This section will be dedicated to answering the questions you have been meaning to ask your dentist but were too distracted by the nurse to do so.

So, please, send me your questions and I will do my best to give you the most unbiased answer possible. You can use my mail form over here or you can send mail directly to me.

Question of the moment

• My friend just got his wisdom tooth extracted under surgery. Tell me about it.

Sure. Let's talk about the what, the why, the how and most importantly, the how much about the wisdom tooth and its removal. It's kinda wordy. Ready ? Let's do it.

The wisdom tooth is actually the common name for the third molar. Molars are the huge grinding teeth at the back of the mouth. Most times they look like a smaller version of the second molar. They erupt around the end of puberty, that's usually after the "A" levels or poly for the girls and the army for the guys (do guys ever grow out of puberty ? hmmm). They need to erupt into a proper position behind the second molar and biting with the corresponding third molar.

Must the wisdom tooth be taken out in the first place ? The answer is a big NO, unless. Yes, unless it is giving you problems or looks like it will be giving you problem. Since the third molar is always the last to erupt into the mouth, more often than not, there is insufficient space for it to get to its proper biting position. Major bummer. But that's not it's only problem. It may not be standing upright. It may be slanted or angulated (horizontal, transverse, mesio or disto angulated). It's eruption path may be blocked by obnoxious bone or fiber. It may be so buried in bone it;s going to take like, forever to reach the top. If it erupts and settle in a weirdo position, it may create a pocket between it and the second molar. Plaque easily settles in and this create a feast for bacteria. Definitely not good. You may get unrestorable caries for both teeth, gum disease or bone resorption (removal) in severe cases. Does the wisdom tooth cause crowding of the lower front teeth ? Nope. This has been debated and most times there are other causes of crowding. So, the best reason for wisdom tooth removal is still pain.

OK. So your dentist says the tooth's gotta go. You do want to know how it's going to be done, yes ? First thing, an x ray is vital. Only an x ray can tell the dentist the position of the impacted (stuck) tooth in relation of important structures around it. Structures like the Inferior Dental Nerve (it supplies sensation to one side of the tongue, lips, gums and teeth), the closeness to the second molar, its depth in bone, the state of the bone around it and it's angulation. In fact, angulation is so important, it usually determines how difficult the extraction will be. (note the look of panic next time your dentist peers into your x ray).
Next, you have to be fit for the procedure. If you are in pain or feverish, you will be given analgesics (pain killers) and anti pyretics (for your fever) to let the inflammation simmer.

OK, this part is gross, so guys if you're squeamish, skip it.
The extraction is done under local anesthesia. You will not feel pain but you will be awake, aware and fully functional. Once the injection has kicked in, you will be draped under surgically clean sheets to isolate only the extraction area. Contamination is a big deal since bone will be exposed. Only when total anesthesia is achieved, will the dentist make the initial cut into the gum. The necesary amount of bone will be removed, and if needed, the tooth is cut into smaller portions. Once the tooth is removed, the area is cleaned thoroughly, the bleeding stopped and the gum is secured back using surgical threads. Simple.

What you will feel after the extraction is this incredible numbness. It's like you've been kissed by Gywneth Paltrow. You may eat, but lay off the kacang and prawn crackers, only soft foods for you. You will be given pain killers, take them immediately to avoid pain when the injection wears off. If you find the area bleeding, keep cool. Rinse once to clear the mouth, take the given gauze, press down and bite on it gently. Do not rinse. Rinsing will only dislodge the meticulously built clot and you will bleed again. If your mouth wells up with drool, swallow it. It's only saliva, no harm.

The one side of your face will swell slightly due to normal post operative trauma. Take plenty of rest (remember 5 days MC, use it man). No soccer matches, no late night dates. You will return one week later for a review and to remove surgical threads, if any. Your removed bone will grow back, the last reminder of a missing unwanted wisdom tooth.

The Singapore Dental Society released comprehensive guidelines on the fee structure of a wisdom tooth removal. The fee ranges from $150 to $400 depending on the complexity of your case, as explained above. You will also have to pay for X rays taken, post op care and the medicine prescribed. Some companies have dental benefits, but are limited on the surgical options, so investigate. Be willing to talk about payment during your first visit. Dentists are human too. Besides private practitioners, you can also try Government clinics like the one at the Singapore General Hospital. The army has a dental service too. The Dental Faculty at the National University Hospital have dental students in training. The charges are very affordable, but you have to adhere to their strict scheduling.

That's all for my lecture today. If you need any clarifications, use my mail form over here or mail to me directly over here. Next week, I will talk about the impact of the post modernist movement on the evolution of orthodontic thinking and techniques.

Just kidding.