your dentist or orthodontist for treatment once you’ve healed from your surgery. Patients should also be aware that adjacent periodontally-involved teeth, or teeth that are loose or mobile before surgery may be inadvertently dislodged during surgery.

Trismus means difficulty opening the mouth. This very commonly occurs after the removal of teeth, and may persist for several weeks following surgery. It may be difficult to open the mouth widely, or to eat normal foods during the initial healing period. Occasionally, the jaw joints may be very sore or stiff after surgery. This is particularly common if the patient has a pre-existing jaw joint problem. Rarely, an existing jaw joint problem can be worsened by any oral procedure that requires the mouth to be open for an extended period of time. If stiffness or jaw joint pain persists, additional treatment may be required.

In order to administer medication for sedation anesthesia, a small needle (an IV) is placed in a vein in the arm or hand. Rarely, bruising around the IV site or soreness inside the vein, referred to as thrombophlebitis, may result. If this occurs, please inform Dr. Eidinger.

Sharp edges may be felt and/ or bone splinters may come out through the gum, in the weeks or months following extraction. Minor surgery may be needed to smooth down the edges or remove the splinters.

Very rarely, the removal of an impacted tooth may weaken the lower jaw, predisposing it to fracture. The lower jaw may be weakened if the impacted tooth is unusually large or deep. This can be predicted before surgery, in most cases. Every possible precaution is always taken to prevent such an occurrence. Patients are strongly advised to refrain from eating hard or crunchy foods for four to six weeks after surgery, and avoiding engaging in high-risk activities, such as strenuous exercise or weight lifting.

Some of the medications prescribed to you after your surgery may interfere with medications prescribed to you by other doctors. For example, the birth control pill’s effect may be lessened when taken with antibiotic medication, such as penicillin.  To avoid the possibility of drug interactions, be sure to inform Dr. Eidinger of any medications you are taking prior to your surgery.

The receipt of this information sheet indicates that, in consenting to have teeth removed, the patient understands the rationale for surgery, including the possible associated risks and complications. Dr. Eidinger or her staff will be happy to discuss any information with you, or address any questions or concerns you may have.