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17-08-2010, 00:55   #1
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Impacted (lower) wisdom tooth

I have an impacted wisdom tooth which, up until about a month or 6 weeks ago, hasn't caused any problems. However, in the last 6 weeks I've noticed a bad taste (and smell) in my mouth and it turns out I've an abscess on my tooth. I'm on antibiotics on the moment for the infection and have been referred to a specialist to take a look at the tooth before it's extracted- my own dentist can't take it out because it's quite badly impacted.

However, I had the same issue last year (except it turned out I had an infection around the tooth for at least 2 years - hadn't been picked up by the dentist) and after the abscess flared up really badly once I was referred to the specialist who, after x-raying the tooth, decided to extract it. No problems with the extraction, etc. even though it took over 30 minutes, but during the procedure I was chatting with the specialist who told me that they have a policy of leaving the tooth if at all possible, and that they wouldn't have extracted my tooth as it had only flared up once except it had cavities underneath the gum.

Now I know every dentist is different and each has their own procedure (and I completely accept that), but if I go to this specialist and they decide that because my tooth hasn't caused any 'major' problems (apart from the infection) they'll leave it for another while, do I have any say in asking them to extract it now rather than a few months down the line when it flares up again? I suffered months of ill health and low energy levels as a result of a suppressed immune system which stemmed from the (granted, undiagnosed and hence untreated) abscess, but haven't been ill since (not even a cold). However, I can feel the onset of the same symptoms starting again now and would prefer to have the tooth extracted now rather than a few months down the line when I'll be back to square one with my health and I would really rather not go down that road again having spent the last year or so building up my health.

I know it's difficult to comment on the situation without actually examining the tooth, but any help/advice would be appreciated. Thanks.
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17-08-2010, 01:24   #2
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Hi covert
Sorry to hear bout your ill health, my brother had one of these and went to budapest to get it removed, and was very luck, the tooth had begun to turn in the gum and was about to protrude out through the side of his gum, he was awake getting the tooth extracted, The dentist hired a surgeon to extract the wisdom teeth, was 2 hours in the chair for impacted one alone, but the others were a lot more straight forward 3 wisdom teeth out in an hour, done over 2 trips. the dentist was very professional, he was told he would have to wait 5 years on medical card over here, he would have suffered desperately if he waited. Instead cost him €140 for impacted wisdom tooth extraction, and €100 each for 3 other non impacted wisdom teeth. Some people might not be able to cope with getting extractions while awake, but you heal a lot quicker. If you need any details of dentist just pm me. best of luck
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17-08-2010, 18:53   #3
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The cost of going abroad for a surgical extraction is ludricus, it only costs about 300 euro to have a surgical extraction with a specialist oral surgeon in dublin city center. and maybe 550 for one surgical a 3 non surgical making a saving of only 110 euro, then you get tax back....not worth the hastle IMHO.

Also best go to a specialist oral surgeon, who will not take 2 hours on an impacted tooth (totally incredable ammount of time BTW even the most difficult impaction would take an experianced oral surgeon about 30 mins tops)

There are risks of nerve damage with impacted lower sidom teeth, so your surgeons advice is caution and wise. Unless its causing persistent problems leave it be.
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17-08-2010, 21:04   #4
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Hi Fitz
€550 for the 3 wisdom teeth to be extracted, if this option was made available i'm sure he would have availed of it. But I guess the dentist he attended assumed that he would take her advice and just go for it like a sheep, incurring a cost of €1500 euro. Its assumed that this proceedure under general anesthetic is the only one available I don't think your been realistic when you say the impacted tooth would be removed in half an hour, its not a proceedure i would like to have a dentist with a scalpal in his hands rushing through, their were unforessen complications the tooth had moved and being stitched up and monitored for a 30 mins period afterward. She was careful as there are alot of nerve endings in the part of the gum, but the only one i have hear of making a botch job of it where they lost feeling was by an irish dental surgeon. I have read some of you post and i understand you are the professional
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17-08-2010, 23:05   #5
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OK let's clear up some things here, because this thread is going down a road of myth and heresay.

Fitzgeme and I are trying to encourage an evidence base to be used here in discussions.

In Ireland, most surgeons will use the NICE guidelines which are published by the National Institute of Clinical Excellence based on the best available evidence. These guidelines are designed for the public health system in the UK and so are governed by several factors including a risk/benefit analysis. So they would look at all of the available data for wisdom teeth extraction published in the literature and decide when the best time is to have the wisdom teeth extracted based on the level of morbidity/mortality, nerve damage and other post-operative complications. They put the data through some statistical analysis algorithms and came to the conclusion that the best time to extract wisdom teeth given all the variables is after two bouts of pericoronitis, which is an infection that commonly affects the soft tissue around wisdom teeth that are partially erupted. This infection is acute.

Some surgeons use the NICE guidelines as what they are - guidelines, not hard and fast rules. Sometimes you see a wisdom tooth that clinical experience will tell you is going to cause problems, most usually because it cannot be cleaned properly by the patient. However, there are some wisdom teeth that appear to be badly impacted that never give problems. In the US wisdom teeth are generally extracted in most patients before they fully develop.

Wisdom Teeth Guidance

There is no evidence that I am aware of that pericoronitis (which is most likely what the OP was suffering, not abscess, which is an acute infection associated with much pain and swelling. This is not something that would go on for several months without treatment) would cause a decrease in the immune response, if anything the opposite. I do know that recurrent tonsillitis can cause kidney disease in very rare cases, but that is not the case with wisdom teeth infections.

To answer your question OP, you can request that the surgeon remove your wisdom tooth. It is your right to decide what you want to do. Your surgeon may also refuse to do this, as is his right. You will be able to find a surgeon who will do it for you.

As far as some of the so called facts stated here, the current waiting time in the public system for wisdom tooth removal is about 18 months not 5 years. The average amount of time it takes a skilled oral surgeon to remove a wisdom tooth is between 15 and 30 minutes. Evidence suggests that the quicker the surgery the quicker the healing afterwards, and the less post operative complications. 2 hours is ridiculous for a single wisdom tooth surgery.

There is no difference in healing between being asleep or awake. The surgery may go more quickly if you are asleep. Nerve damage is rarely a 'botch job' it is a risk of all lower wisdom tooth removal.

And by the way clancyoo, your brothers dentist charged more than most Irish dentists would for the same treatment. And I doubt he was a specialist (two hours for impacted wisdom tooth removal, really?). I charge 80 euro for non-surgical extraction and 120 for surgical extraction. I rarely extract lower wisdom teeth that are impacted, I send the patients to the oral surgeon for this treatment.

Last edited by Big_G; 17-08-2010 at 23:06. Reason: spelling
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17-08-2010, 23:47   #6
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Originally Posted by fitzgeme View Post
The cost of going abroad for a surgical extraction is ludricus, it only costs about 300 euro to have a surgical extraction with a specialist oral surgeon in dublin city center.
I'm not planning on going abroad to have the tooth extracted - I don't have the time and I'm quite happy with the oral surgeon who extracted my wisdom tooth the last time.

Quote:
There are risks of nerve damage with impacted lower sidom teeth, so your surgeons advice is caution and wise. Unless its causing persistent problems leave it be.
At the moment my face is swollen, my gum is bleeding and swollen, there's an awful taste in my mouth... For the moment the pain is gone (thanks to antibiotics and pain killers), but my dentist has recommended it be extracted as it will only cause further problems, hence my referral to a specialist.


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Originally Posted by clancyoo7 View Post
I don't think your been realistic when you say the impacted tooth would be removed in half an hour, its not a proceedure i would like to have a dentist with a scalpal in his hands rushing through, their were unforessen complications the tooth had moved and being stitched up and monitored for a 30 mins period afterward.
In fairness, to fitzgeme, 30 minutes 'extraction' time is what I experienced the last time. However, the total time I was with the dentist was probably a bit more than an hour as I had to have x-rays, a discussion with the dentist re my options, another while to wait for the anaesthetic to take effect, and then I had stitches, a chat about after care and what to expect for the healing process, etc.

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Originally Posted by Big_G View Post
OK let's clear up some things here, because this thread is going down a road of myth and heresay.

Fitzgeme and I are trying to encourage an evidence base to be used here in discussions.
I didn't think I'd gone down the route of 'myth and hearsay' - anything in my post was based on the consultation I had with a specialist last time I had an impacted wisdom tooth extracted, and felt this was necessary background info. for asking advice here. I didn't want it to appear that I was just being awkward or presumptuous.

Quote:
In Ireland, most surgeons will use the NICE guidelines which are published by the National Institute of Clinical Excellence based on the best available evidence. These guidelines are designed for the public health system in the UK and so are governed by several factors including a risk/benefit analysis. So they would look at all of the available data for wisdom teeth extraction published in the literature and decide when the best time is to have the wisdom teeth extracted based on the level of morbidity/mortality, nerve damage and other post-operative complications. They put the data through some statistical analysis algorithms and came to the conclusion that the best time to extract wisdom teeth given all the variables is after two bouts of pericoronitis, which is an infection that commonly affects the soft tissue around wisdom teeth that are partially erupted. This infection is acute.

Some surgeons use the NICE guidelines as what they are - guidelines, not hard and fast rules. Sometimes you see a wisdom tooth that clinical experience will tell you is going to cause problems, most usually because it cannot be cleaned properly by the patient. However, there are some wisdom teeth that appear to be badly impacted that never give problems. In the US wisdom teeth are generally extracted in most patients before they fully develop.
As I mentioned in my above post, I am aware that these guidelines exist (the oral surgeon I attended was very open and informative about all the guidelines and explained them clearly to me) and I am not questioning them or their accuracy.


Quote:
There is no evidence that I am aware of that pericoronitis (which is most likely what the OP was suffering, not abscess, which is an acute infection associated with much pain and swelling. This is not something that would go on for several months without treatment) would cause a decrease in the immune response, if anything the opposite. I do know that recurrent tonsillitis can cause kidney disease in very rare cases, but that is not the case with wisdom teeth infections.
Having attended my dentist on two occasions regarding this wisdom tooth, I have been diagnosed with an abscess on my wisdom tooth (I was initially diagnosed with severe pericoronitis). It showed up clearly in the x-rays that were taken before I was treated. It was the same on the last wisdom tooth I had extracted. I had to go through two courses of antibiotics before the oral surgeon would attempt to extract the tooth.

Quote:
To answer your question OP, you can request that the surgeon remove your wisdom tooth. It is your right to decide what you want to do. Your surgeon may also refuse to do this, as is his right. You will be able to find a surgeon who will do it for you.
Thank you. This is all I needed/wanted to know before my appointment.
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18-08-2010, 00:48   #7
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Originally Posted by convert View Post

Now I know every dentist is different and each has their own procedure (and I completely accept that), but if I go to this specialist and they decide that because my tooth hasn't caused any 'major' problems (apart from the infection) they'll leave it for another while, do I have any say in asking them to extract it now rather than a few months down the line when it flares up again? I suffered months of ill health and low energy levels as a result of a suppressed immune system which stemmed from the (granted, undiagnosed and hence untreated) abscess, but haven't been ill since (not even a cold). However, I can feel the onset of the same symptoms starting again now and would prefer to have the tooth extracted now rather than a few months down the line when I'll be back to square one with my health and I would really rather not go down that road again having spent the last year or so building up my health.
i think this is the bit that big_g is referring to, there's a place in westport that can sort this out for you. bring cash. and crystals.
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18-08-2010, 14:14   #8
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OP I wasn't referring to you when I said myth and heresay but Clancyoo, who really needs to get the facts straight. Sorry if that was misunderstood.
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18-08-2010, 14:23   #9
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Ok. thanks for the clarification. I misinterpreted your post and felt some of your points were directed towards me.
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18-08-2010, 14:53   #10
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I am talking about the south west of Ireland which there is a waiting list of 3 -5 years to be exact. There is only one oral surgeon attending to patient's on the medical card for Munster, this is according to the dentist he attended, you said yourself you would not touch a impacted lower wisdom tooth and he was told the exact same thing by his dentist, so your quoting prices that realistically have not hope of getting. I am not getting into a debate about foreign dental work, because like i mentioned earlier i have read a number of post on this topic here on boards, and its a bit of a sore subject amongst some of the dental profession subscribed to boards, I hope what ever happens convert will recover soon.

Last edited by clancyoo7; 18-08-2010 at 15:01. Reason: spelling
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18-08-2010, 15:15   #11
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Originally Posted by clancyoo7 View Post
Sorry to hear bout your ill health,
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I hope what ever happens convert will recover soon.

Thanks for your replies, clancyoo7. I don't have the option of going abroad, but thankfully I've put some money aside so I can pay for the extraction. Thanks for your good wishes - hopefully it'll go smoothly enough and I'll be back to normal in no time!
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18-08-2010, 23:37   #12
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Originally Posted by clancyoo7 View Post
I am talking about the south west of Ireland which there is a waiting list of 3 -5 years to be exact. There is only one oral surgeon attending to patient's on the medical card for Munster, this is according to the dentist he attended, you said yourself you would not touch a impacted lower wisdom tooth and he was told the exact same thing by his dentist, so your quoting prices that realistically have not hope of getting. I am not getting into a debate about foreign dental work, because like i mentioned earlier i have read a number of post on this topic here on boards, and its a bit of a sore subject amongst some of the dental profession subscribed to boards, I hope what ever happens convert will recover soon.
Again not true for Munster. There are at least two centres for wisdom tooth removal, the Regional Hospital in Limerick and UCH Cork and the waiting list is not near 3 years yet. I am quoting the prices that I charge for those procedures, I think I would know what they are. You're better off not getting in to a debate about foreign dental work.
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12-07-2012, 19:24   #13
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Hi, my daughter who is 18 was today told she has to have all 4 wisdom teeth removed under GA. I can't afford the money mentioned. She has a GP card but no medical card. How long would the wait be if she went public. How does one get on the NTPF. If I got VHI for a year for her would it be considered a pre-existing condition or could she get it done after the six month waiting period. Thanks.
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12-07-2012, 22:44   #14
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Quote:
Originally Posted by maude6868 View Post
Hi, my daughter who is 18 was today told she has to have all 4 wisdom teeth removed under GA. I can't afford the money mentioned. She has a GP card but no medical card. How long would the wait be if she went public. How does one get on the NTPF. If I got VHI for a year for her would it be considered a pre-existing condition or could she get it done after the six month waiting period. Thanks.
Why does she need to have these removed?? Is there any pain/ infection/ decay/ pathology etc etc...? Also why does this need to be done under GA?? GA is not necessary for the majority of wisdom tooth removals, IV sedation is cheeper, quicker, more comfortable and has less morbidity and mortality than GA.

To answer your questions;
The money mentioned was probably e1800-e2000 for treatment under GA, you could have this treatment under IV sedation for less than half that.....

Afaik you could be referred to a maxfax unit and following a 18-24 month wait, have this treatment on the public system....

The dublin dental hospital is a little different and does charge patients who have no medical card and have a 2 year wait approx....

To qualify for the NTPF, you need to have been assessed publicly and if then waiting for 6 months (I think), the ntpf will pay to have the treatment done privatly. Problem is that most of the wait is for the initial assessment....

If you get private medical insurance. They ask when you first had signs or symptoms, when you first attended your doctor/dentist about this and when you were made aware of the need for this treatment.... So they would likely class this as a pre-existing condition and not cover it.....

Good luck,
OS
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12-07-2012, 23:31   #15
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She has had lots of bother with infections etc during the year, her father and all her aunts had the same problem and had them removed. There is overcrowding too and tension caused in the teeth. I'll ask my dentist more questions tomorrow and see if he sheds more light on it for me. Thank you for all your help.
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