Nothing but the Tooth column: Picking the right time for a tooth extraction
Columns share an author’s personal perspective.
Q: My name is Kaci and I live in L.A. County which is currently a hotspot for COVID-19. I have a wisdom tooth removal scheduled for next Friday. The tooth is my bottom right molar. The tooth has never really caused pain; it’s just uncomfortable because of its position. It’s fully erupted and has been filled before. Lately I’ve been clenching and grinding my teeth and the tooth gets in the way of my cheek so I’ve been getting a lot of biting and irritation on that side. Again, nothing that’s been causing me great pain, just irritation. Should I move forward or wait to be vaccinated?
A: I would first answer the question of whether or not to extract at all. As you state, it is not the tooth itself that bothers you but rather the position that is uncomfortable in that it is causing you to bite your cheek. I completely relate to that as it has happened to me as well as to many patients that I have seen through the years.
If your upper wisdom tooth present, it is the position of the two when they come together that is trapping your cheek. Sometimes the upper wisdom tooth does not deflect or push the cheek out of the way when you are biting. If this is the case, it might be possible for a dentist to do some prudent adjustment of your upper or lower tooth by cutting some of the enamel. As long as the enamel is not removed completely in this adjustment, there will be no problems. If the enamel is adjusted or shaved too thin, you could have sensitivity but your dentist should be able to advise on whether this might be a problem.
Another solution, if it is the upper tooth that is trapping your cheek against the lower tooth, is to extract only the upper wisdom tooth and leave the lower erupted and filled tooth. The reason here is that it is usually much easier to extract upper wisdom teeth than lowers. Extraction of lower thirds or wisdom teeth can be accompanied by much more post-operative pain and possible swelling.
It is also possible that the upper tooth is not present and you still are trapping your cheek. If this is the case then extraction of the lower tooth is the proper treatment.
Whether you choose to do the extraction during these COVID times is completely up to you. You have to evaluate how much of an annoyance the cheek biting is. Most dental offices are properly equipped to deal with coronavirus. Sanitizing dental offices has been done for many years prior to this pandemic and now, additional measures have been added in all operating dental offices. These measures will decrease dramatically the possibility of the virus affecting you. But, as I am sure you are aware, untoward or unpredictable situations can occur. Sadly, health treatment is often not a perfect science. For this reason, I personally would not do the extraction until you are vaccinated. This of course assumes that you can manage the biting of your cheek until this occurs. If you cannot tolerate it then I would discuss the COVID-19 precautions that your chosen dentist has taken. At that point you will be ready to make the decision as you see fit.
I hope my remarks have clarified the possible treatment options to allow you to make a comfortable decision. I wish you the best in these troubled times.
Dr. Richard Greenberg of Ipswich practiced dentistry for 45 years after having attended dental school at Columbia University, where he was later an associate clinical professor of restorative dentistry and facilitator of the course of ethics. Do you have a dental question or comment about the column? Email him at email@example.com.