Wisdom teeth removal in Costa Rica

Many wisdom teeth have no room: they stay trapped in the bone or partly through the gum, where they can get infected or damage the neighboring molar. Others are healthy and can stay, with regular check-ups. Before deciding, I measure where each one sits, how it is tilted and how close the nerve runs. I am an oral and maxillofacial surgeon (UNAM), certified by the Mexican Board of Oral and Maxillofacial Surgery, and I see patients in Tower 1 of Hospital CIMA.

Imaging

Panoramic X-ray; CT if a root is near the nerve

Anesthesia

Local; sedation depending on the case

Hardest day

Usually the first

Consultation

60,000 colones · by video, 20,000

When it's indicated

• Pericoronitis (infected gum over the tooth) that comes back; a first, mild episode is usually not enough.
• Decay that can no longer be fixed, or a nerve or root infection that cannot be treated.
• An abscess, cellulitis or osteomyelitis (bone infection).
• Resorption of the wisdom tooth or the neighboring molar, or a fractured tooth.
• A cyst or tumor around the wisdom tooth.
• It is in the way of jaw surgery, such as orthognathic surgery, or of a tumor treatment.

Before surgery

• If you already have a panoramic X-ray or CT scan, bring it or send it ahead; we can review it first by video.
• Bring a list of your medications. If you take blood thinners, don't stop them on your own: stopping is associated with a higher risk of blood clots. I coordinate with your doctor.
• Tell me if you take bisphosphonates (osteoporosis drugs) or have a weakened immune system: in those cases the plan is coordinated with your doctor.
• If you smoke, stop before surgery and while you heal: dry socket is more common in smokers.
• If we use sedation, follow my written fasting instructions and come with someone: you can't drive that day.

How I plan it

How I do it

1. 01ConsultationI review your imaging, health and medications, and explain which teeth to remove, which to monitor, and why.
2. 02AnesthesiaLocal and, if we agree on it, sedation. You feel pressure and movement; if you feel pain, tell me and I add more anesthetic.
3. 03Removal and closingI open the gum and, when needed, remove bone and divide the tooth to take it out in pieces; then I clean and close with stitches. The technique depends on the tooth's position and how close the nerves are.
4. 04Instructions and follow-upYou leave with written instructions and a follow-up appointment. Antibiotics are not routine: I decide based on your health and your risk. While you recover, you can message me.

Recovery

• The first day is usually the hardest; after that it generally keeps improving.
• Pain, swelling and difficulty opening your mouth are expected and temporary; in one study, about 94% had mild to moderate swelling.
• Cold packs outside for the first few hours, soft food, gentle hygiene, and the prescribed medication on schedule.
• To protect the clot: no smoking, no forceful spitting, no straws and no vigorous rinsing.
• If your lip or tongue stays numb, let me know: in a large study, by the end of follow-up 67% of lip cases and 72% of tongue cases had fully recovered; follow-up can take months.

Risks and how I prevent them

Lip and chin numbness

It involves the inferior alveolar nerve, with lower wisdom teeth. In a review of 44,171 impacted lower wisdom tooth extractions it was temporary in 1.20 out of 100 and did not recover in 0.28 out of 100; depending on the study, nerve injury is reported between 0.35% and 8.4%. That is why I measure first and, if the root is pressed against the nerve, suggest a coronectomy or monitoring.

Tongue numbness

It involves the lingual nerve. In a study of 4,338 extractions it occurred in 0.69%; injury that does not recover ranges from 0.07% to 0.28% by technique, so I choose the technique for your case.

Dry socket

The clot is lost: severe pain that usually starts between day 1 and day 5, sometimes with bad breath. It happens in about 6.7 out of 100 impacted lower wisdom tooth extractions. Smoking makes it more common: in a review of extractions in general, 13.2% in smokers vs. 3.8% in non-smokers. If it happens, message me so I can check it.

Infection

Preventive antibiotics may reduce it, but 18 to 19 people must take them to prevent one infection, so I decide based on your risk. Keeping and removing the tooth both carry risks: the most reported causes of wisdom-tooth hospital admissions include pericoronitis and infections after removal.

Bleeding

With newer oral blood thinners, bleeding after mouth procedures was similar whether people continued them (11.8%) or stopped them (13.5%), and in those studies all of it was controlled with local measures.

If a coronectomy is done

The roots left behind often shift (13% to 85% depending on the study) and, depending on the review, 2.2% to 3.63% needed another surgery. It is followed with X-rays.

Other options

Not operating, and monitoring

For an impacted tooth that is healthy and trouble-free, a Cochrane review finds not enough evidence to choose between removing or keeping it, and the UK's NICE guidance recommends against preventive removal: we check it at regular visits. Very low-certainty evidence suggests keeping it may be associated, in the long term, with more gum problems on the neighboring molar.

Coronectomy

If the root is pressed against the nerve, I remove only the crown. In observational studies it can reduce nerve injury and dry socket compared with full removal.

First episode without surgery

A first, mild episode of pericoronitis is treated locally. If it comes back, we talk about it.

Frequently asked questions