Wisdom teeth: Where two is too many

With the impaction of wisdom teeth, I guess many of us will be troubled over what to do with them. Should we extract them or should we not?

The problems that I encountered with my impacted wisdom teeth started months ago. Periodically, there will be pain around the gum where my left lower wisdom tooth had impacted. I used to just ignore them, thinking that the pain is just a stepping stone to the full impaction of my beautiful pretty wisdom tooth. Pain will go away, someday, somehow. And indeed, time after time, I managed to conquer the inflammation!

Yet, the recurrence of this problem irritates me. Recently, at the beginning of July, the pain occurred again. I would use my fingers to probe the gum, checking to see if there will be enough space for the tooth to grow out nicely and beautifully. I guess this is when i introduced some bacteria into the inflamed gum. Three to four days passed and yet the pain remains, intensifying over the next few days. I told myself that I shall extract it as soon as possible as I do not have any more patience to bear with the recurring inflammation. I complained to Juzy (my uni friend) about this and she decided to help me to book an appointment at Orchard Q&M (near to my internship location) the next day. Since it was a rather sudden decision, I did not have much time to research on the available dental clinics and going through the polyclinics route may take too long a time which I am able to tolerate. 9th of July 2013, 4:30pm appointment it shall be.

On that faithful afternoon, I rushed off to Q&M Orchard with juzy (so nice of her to accompany me!) right after work. The clinic, as expected, was posh and elegant. The lady at the front desk was dressed professionally and was very polite. I had to fill in some particulars (since it was my first visit) before I was asked to wait for the dentist whom Juzy had made an appointment with.

Counsultation
He was a Caucasian, tall and rather charming. (At least that's what Juzy think of him haha). He took a few peeks into my mouth and analysed my teeth before having a short chat with him. He took down some history from me (e.g. when the pain started, which side etc.) He jokingly mentioned with a sneer that "yea yea yea, that's what most people think (that the pain will somehow disappear and hence not seek treatment)" in response to my delayed consultation. He mentioned that the problems will usually recur unless the tooth is removed. After which, I was sent for an X-Ray.

X-Ray
I was asked to put on a lead apron (to protect the rest of my body from radiation exposure) which was rather heavy. My head is then positioned with chin, forehead and side rests. There are come clamp-like things to fix my head in position. I was then asked to bite a bite blocker. If I'm not mistaken, Panoramic Dental X-Ray was done in this case. Throughout the whole procedure which lasted for less than a minute, I had to keep still while the x-ray tube rotates around my head in a semi circle.

 Here's a link for more information regarding Panoramic X- Ray: http://www.radiologyinfo.org/en/info.cfm?pg=panoramic-xray

Tada! This is the X-Ray of my teeth! So cool right!

Consultation (after the X-Ray)
Alright, so the left lower molar which was giving me problems is the one shown on the right of the X-Ray film. The left upper molar has also impacted but it has been rather obedient thus far! The dentist said that it would be better to extract the left lower molar since my jaw is not big enough to accomodate it. Otherwise, the pain/inflammation will recur. Judging from the upright position of my tooth, the extraction would be rather straight-forward and simple!

He also recommended me to extract my left upper molar since it is angled in a position which is detrimental to the one beside it. If infected, there would be a need to remove both the impacted tooth and the adjacent tooth. However, due to its awkward position and surgical intervention may be required.

I agreed to the removal of both the left lower and upper molars but the dentist decided that it would be better to book another appointment to do so after infection on the left lower molar had cleared.

Fees
I had to pay a total of $159 for this dental trip! How expensive!

I was prescribed with Amoxicillin ($6.60) for the infection. Panadeine ($22) for pain relief (which I did not consume after all). The consultation fee was $30. X Ray costs $80. There is an additional charge of $10 for sterilisation and disposables. (gasps). An appointment was then made on the 22nd of July for the extraction. My dad would be back by then so that I can claim the extraction fees via his Medisave!

Troubled
20 Jul 2013. The pain and inflammation had disappeared!All thanks to the antibiotics. In just one day away from the extraction, I started to have second thoughts about having it done at Q&M since it is sure going to be very expensive! I spent the whole night googling the possible clinics to have the wisdom teeth removed. I read forums, explored various websites of dental clinics to compare the prices and had come to the following conclusion:

1. Hospitals are not an option as i did not want to delay the removal of my wisdom teeth.
2. Q&M: services are good and the dentist seems rather confident but the high price is an issue.
3. Emailed Shenton Dental re their fees.
4. To ask Jamaica regarding the dental clinic she is working at! She had her wisdom teeth extracted there and the prices are much more reasonable!

I messaged Jamaica that very night to ask her more about the wisdom teeth extraction/surgery done by her clinic.

21 July 2013
Jamaica replied early in the morning, quoting me the prices and stuff to take note of. The prices are much more reasonable and there are no additional administrative charges (that Q&M would charge) if I were to claim from Medisave. She even agreed to book an appointment on my behalf with a senior dentist that she recommended! So nice of her! Since Sunday's appointments were fully booked. I decided to go for the 11am slot on Monday. Here are the rough estimates of the costs involved:

Q&M:
Extraction: ~$200-500 per tooth.
Surgery: ~$700-1000 per tooth
Administrative charges for Medisave claims: $21.40
Sterilisation and disposables: $10
Medications: $?

The downside of Q&M is that we have to pay the fees upfront while they process the Medisave claims. If approved, we will then be reimbursed with a cheque. The whole process may take up to three months. :/ I believe that the prices will be much higher as some paid around 800++ to 900++ per tooth (surgery) based on forum entries long before.

de Pacific Dental Group
Extraction: ~$80-120 per tooth
Surgery: ~$600-1000 per tooth
No administrative charges/sterilisation and disposables charges.
Medications: $?

Since the fees for de Pacific Dental is lower, this would be an obvious choice!!

22 July 2013: Off to de Pacific!
My dad drove me to de Pacific Dental since the branch that Jamaica is working at is all the way at Jurong West!! We reached the clinic at around 10:45am and had to settle some administrative matters. I was just a little bit nervous but other than that, I wasn't scared or absolutely terrified that I am going to have two teeth removed. There were quite a number of patients in the clinic at that time, maybe around 3. One of them was collecting his medications, the other had to do some X-Ray and the other was called in shortly after. Business seems rather good!

Consultation
At around 11:06, the dentist called me in! He is so nice and friendly! Such a far cry from what I expected: cold and lack of empathy behind his mask and blue gown. He apologized for having me to wait for so long before inviting me to take a sit! I showed him my X-Ray and had a short chit-chat session with him. He mentioned that as far as possible, he would not want to remove any tooth unnecessarily if they are not causing any problems (referring to my left upper molar). However, from the X-Ray film, it is shown that it has caused a slight resorption of the adjacent tooth, a situation he deemed as rare. He thus advised the removal of the left upper molar in view of further resorption that may occur. As for the left lower molar, since it has caused inflammation/pain for more than two occasions, it would be better to remove it since this problem is likely to recur again in future. (If it happened for one occasion only, he would advise for the monitoring of the situation.)

To me, I have already made up my mind to remove both the upper and lower molars. However, in view of the risks involved, he even wanted to speak to my dad to inform him of the procedure and risks involved! Nice! He went out of the room and called for my dad. However, my dad had left the clinic, possibly to buy some food to eat. Alright, I told the dentist that it is fine to speak to me individually and so he analysed the X-ray and procedures with me. He mentioned something about the bone and sinuses near the upper molar. There is a 2-5% chance that the bone may be drilled open and additional surgeries may be required to close it up. For the lower molar, due to the proximity of two nerves to the lower molar, there is a 1% chance that the nerve may be affected by the extraction, affecting the sensation of the tongue or something. I guess i was just too mesmerised by his professionalism and friendliness that I couldn't pay much attention to the details. hahaha. He added on mentioning that the lower molar is growing in such an upright position that it is so "wasted" to remove it even though it would make the procedure rather straight forward.  Sigh, if only my jaw is a little bit larger to accommodate this pretty tooth! Then he went on to discuss the medications that I would require and everything under the sun that I needed to know before the procedure. On seeing that I am so familiar with the drugs, he was rather surprised until I told him that I am studying in the Pharmacy school

The procedure
Then we started chatting about school, anatomy classes, physiology, his dental classes etc. It was so fun chatting with him as he would generously share his experiences with me. Meanwhile, he applied some blue minty paste on my gums which i suppose is a mild anaesthesia to numb the area before the injection of LA. Then came the injections! I couldn't remember exactly how many injections were needed. Maybe 2 at the top and 2 below.They felt nothing more than an ant's bite. He warned me that my lips, tongue and the gum will start to feel numb in a while. Indeed, I felt I was speaking so weirdly in just a few seconds! It felt like there was something stuck in my mouth or rather, like my mouth is half paralysed. As we continued chatting while waiting for the LA to take effect, I could feel the gradual loss of control of my saliva and my left facial muscles, I must have looked rather weird.

Shortly after, the dentist asked if I am ready! YES! I just can't wait! The dental assistant place a black cloth over my face, exposing only my mouth. I guess to spare me from looking at the scary instruments and stuff. The dentist pressed against my gum and asked if I could feel any pain. After which, I could feel some tugging here and there as he tried to pull my teeth out. A drill had to be used at some point in time for my lower molar. He pre-empted me of the drilling noise I was about to hear before he started the drills. I could hear the dental assistant saying that my tooth doesn't want to be pulled out. hahah! In just a blink of an eye, the tooth was out! (as declared by the dentist) I didn't even feel a thing! Then he proceeded on to the upper molar. It required much more effort compared to the lower molar. In a way, it is more difficult to have a good view of the upper molar and the weird angle it is positioned further adds to the complexity of the procedure.He had to pull it with much effort for quite a few times before the tooth finally gave way.

Overall, the surgery was painless! :D I kind of enjoyed the whole procedure as it felt like I was having some free massage of my gums hahaha!

After the surgeries, he had to stitch my gums. The stitch was hurting my mouth a bit due to the abrasion to the side of my mouth. Imagine a paper cut..Ouch! His actions were really quick! Before I knew it, the surgeries were over!! He showed me my teeth and asked his assistants to wash it up for me to bring them back home as souvenirs. I am sooo elated that both my teeth came out as one piece!

Half my wisdom's worth!

Exemplary service by the dentist!! He is so passionate about his work! :D Thumbs up! And thank you Jamaica for the excellent recommendation of this dentist!

Fees
Everything could be covered by Medisave and so we didn't have to pay a single cent. Both my teeth require surgery and so the fees were higher. The breakdown of the fees is as follows:
Wisdom tooth surgery: $600 x2
Metronidazole: $10
Naproxen Sodium: $5
Mouthwash: $6
Consulation: $15

I was also given an information leaflet of what to take note of post-surgery.

I am very satisfied with the service I received from the dentist! YAY!

I shall elaborate on the recovery process (post surgery) in my subsequent posts! :)