Sunday, September 29, 2013

Having Wisdom Teeth Removed After 30

For years, every dentist I've seen has told me I need to have my wisdom teeth removed.  I've always resisted because the top ones were fully erupted and the bottoms ones were partially erupted, but straight, and they only rarely bothered me.  When I was younger, I had a root canal done that had some complications and because of that I've had a (probably only partly rational) fear of nerve damage if I had my wisdom teeth out.

The dentist I go to now had given me the same talk:
"You know those wisdom teeth need to come out?" 
"You're not gonna do it are you?"
"Are they hurting you?"
"Okay then"

He earned my trust by not pushing the issue.  At my exam this year, I was having some odd come-and-go tooth pain on another molar that couldn't quite be pinpointed.  He examined my teeth, looked at my x-rays and pointed out that cavities on one of my wisdom teeth was causing decay under the crown of an adjacent tooth.  If the tooth under a crown decays too much, you can't fix it, you just lose the tooth all together.  The other wisdom teeth also had some degree of decay and I had noticed my top teeth had gotten noticeably more crowded lately.  So I bit the bullet and scheduled the consultation with the oral surgeon.

Here's the thing about wisdom teeth though...they are more firmly attached in the bone the older you are.  30 seems to be the magic tipping point where it's just plain rougher to get wisdom teeth removed and the chance of complications goes up.  I'm 32.  And a half.  So things could be worse, but they could also be a heck of a lot better.

Here was my experience of having all 4 wisdom teeth extracted after age 30:
Day 1:
    Surgery scheduled for 2pm.  This was a piece of cake.  Got the IV in, sedated with versed and propofol, and woke up less than 45 minutes later all done with a numb mouth.  There is only one thing I would do differently here based on things I've read online.  Apparently, if you're on birth control, they schedule your surgery so that you are not at a high estrogen time of your cycle.  Higher levels of estrogen are correlated to higher incidence of dry socket.  This never came up before my surgery and it seems no one thinks about it at all unless birth control is involved (maybe because levels are higher?), but personally, I would've rather been on the safe side and scheduled just before or during my period, when estrogen is the lowest.  Instead, I inadvertently scheduled right around ovulation, when estrogen is the highest. 
   After the extraction, I was sent home with a pack of sterile gauze and told that every 30 minutes, I needed to swap the gauze that was in my mouth for fresh, moistened gauze to help stop bleeding.  Bleeding was going on a little longer than the 1-2 hours they told me to expect, but it was slowing down, so I wasn't worried.  About 3.5 hours after surgery, bleeding had stopped and I was going to eat some soup (no food or drinks 6 hours before sedation, so I was quite hungry).  I stuck my finger in to be sure it wasn't too hot since I was still numb, and then I stuck my tongue out to lick my finger.  My mouth immediately filled with blood.  We were out of sterile gauze at this point and raiding our first aid kit, so we called the after hours line and the on call surgeon told us to meet him at the office.  He made sure there was not a serious cause for the bleeding, then packed the 2 bleeding sockets with a dressing to help stop the bleeding.  This was uncomfortable, but bearable and it worked.  I got to go home and eat.

Day 2:
   I woke up throughout the night hurting and took advil and my prescribed narcotic (I get tramadol ever since my lovely reaction to vicodin a few years ago).  Also very hungry throughout the night, probably because I had done a 13 mile run a couple days before the surgery and was still in a calorie deficit.  I drank some of Secora's pediasure over night.  The next morning, I was still hurting pretty bad and was really tired.  I pretty much stayed in bed either sleeping or watching netflix.  Still only ate very soft foods like over cooked oatmeal (swallowed without chewing), soup and pudding.  Later that afternoon, had a baked potato with a lot of sour cream and butter to soften it up and a frosty (with a straws allowed because the suction can cause dry socket).

Day 3:
    Slept through the night, but the lack of pain meds for 7-8 hours caught up to me and I was pretty miserable when I woke up.  Slept a lot in the morning.  Josh went back to work in the afternoon and after I got Secora down for nap, I went back to bed.  Back when I had my gallbladder out, the surgeon told me I would be extra tired until my body healed up all the injury, so I think that's why I'm so tired.  Josh thinks it's because the sedation isn't totally out of my system yet.  Doesn't much matter why though. I'm tired, a lot.  Still on super soft foods.  Swelling is at its worst today.  It's noticeable from looking at me and on the inside it feels like I can't close my mouth without my cheeks getting caught between my teeth.  This meant I drooled a lot when I slept, so I kept a towel on my pillow.

Day 4:
   Josh had to go out of town for work, so a friend came over to watch the girls in the morning.  I slept a lot again.  In the afternoon, I put Secora down for a nap and started suspecting I was developing a dry socket.  I had a radiating pain in one jaw that felt a lot different than all the other sockets.  I called the office and the person who answered the phone said it was a bit early for dry socket, but call first thing in the morning if it was still bothering me.  I ate restaurant style mac and cheese, more soup, more oatmeal, chocolate spoon cake (again, all no chewing necessary foods).

Day 5:
  Overnight, I was up several times in pain despite taking meds.  The pain was now extending through all the teeth in that quadrant of my mouth as well as my ear hurting.  We called the office at 8am and I went in at 10 to be checked out.  Because they were fitting me in, I saw a different oral surgeon and she told me I had a dry socket that needed to be packed.  She apologized that it was going to hurt, but she'd try to be gentle and 15-20 minutes later I would feel all better.   I should preface this by saying I've birthed 3 children without pain meds, I've had cavities filled with no novocaine, I've had my teeth scaled with no novocaine, I've had pancreatitis (which was the only time I'd cried in front of medical staff due to pain).  Dry socket means the blood clot that should be protecting the bone and the nerve in the socket has come out prematurely.  Packing one means pushing packing into that hole.  You know, the one with the exposed nerve.  It probably takes 4-5 pushes and the first 3 hurt, but are bearable.  But that's when I hit my limit.  I suppose I was already worn down from having been in constant pain for a while and being hungry and cranky.  I lasted through the packing, but as soon as it was over, I burst into tears.  I was just DONE.  And now my jaw was throbbing even worse than before.  It's awful, but I will say it works.  15 seconds of unimaginable pain bought me days of relief.  The pack numbs those nerves.  It's a bit weird, because your cheek/tongue/gums feel fine, but the bone itself (which you never really noticed before) feels numb.  I've been assured replacing the pack (which has to be done periodically) doesn't hurt nearly as bad.   The other weird thing is the pack includes eugenol....clove oil extract.  So for the rest of this day, all of my food tasted like cloves.  That is always there to some extent, but fades (or you get used to it?) after the first day.

Day 6:
  The socket I had packed was feeling a lot better.  Woke up with pain on other side thorough out the night.  By the afternoon, I was pretty sure I was developing a dry socket in the other bottom tooth.   Still on soft foods.  Smoothies and milkshakes eaten with a spoon are the order of the day.

Day 7:
  Took advil during the night, but woke up with no pain for the first time all week.  By mid-morning, low level nagging pain developed, but not to the extent it was yesterday.  Ate pancakes for the first time (cut into very small bites and eaten very slowly).

Days to come:
  I go back to the oral surgeon tomorrow (day 8) to check everything out.  I think it will be another week before I'm eating somewhat normally.

What I Wish I Knew Then:
  •    I don't regret having the teeth taken out.  It needed to happen.  I DO regret not having it done when I was younger.  
  •   The nerve damage I was so worried about, I didn't need to worry about.  I thought it would be motor nerve damage affecting a large portion of my face.  The surgeon explained to me that it's sensory nerve damage that can happen and would only affect my lower lip and most likely be temporary, if it happened at all.  It turns out I do have one spot that feels numb, but it's only about the size of a dime and I'm not sure yet if it's from trauma of surgery or actual nerve damage.  I haven't asked because it doesn't much bother me.  I didn't even notice it until the third day.
  •    Risk factors for developing dry socket include: being female, being over 30, having wisdom teeth extracted (especially lower ones), having surgery done when estrogen levels are high, using a straw, smoking, swishing/rinsing vigorously.   My odds weren't great for avoiding it anyway, but I would've scheduled at a low-estrogen time if I'd known about that.  
  •    Recovery has been much more involved than I expected.  A lot of people bounce back in 2-3 days, especially if they're younger, but you might not.  I would've cleared a little bit more of my calendar ahead of time.  
  •    Because recovery takes longer than you'd think, stock up on more soft food than you think you'll need.  Chicken noodle soup is hard to eat without slurping it off the spoon because it's TOO thin.  Tomato soup was easier and baked potato soup was easy too (you can mash any potato pieces with your front teeth).  Smoothies are good as long as you use a spoon.  Pudding is really good too and so is oatmeal (just swallow very small spoonfuls without chewing).  Baked potatoes and baked sweet potatoes are easy to eat if you mix in enough butter or sour cream to make them very soft.  
  •   Stock up on advil and sterile gauze pads (just in case) before surgery so you don't run out. 
  •   If you have kids at home, maybe pick up something for them to do while you recover.  A new movie, or a sticker book or whatever it is that will entertain and keep them quiet. 
I can't be the only person that googles medical procedures to try to plan out what to expect, hopefully this helps someone else out there figure out what to prepare for!

Update: I did develop a second dry socket (had that packed for the first time on day 8).  Re-packing a socket that has already been packed is uncomfortable, but not what I'd call painful, it just feels weird.  The packs are well worth the very temporary pain, they take you from "narcotics aren't really helping" to "I don't even need advil".  I was able to slowly increase my diet and activity level through the week and on day 12 ate a sandwich without cutting it into pieces first.  It's now day 13 and I'm completely comfortable brushing my teeth and eating most foods within reason.  I no longer feel like I need naps (that stopped around day 10).  I still have the dry socket packings in.  I go in next on day 18 and they think they'll be able to take them out and leave them out at that point.  


Clinton Zelman said...

Congratulations on finally taking the leap and having your wisdom teeth removed. That must have hurt, having the procedure done at 30! Well, as they say, better late than never. At least now, you have taken away a potential risk for tooth decay. Good thing you have prepared yourself very well before the surgery.

Clinton Zelman @

Erin - Reno, NV said...

Happened to come across your blog this morning. I'm 38 and having mine removed on Friday with just local anesthetic. Gotta say, your blog both freaked me out even more AND made me feel better. Thanks for sharing your experience. I've spent the whole week obsessing about this after canceling so many times for the last 20 years. Yours is the best advice I've come across so far, so thanks!

The Hills said...

It's been a year now, and it was worth it! I ended up getting my dry socket packings out a day early (so day 17, I guess) and everything's been fine since then. The packings were so very very worth the pain of having them put in the first time and having them changed was not a big deal.

Rural Swelley said...

Thanks so much for this blog! I moved to the US from the UK last year. Removing wisdom teeth seems to be less of a standard thing in the UK than it is over here and it had never been brought up by my dentist back home. My bottom wisdom teeth do need to come out and - at age 34 - I'm having the procedure in January as recommended by my new dentist. I'm a little nervous about the pain of course, but I know that I'll cope with that - it's actually the anesthesia that freaks me out as I've never been "under" before. EEK! So thanks for your blog as it really helped reassure me on that aspect and feel prepared for what's coming.

Anonymous said...

Thanks so much for this blog! I'm 45 and will be having all four of my wisdom teeth removed this week!I am very nervous, but your blog helped a lot.

Anonymous said...

Thanks for this blog post. I am 34 and contemplating this very thing. Would love to hear from the other similar aged folks about their experience with the whole procedure as well. I'm still unclear how they pull these teeth out? Do they just yank them out? Mine are fully exposed and I've really had no problems with them except that they are developing cavities. Also because of braces had 4 permanent teeth previously removed to make room for these Wisdom teeth to come in without making a huge mess with my other teeth. Oh well. Thanks again for the info.

Anonymous said...

So grateful to have found your blog post. There is so little information on the healing timeline for the 30+ crowd. I'm almost a week out from having all 4 wisdom teeth removed and the recovery is going far more slowly than I had hoped. The pain is mostly just annoying at this point, it's nothing ibuprofen or tylenol can't mitigate- but I can't handle this terrible breath! Ugh!

Anonymous said...

I am glad you healed fine after going through the pain of dry socket.

Recovery is not like yours but still a horrible nightmare with pain, restitching, still soft diet, etc.

Hope someday soon, can look back and say that happy this is a rather short duration (3 weeks and counting).

Unknown said...

I am so nervous. I am 30 and will have my wisdom teeth extracted in 6 weeks.

Anonymous said...

Thank you for your honesty. My stomach is churning, but I am so glad to have read your comments. I am now over 30 and need this face is starting to swell on one side so I will be taking the plunge soon. I am thankful to know what to expect from someone who has been there! God Bless!

Bec said...

Thank you for this blog post! I am also 32 (and a half) and need to have two impacted wisdom teeth removed that are more complicated than normal because they are very close to a nerve. The oral surgeon at my dentist didn't want to touch them so they are referring me to someone else but I've been waiting weeks. I also have a trip to London planned in three weeks so I'm starting to think I shouldn't schedule surgery until after the trip!

Anonymous said...

Thank You so much for this post. I'm 32 and a half and im getting 2 impacted wisdom tooth pulled in 3 weeks on the right side after postponing for over 6 years due to fear. Your post has been helpful in more ways than one. I am so grateful. Thank You and God Bless.

Nadia Rofail said...

Had my four wisdoms (2 impacted) out a week ago under general anesthesia. I'm 33 and seriously didn't think the pain would last this long! It's day 7 and I'm still relying heavily on Stillpain and Nurofen! I have tried chewing bread and that was a complete mistake! So much pain and discomfort afterwards... but reading this blog helped me realize that perhaps I just need to be a little more patient...


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