Patient Problem
A woman visited our clinic asking for the removal of her upper left wisdom tooth (tooth #28). She had been experiencing problems with this tooth for several years already.
Although previous dentists had recommended extraction, the procedure had been postponed multiple times. The patient reported tenderness that would come and go, and she used ibuprofen occasionally to manage the pain.
However, the discomfort worsened over the last two nights, disturbing her sleep. The pain radiated from her upper left jaw to her head, ear, and throat.
During the examination, we found a large filling on tooth #28 and a metal crown on the tooth next to it (#27). Tooth #28 was sore when tapped, but there was no swelling or visible infection.
We also noted decay and failing fillings on several other teeth, including teeth #17, #45, and #47. X-rays confirmed deep decay under some crowns and ongoing issues in other areas.
Proposed Diagnosis & Treatment Plan
The patient was diagnosed with deep decay involving the nerve of tooth #28, leading to chronic pain. Based on clinical and X-ray findings, we recommended extracting the tooth. We also identified early decay in other areas of her mouth, which would be treated in a later appointment.
We discussed the risks of removing the wisdom tooth, including:
- Pain, swelling, and bleeding after the procedure
- Bruising, dry socket, or infection
- Potential damage to the surrounding tooth (#27), including the need to remove its crown
- Rare complications like a small hole between the mouth and sinus (oro-antral communication), root tip displacement, or jawbone fracture
Although a referral to an oral surgeon was offered for added precaution, the patient declined and agreed to proceed with the extraction in our clinic. She gave verbal consent after fully understanding the possible risks and treatment costs.
Treatment Procedure
We applied a numbing gel to the area, followed by local anaesthesia using articaine that numbed both the cheek (buccal) and palate areas. The patient was told that numbness would last a few hours, and she was advised to avoid biting her lips or eating until the feeling returned.
Tooth #28 was carefully removed using a simple surgical technique with dental forceps. After the extraction, we checked the socket to make sure no roots were left behind. A special dressing and gauze were used to stop the bleeding and help the area heal.
Postoperative Care
The patient was given both verbal and written instructions, including:
- Avoid rinsing, smoking, and alcohol for the first 48 hours
- Keep gauze in place with gentle pressure for 30 minutes, replacing if needed
- Only eat soft foods at room temperature, and wait until the numbness wears off before eating or drinking
- Do not touch or disturb the healing area
Medications prescribed:
- Ibuprofen (400 mg) + Paracetamol (1000 mg), taken together as needed, up to four times a day for up to 5 days
- Amoxicillin (500 mg), taken three times a day for 5 days to help prevent infection
Outcome and Follow-Up
The patient felt well immediately after the extraction and had no concerns at the time. She was also scheduled for a follow-up in 1–2 weeks to check healing.
A longer appointment (around 80 minutes) was also planned for a full dental check-up, teeth cleaning, and treatment of other cavities identified during the initial assessment.
Clinical Discussion
This case highlights the importance of timely management of wisdom teeth that are no longer functional and have become a source of chronic discomfort. Despite multiple past attempts to restore tooth #28, the decay had progressed to the nerve, causing persistent pain. Extraction was the most appropriate option to prevent further discomfort and potential complications.
We took a cautious and informed approach, ensuring the patient understood all possible outcomes. Managing expectations and providing clear aftercare instructions helped reduce the risk of complications after the procedure. Follow-up care will focus on restoring other teeth with early signs of decay to prevent similar problems in the future.
Disclaimer: The information provided on this website is for general educational purposes only and is not intended as a substitute for professional medical or dental advice, diagnosis, or treatment. Always seek the advice of your dentist or other qualified health provider with any questions you may have regarding a medical condition.
Important Note on Surgical Procedures: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.