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In some impacted wisdom teeth , the roots are in close proximity to the dental nerve supplying the lower jaw.
With the precise position of the inferior dental nerve map out by the Dental Conebeam CT Scan , our surgeons will be able to plan the wisdom teeth surgery in 3 dimension so as to minimize the risk of injury to the dental nerve. |
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Our In- office Cone Beam CT Scan enable our surgeons to view the jaw bone in 3 dimensional slices as small as 0.1 mm. With low radiation dosage compared to conventional full size medical CT Scan , thousands of 3 dimensional xray images of the jaw is available for our surgeon to plan the wisdom teeth surgery in a matter of few minutes. |
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 | The cone beam CT Scan on the left shows the close proximity of the dental nerve to the roots of the wisdom teeth . ( dental nerve marked in green) . With the location of the dental nerve fully located , our surgeons will be able to minimize dental nerve injury significantly |
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Meet our Specialist Oral - Maxillo Facial Surgeon
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 | Dr Loh Hong Sai
BDS Singapore
MDS Singapore
FDSRCPS (Glasgow)
FDSRCS (Edinburgh)
FAMS
SDC Certified Specialist
in Oral &Maxillofacial Surgery |
Dr Loh Hong Sai was Professor and Head of Oral & Maxillofacial Surgery ,National University of Singapore from 1980 to 1998. He was also the Dean of the Faculty of Dentistry ,National University of Singapore from 1986 to 1995. He was also a Senior Consultant Oral Maxillofacial Surgeon at National University of Singapore.
His specialized skills ranges from wisdom teeth surgery to complex oral & maxillofacial surgery. He also teaches part time at the Oral & Maxillofacial Surgery Department , Faculty of Dentistry. He is also a well known local and international speaker on a wide range of oral surgery subjects. |
Sedation for wisdom teeth removal
Some patients can be very anxious about wisdom teeth removal .In our clinic , our surgeons have several additional sedation techniques to help patients control their anxiety.
Nitrous Oxide
Nitrous oxide is also known as “laughing gas “. Nitrous oxide has a calming effect when the patients breath the gas . The effects is rapid onset when the patients breath in the gas and its effects disappear fairly rapidly when the patients stop breathing in the gas. As the level of sedation by nitrous oxide is relatively shallow , we used it for simpler cases of wisdom teeth removal.
Intravenous Sedation
I.V sedation will put you into a deeper and controlled state of sedation compared to nitrous oxide. It is safe as our clinic is fully equip with advance monitoring equipment for our anaesthesiologist to monitor all your vital signs throughout the surgical procedure. I.V sedation is suitable most difficult wisdom teeth surgery
General anaesthesia . In cases that are very difficult , the wisdom teeth surgery can be carried out under General Anaesthesia. Our surgeons are qualified specialist with admission privileges to all major private hospital in Singapore .
Medisave
We are accredited by Ministry of Health as a Day Surgery Centre . As such for Singaporeans and permanent residents , it may be possible to claim part of the surgical fees from medisave.
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Reasons for removing wisdom teeth ? |
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Pericorontis / infection associated with a wisdom tooth
Because the third molars is at the back of the mouth, frequently oral hygiene procedures is more difficult. The tissues around the gums may become repeatly infected. This condition is called pericoronitis. This can cause severe tooth pain and gum swelling . In some case ,because of the spread of bacteria infection , there may be facial swelling as well. |
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 | Complications associated with tooth decay
There might be tooth decay in the wisdom teeth itself and in some case tooth decay in the adjacent tooth ( adjacent 2nd molar ). In the some cases , the tooth decay in the adjacent 2nd molar is so advance , both wisdom teeth and the 2nd molar had to be removed at the same time.
OPG xray on the left shows a big decay in the upper and lower wisdom teeth .
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 | OPG xray on the left shows a big decay in the 2nd molar
This is the result of food impaction in the wisdom teeth area (3rd molar)
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 | Complications with gum disease.
Wisdom teeth can be very difficult to clean and thus the possibility of developing gum diseases is much higher. In long standing cases, with prolong plaque retention , the gum disease can spread to the adjacent 2nd molar . In advance cases ,the 2nd molar had to be extracted as well
The OPG xray on the left shows bone loss on the distal of the 2nd molar as a result of a impacted 3rd molar. |
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 | Cyst and tumors
While this is not common, cyst and tumors may develop in the tissues around the impacted wisdom teeth
The OPG Xray on the left showing a large cyst due to a wisdom tooth.
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Teeth crowding
The wisdom teeth being impacted can exert pressure on the other teeth in front of the wisdom tooth .In some cases ,the pressure can result in crowding and shifting of the lower front teeth.
Should all wisdom teeth be removed ?
Not all wisdom teeth need to ne removed. In those patients with bigger jaw , the wisdom teeth can be fully erupted . These wisdom teeth can be accessible to oral hygiene procedures and hence do not have o be extracted.
In some cases of impacted wisdom teeth ,they are fully encased in bone . These are the least likely to give problems and can be left in situ most of the time
When should I remove my wisdom teeth ?
Removal of wisdom teeth is best done when the patients is young . In a young patients ,the bone is more elastic and the roots are not fully formed. Hence wisdom teeth removal is easier. Also the wound healing in a young patient is faster. The incidence of nerve damage associated with wisdom teeth removal is higher in people over 35 years whereas in teenagers it is rare.
Is it a painful procedures ?
With modern advance surgical techniques , wisdom teeth extraction can be done rapidly with minimal pain .
Wisdom teeth removal procedures
The wisdom teeth and the surrounding gums is first numb with local anaesthetic.
If the wisdom tooth is covered in gums , our surgeon will open a gum flap to expose the tooth . Any bone that that is covering the wisdom teeth is then carefully removed. To make the wisdom tooth removal easier, the tooth is section into small pieces. After this the gum flap is closed back with sutures.
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Types of wisdom teeth impaction |
 | Horizontally impacted wisdom tooth
In this type of impaction , the wisdom tooth is lying flat on its side .
It is usually significantly covered in bone ,
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 | Mesial angular impaction
In this case the wisdom tooth is angled forward towards the front of the mouth.
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 | Vertical wisdom tooth impaction
In this type of impaction, the wisdom tooth is vertical and it prevented from full eruption by bone at the back of the mouth
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 | Distally impacted wisdom tooth
In this type of impaction , the wisdom tooth is leaning towards the back of the mouth
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Post op instructions for wisdom teeth surgery
There is usually some post operative swelling and discomfort. Use ice pack for the first 2 days to reduce the swelling .Complete your course of antibiotics and painkillers as instructed.
Rinse your mouth with antiseptic mouth rinse and brush the rest of the teeth and keep your mouth clean.Soft diet for a few days and avoid vigorous exercise for 24 -48 hours to minimize risk of infection.
Avoid smoking and alcohol.
Wisdom teeth extractions- complications and risks
Dry sockets
In a dry socket ,the blood clot fails to form in the extracted socket. Since the blood clot is very important for socket wound , in a dry socket , the wound healing is delayed.
Symtoms of dry sockets include dull throbbing pain that appears 3-4 days after extractions. The pain can be moderate to severe and there is usually a foul smell or taste from the socket.
Lip paresthesia
Some wisdom teeth can be close to the dental nerve in the lower jaw. Sometimes in the process of extracting wisdom teeth, the dental nerves may be bruised or damage. As a result , numbness of the lip may occur. (lip parathesia ). In most cases the paresthesia is temporary and resolves on its own within a few weeks to a few months. In our clinic, using state of the art Conebeam CT Scan will result in lower risk of nerve injury during wisdom teeth removal. |
