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Oral Surgery/Upcoming Wisdom Tooth Extractions

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Question
Hello,

I am having two wisdom teeth extracted next week, and I am absolutely panic stricken. I have a couple of questions.

1) The only reason why I am having these extractions is because my lower right wisdom tooth is broken to the gum line in one area and is decaying. The upper right is fine, but I have been told that it would be bad for it to be unopposed. So, what I would *love* to do is fix the lower right tooth and avoid the extractions entirely. Can a wisdom tooth that is broken at the gum line in one area and rather badly decaying be salvaged? I would not mind a large filling and even a crown, but I know a root canal would be unreasonable on a wisdom tooth. The tooth does not *usually* hurt, but is sensitive at times.

2) Both teeth are fully erupted, but my oral surgeon said he still may have to remove bone around the teeth (particularly the lower) and section them prior to removal. Why? I was hoping that since they were erupted, this extraction would be "easy". How long does an extraction like this typically take?

3) My oral surgeon has highly recommended IV sedation in his office for this procedure. Honestly, I am far more scared of the sedation than the procedure. He has said he will use versed and fentanyl (I know some oral surgeons use other things...if he plans to, he didn't tell me about it). When the time comes, can I request to be "lightly" sedated to the point that I am very relaxed, but still somewhat alert? Is it possible to titrate versed/fentanyl that way? My overwhelming fears are: 1) Being oversedated, and 2) Experiencing pain from inadequate local but being unable to clearly convey that to the doctor because of my level of sedation. I was actually just going to ask for local without sedation, but my doctor does not feel that I will be comfortable that way. I do trust him. He was very nice and thorough during my consult.

Thanks!
Katherine

Answer
Katherine - Extensive decay in a lower wisdom tooth can be a difficult problem to resolve.  The position of the tooth and the increase chance for bacterial accumulation in that region often produces decay.  Repair of such a tooth can be difficult for the long run.  Sure a filling can probably be placed, but because the area is a catchment area for bacteria, the tooth will often decay again. Then the tooth will be more difficult to fix and need extraction.  So extracting a lower wisdom tooth with extensive decay is a good idea.

The only reason for removing some bone for that lower tooth is if the doctor is unable to grab onto the tooth securely.  If not, the tooth will break and that will make the extraction much more difficult.  So planning in advance for sections the tooth and removing some bone to allow the tooth to be extracted simpler is good planning.

You can definitely ask the surgeon to keep you lightly sedated, but there is stage of sedation when light that can produce problems.  Patients who are tooth light often overreact to simple stimuli like pressure.  For that reason either a deeper sedation or no sedation at all is appropriate.  You can ask for sedative like intravenous Valium and that is lighter, but again you might react inappropriately and make the procedure more difficult

Every doctor titrates (adjusts the level of anesthesia or sedation appropriately or as necessary) and just does not just over medicate you.  So if you trust the surgeon, let him keep you at the appropriate level of sedation, but ask if he can keep that light.  I wish you well and hope you are comfortable with the extractions.  

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicing for over 20 years. Assistant Clincal Professor at State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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