Is it safe to have all four wisdom teeth removed at once?

February 28, 2017

Is it safe to have all four wisdom teeth removed at once?
Wisdom teeth
When it comes to wisdom teeth removal, many patients worry about having all four teeth extracted at once. Wouldn’t it be safer and less painful to perform the surgeries over two or more appointments? Better yet, can’t the wisdom teeth just stay where they are? Not necessarily. Here is what you need to know:
What are Wisdom Teeth?
Wisdom teeth (third molars) typically grow in at the back of the mouth during early adulthood. In ancient civilizations professionals believe these teeth served a purpose. They filled the gaps of secondary teeth that had already been lost due to tough raw diets and poor hygiene. But today, because of improved hygiene and soft diets, most people retain all secondary teeth through early adulthood. This leaves no room for third molars to grow in. So instead of filling the gaps, the third molars often come with several complications. 
What are the Complications of Having Wisdom Teeth?
Today a lucky 35% of Americans do not get any third molars at all. The rest typically have anywhere from one to four wisdom teeth (sometimes more), and will need to decide what to do with them. Some third molars will have plenty of room to grow in and cause no damage at all. However, in most cases wisdom teeth erupt and crowd out existing teeth, causing occlusal problems. Or third molars might remain impacted, growing on an angle or only breaking partway through the gum line. This can cause pain, infection, or more serious damage to existing teeth, which is when dentists recommend extraction. This decision depends largely on the size, shape, location, and projected path of the third molars. Dentists and surgeons must also consider the patient’s age, oral hygiene, and health status before recommending removal. 
Why Have all Four Wisdom Teeth Extracted at Once?
Removing all four wisdom teeth at once is common, and often the preferred method for many dentists and oral surgeons. If extraction involves four small, erupted teeth, then the procedure is fairly simple and comes with little risk. However if teeth are large and impacted they require more extensive surgery. In these cases the dentist must often slice open the gum, cut the wisdom teeth down, and remove them piece by piece. This procedure is also safe, but is more painful, takes longer, requires longer recovery time, and has greater risk of complications. So why not break it up like dentists often do with other treatments like fillings and crowns?
If you require general anesthesia, the dentist (and patient) will typically prefer extract all four at once. The same goes for local anesthetic, with or without sedatives. Why? The short answer is because not many people want to undergo that type of surgery twice. It is easier to do it once, and be done with it. This reduces recovery time and cuts down on the risk of dry socket, infection, and other complications associated with wisdom teeth removal. 
What are the Risks and Complications of Wisdom Tooth Removal?
Dentists and surgeons do all they can to prevent risks, and extractions do not often result in long-term compilations. But no surgery always involves some risk. Complications with wisdom tooth removal might include:
  • Bleeding. Immediately after the procedure the dentist or surgeon will have you bite firmly on pieces of gauze to help control the bleeding and form the blood clot. He or she will give you instructions on what to expect and how often you should change the dressing. Minimal bleeding will persist for approximately 24 hours. If bleeding goes beyond 24 hours contact your dentist. 
  • Infection. This most often occurs when food particles or bacteria gets trapped in the socket. Signs of infection include fever, white or yellowish discharge from the site, and persistent swelling or pain. If you notice signs of infection, contact your dentist. He or she might prescribe an oral or topical antibiotic. 
  • Dry Socket. This happens when a blood clot does not develop in the empty socket, or when the blood clot disappears or gets dislodged. This type of complication might occur up to five days after the procedure and is common when patients do not follow post-surgery instructions. 
  • Nerve Injury. In the majority of cases the damage is temporary, lasting for just a couple of weeks. However, depending on the severity, nerve damage can be permanent. This complication can result in pain, a tingling sensation, and numbness around the surgical site. 
  • Damage to Sinuses. Depending on the thickness of the bone and the length of tooth roots, the upper teeth may be very close to the maxillary sinus. Once in a while an opening into the sinus occurs after wisdom tooth removal. This is known as an oral-antral communication or sinus-hole. The result is sinusitis, when bacteria enters the sinus and prevents healing. 
  • Reaction to General Anesthesia. Sometimes dentists must use general anesthesia during wisdom teeth removal. This carries additional risks, which the dentist will consult you about, but complications are rare and happen less than one in every 10,000 cases. 
By spreading out procedures the patients have to undergo surgery and the recovery process multiple times. They also have to repeatedly watch for these risks. For these reasons most patients opt to have all wisdom teeth removed simultaneously. That said, it is possible, and sometimes warranted, to break up the procedure over two or three appointments. The dentist or surgeon will give their recommendation, but ultimately the decision is up to you.  


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