Best treatment approach
The best treatment approach is early removal of all four third molars before development of inflammation or symptoms. It is best to have all four third molars (or more if supernumarary) removed at the same visit under IV sedation anesthesia.
In the presence of inflammation or infection associated with wisdom teeth, place the patient on appropriate antibiotics, recommend saline rinses, and refer for immediate removal of third molars. It is not necessary to wait before extraction. Inflammation or infection is resolved best by immediate removal of the offending teeth along with localized debridement and irrigation.
The ideal anesthesia is IV sedation, which provides patients with optimal level of comfort and experience. It is safe and administered under full monitoring. Patients can go home after a 30–45 minute recovery period and most feel back to normal within 24 hours.
Pain: The level and duration of pain depend on the complexity of the surgery, the technique, and the patient’s tolerance. Most patients experience three to four days of elevated pain, commonly managed with pain medications such as Vicodin or Percocet. As pain gradually diminishes over the next two to three days, Ibuprofen (Advil) or Acetaminophen (Tylenol) can be used. After seven to ten days, most patients no longer have pain and may stop their medications.
Swelling: Any swelling related to surgery will maximize in 36 to 48 hours following the procedure, and gradually taper over the next five to seven days. Ice helps to reduce swelling in the first 24 hours. If extractions were done in a conservative fashion, a patient may experience no swelling at all.
Diet: Upon arrival home, patients may have water, juices, soups, shakes, purees, and very soft food. A soft diet is recommended for up to five to seven days. No hard, crispy, or spicy foods should be eaten during this period. The general rule is, if you have to chew, it’s probably too hard. After seven days, patients may gradually return to normal food.
Activity: A patient should get plenty of rest on the day of surgery. Some patients may feel well enough the following day to walk and go out. That’s alright, but they should take it easy and avoid strenuous activities for the first two to three days. Patients should refrain from sports, lifting, or doing anything that requires exertion. After three days, if patients feel more comfortable, they can walk, go for a gentle swim, or do very low-impact exercise., such as swimming or walking. Mild activities may cause some pain but not enough to disturb the surgery site or open the sutures.