Third molar removal - outcomes audit

The removal of impacted third molar (wisdom) teeth is one of the most common surgical procedures. The UK National Institute for Health and Care Excellence (NICE) has published guidelines that indicate who stands to benefit (and when) from having their wisdom teeth removed. We follow these guidleines locally and encourage referrals from medical & dental colleagues in primary care when the criteria for referral are met. To this end a specific third molar referral form is available to ensure that criteria are met.

Whilst the vast majority of patients who have their wisdom teeth removed have no significant post-operative problems there are a number of well-known complications that can develop in a very small number of individuals.

Complications that can develop after removal of wisdom teeth

Persistent bleeding - all intra-oral surgical procedures tend to bleed a little afterwards. On occassions the bleeding may be to the extent that the patient needs to re-attend the clinic for further treatment. This is more common if infection has occurred or if the patient takes medication to thin the blood for medical reasons.

"Dry socket" - this is an inflammatory & very painful condition that can set in after any dental extraction but is somewhat more common after removal of lower wisdom teeth. Relatively straight forward treatment can be provided in our clinic to help with these symptoms. Smokers and those who rinse their mouth out vigorously are more prone to this.

Infection - the mouth is naturally "full" of bacteria which cause plaque to build up, teeth to decay and gum disease to occur. It is not surprising therefore that infection can set in when an open wound is present (an extraction socket). Fortunately this is not common and can usually be avoided by keeping your mouth clean and not smoking.

Damage to adjacent teeth - great care is taken when removing wisdom teeth to avoid damage to the neighbouring teeth. If the adjacent teeth themselves are damaged or heavily-filled then small pieces can break away when the wisdom tooth is being removed.

Altered sensation to lips, chin and tongue - wisdom tooth removal surgery is associated with this risk due to the relationship between the roots and two nearby sensation nerves.

 

The results below are the result of a departmental audit comparing our complication rates with published studies.

 

Complication

Rate (%)

Cycle 1

Rate (%)

Cycle 2

Standards (%)
Bleeding (further treatment required) 0 0 3.9
Dry socket occurrence 7.4 3.4 3.1
Infection (further treatment required) 5.9 1.4 2.8
Damage to adjacent teeth 0 0 0.3

Inferior dental nerve altered sensation

     
     <2 weeks post-op 1.5 1.4 8.9
     persistent at > 2 weeks 1.5 0.7 0.5
Lingual Nerve numbness      
     <2 weeks post-op 10.3 0.7 5.8
     persistent at > 2 weeks 2.9 0.7 1.1

The intervention introduced after cycle 1 was the provision of an antibiotic tablet or injection, anti-bacterial mouth-rinse and analgesic tablet pre-operatively. No anti-biotics were routinely given post-operatively unless there was a specific indication.

These result show that we as a department compare favourably with the published complication rates.