90 Second Wisdom Tooth Extraction Video

This post, featuring an HD video of a wisdom tooth extraction, is different from many previous posts. Instead of tackling a topic and answering questions via the written word, this post uses a YouTube video to answer questions regarding one of the more feared and dreaded procedures in all of dentistry: wisdom teeth removal.

This video was shot in my office and features a young, early 20s patient having a lower right impacted wisdom tooth removed under IV sedation. The third molar and sedation procedures are performed by me along with two assistants. Check it out here:

Having participated in the filming of dental procedures before, I will tell you that capturing high quality video footage is not easy. Camera angle, proper lighting, patient participation, etc. are all difficult to control. I can confidently say that this is very high quality video footage of a third molar extraction (click here to go directly to the video on YouTube).

This video does answer many questions and resolve many myths that I’ve seen in blog comments and in questions I’ve received over years of private practice. Let’s review them.

Does getting a wisdom tooth extracted hurt?
  • No. In the YouTube video, the patient was given local anesthesia (a.k.a. novocaine) beforehand. She does not flinch nor respond during the procedure. That is because she is numb and is also under twilight sedation.
Does the dentist have to put a knee on my chest to pull the tooth?
  • No. That is a popular myth that I debunked in this post. Extraction of a tooth requires the controlled, precise application of force. It rarely requires a pulling force. The tooth literally slides up and out of the socket – as you can see at the 2:00 mark of the video.
Will I be in pain for days after getting my wisdom tooth out?
  • Not necessarily. Each and every case is different. In this video, the extraction itself only took 90 seconds. So she had very little pain afterwards. Other third molars require more time and are more invasive. Those will likely be more painful afterwards.
What is an impacted tooth?
  • An impacted tooth is when bone, gums, and/or other structures prevent the tooth from coming into the mouth properly. Wisdom teeth are frequently impacted. In the YouTubevideo, we see a soft tissue impacted tooth, meaning that there was a flap of gum tissue preventing the tooth from coming in properly. Other teeth are considered bony impactions in which there is bone preventing the tooth from coming in completely. Bony impaction extractions are typically more invasive.

I hope you enjoyed the video and it helped to answer questions and dispel some myths. Comments are welcome.

What the heck is numbing jelly?

“Numbing Jelly” or Dental Topical Anesthesia.

I often ask my patients what they hate the most about a trip to the dentist, and a solid majority always says one thing: The Shot.  There are other things that patients do not like, and I even compiled an abridged list of things patients have told me they dread:

  • The sound of the dental drill.
  • The feeling of “too many things” in their mouth.
  • Being tilted back too far.
  • The thought of a “hole” being drilled into a body part.
  • The “suction thingy” (a.k.a. saliva ejector or spit sucker).
  • The spray of the water.
  • The taste of metal instruments.
  • Two individuals (dentist and assistant) staring into their mouth
  • And literally hundreds of other things…

All of these things are reasons why patients avoid the dentist.  However, based on my experience as a dentist, these items all pale in comparison to the administration of local anesthetic.  Local anesthetic is necessary for all types of dental procedures, including fillings, crowns, root canals, implants, etc.  It doesn’t matter whether you’re in Orange, CT where I practice or thousands of miles away, patients hate the shot!

Dentist and Needles | Topical anesthetic| West Hartford Family DentistryNot surprisingly, dentists and dental supply manufacturers have been identifying and developing techniques over the years to eliminate the pain and fear associated with the local anesthesia injection.  Perhaps the biggest and most significant development was the introduction of narrow diameter disposable needles.  Prior to the 1950s, the needles used were much larger in order for them to be able to stand up to multiple sterilization cycles. I’ve had many older patients who experienced dental procedures back in the 1940s who described these as “horse needles.” Now we use much narrower disposable needles.  I will cover the history of dental needles in a future blog post.  But regardless, a needle is still a needle!

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Redhead Dread

Do redheads dread a trip to the dentist?

Redheads dread the dentist due to resistance to local anesthesia

Redheads. Image courtesy The New York Times

When I stumbled across this article in the New York Times back in 2009, the conclusions seemed eerily familiar.  In my own personal experiences as a dentist in Orange, CT and elsewhere, patients with red hair seemed to be more apprehensive regarding dental care, and also seemed to have the dreaded “well, it looks like you’re not quite numb enough with the first shot, let me give you a bit more” phenomenon occur to them with much greater frequency than patients with darker hair and complexions.

As much as I would like to delve into the true scientific details, those facts go beyond the scope of this post.  But to summarize, redheads have a mutation (basically a change in their genetic makeup) that produces red hair and fair skin.  But that same mutation also affects receptors in the brain that govern pain perception.  Although the exact mechanism is not quite fully understood, studies show that redheads have resistance to lidocaine.  Lidocaine is the most commonly used dental local anesthetic used in the United States. Chances are, when you visit the dentist, and get “The Shot”, you are receiving lidocaine.

So if redheads have resistance to lidocaine, then they are more likely to feel pain during a dental procedure.  But does that translate into more dental anxiety?  Of course.  You don’t need published research to reach that conclusion!   However, in medicine and dentistry, we do like to have our conclusions backed up by sold research.  A 2009 article by the Journal of the American Dental Association did confirm that redheads have “increased dental-care anxiety” and exhibit “avoidance of dental care.”

As a practicing dentist, I always look at research and then ask myself how the findings apply to my patients, either past, present, or future.  This is true not just with this specific research finding but with all the developments that are continuously occurring in dentistry.  A lot of research doesn’t immediately apply. However, this is one case in which the findings have immediately impacted how I approach my patients – specifically patients with red hair.

Lidocaine also known as xylocaine is a dental local anesthetic used in the United States

Dental Carpule of Lidocaine with epinephrine. Redheads have a documented resistance to Lidiocaine.

No dentist is perfect and can get 100% of the patients 100% numb with the first injection.  Any dentist that claims that is lying. There are too many factors that come into play.  As a dentist, it is tempting to find something or someone to blame when your patient does not get numb with the first injection.  Blame the assistant!  The anesthetic must be expired!  The patient moved!  The sun was in my eyes!  The sun was in the patient’s eyes!  It was a full moon last night!  This happens to all dentists and to all patients – independent of hair color.

However, upon thinking back on my own patients who were “tough” to get numb, a disproportionately large percentage had red hair and fair skin.  These patients seemed to require 2 to 3 injections to get numb.  Another observation is that these patients always knew they would need more.  They were the first ones to say “Hey doc, I always seem to need 2 or 3 shots every time I get a cavity filled.”  But they never knew why they needed more local anesthetic.

In my experience, if you know a patient is going to be a challenge to effectively anesthetize, administering extra local anesthetic right off the bat is the best solution. The patient appreciates it.  The second injection, if done properly, will rarely hurt, and will almost guarantee that the patient does not feel any part of the procedure. Since this article was published in the New York Times in 2009, I’ve told numerous redheads about it.  Upon telling them, they nearly universally have an expression of “Wow!! Now I finally understand why I’ve always felt pain and dreaded coming to the dentist.”  And from then on, their fears are reduced, permanently.

So how do we approach redheads who avoid care because of past negative experiences?  This is a lot more challenging! Most redheads are unaware that their genetics are pre-determining them to have more pain in the dental chair (unless more local anesthesia is administered).  So they must be informed of this. Simply informing anxious patients of this genetic phenomenon and how we address it is enough for many patients.  More severe cases of dental anxiety require different approaches.  I have training in sedation dentistry which has allowed me to treat patients who have moderate to severe dental phobias. This has allowed me to personally treat hundreds of patients too scared for “regular dentistry.”  But unfortunately, very few dentists have the training, equipment, and staff to do sedation dentistry safely. I will try to describe other techniques in a future blog post.

Many redheads still do dread the dentist, but now they don’t need to anymore.  There are many dentists out there equipped with this knowledge helping redheads overcome their anxieties, one patient at a time.