Wisdom teeth, or third molars, are often troublemakers. Being the last teeth to erupt, they sometimes appear in unusual positions, are difficult to clean, and are highly prone to decay. This blog discusses a case of surgical removal of tooth 28 (upper left wisdom tooth) which was both carious and buccally placed.
Patient’s Complaint
- A 27-year-old male patient came to our clinic complaining of:
- Pain in the upper left back tooth region
- Food getting stuck frequently around the last tooth
- Discomfort while chewing on that side
The problem had been persisting for about two weeks and was gradually worsening.
Clinical Findings
On examination, the upper left third molar (tooth 28) was found to be:
- Buccally placed (tilted outward towards the cheek)
- Grossly carious, with much of the crown structure destroyed
- Tender to touch, with mild gum inflammation
X-ray confirmed the tooth’s abnormal position and damage.
Treatment Decision
Since the tooth was extensively decayed and malpositioned, restoring it was not possible. The best solution was surgical extraction to prevent further infection and protect the adjacent healthy teeth.
Surgical Procedure
The surgery was carried out under local anesthesia in a safe, sterile setup. Here are the steps followed:
Anesthesia – Numbing of the tooth and surrounding gums with a local anesthetic injection.
Flap Opening – A small cut was made on the gum to expose the tooth properly.
Bone Guttering – Minimal trimming of the surrounding bone was done to make space for tooth removal.
Tooth Sectioning – Since the tooth was fragile due to caries, it was divided into smaller parts for easy removal.
Extraction – Each section was carefully lifted out using special instruments.
Cleaning & Irrigation – The socket was thoroughly cleaned and flushed with saline.
Stitches – The gum flap was repositioned and sutured for smooth healing.
The entire procedure was completed successfully and the patient tolerated it well.
Post-Surgery Care
- The patient was given detailed instructions to ensure smooth healing:
- Do not spit, rinse, or use a straw for the first 24 hours.
- Apply cold packs on the cheek to reduce swelling.
- Eat soft and cool foods for a few days.
- Take prescribed painkillers and antibiotics regularly.
- Maintain oral hygiene with gentle brushing and warm saline rinses (after 24 hours).
- Return after a week for stitch removal.
Recovery & Outcome
At the follow-up visit, healing was found to be satisfactory. The patient reported:
- Relief from pain and food lodgment
- No post-operative complications
- Improved comfort while chewing
Key Takeaway
Wisdom teeth that are malpositioned or carious often cause repeated problems. In such cases, surgical removal is the safest and most effective option. Early treatment prevents damage to nearby teeth and keeps your mouth healthy.
If you are facing pain, swelling, or repeated infections from your wisdom tooth, don’t ignore itconsult your dentist early for the best solution.