I can answer your questions....
Erupted upper wisdom teeth that are so far back that they are not being utilized for chewing purposes are prone to decay and periodontal disease because they are very difficult to keep clean. Removing them is usually simple and you would not miss them because you are not using them. Leaving them in predisposes the second molars to decay in between them and the second molar.... again, cleaning that area is difficult. Sometimes the decay on the second molar cannot be accessed until the wisdom tooth is removed because there is no room to angle the drill or even see what you're doing to place the filling.
If #18 is abscessed, it is imperative to have it removed because it can infect that entire area of the jaw and beyond.
As for placing bone graft material in that socket.... that is done to help encourage new bone growth to help preserve some of the bone height meaning when a tooth is removed, there is a minimum of 50% bone loss that is basically non restorable without the bone graft. The loss of bone can have a negative affect on the side of the first molar that is next to tooth #18. The difference in bone graft material varies on the manufacturer... some are derived from pig, cow or cadaver... synthetics are derived from calcium phosphate or hydroxy apatite. The big difference is the way the body utilizes the grafting material... the Alloplasts (synthetic) take a bit longer to work as opposed to the Allografts (cadaver) or Xenografts (animal). The bone is placed directly into the bony socket... a collagen membrane is placed over the graft and the gum is sutured closed. It is not irritating to the gum.
Regarding the choice of anesthesia for the extraction and grafting.... if you chose to be asleep, it is a twilight sedation of which you feel and remember nothing. You also wake up fairly easily afterwards. A local anesthetic is also used with this sedation and you would be very numb for a few hours. If you chose not to sedated, you would be profoundly numb for the procedure and for several hours after wards. You could also consider oral sedation with some valium or xanax taken the night before and the morning of the surgery which helps to take the edge off. A local anesthetic would still be used and again you would be very numb.
I hope this information is helpful to you... all the best!
Originally Posted by lin14534
Went to the OS for a consult today. Upper wisdom teeth are in and bottom wisdom teeth are impacted. Went for consult because #18 molar has an abscess with bone loss and regular dentist thought that there was infection around the wisdom tooth also. After OS did another set of xrays, he said no infection or cyst around wisdom tooth so it does not need to come out (thank goodness). His advice was to pull #18 molar, clean out infection, and do bone graft using cow bone ? or synthetic material. Am I understanding right, he pulls the tooth, cleans out the area and packs in this synthetic material and sews it together so there is no worry about dry socket? Also, what is the synthetic bone material made of and is it safe to have in your gums? He also suggested that since he saw a small cavity between an upper tooth and the wisdom tooth that I should probably pull both upper wisdom teeth also. Why would I do that if they've grown in straight and have no infection around them? That doesn't make sense to me. Also I don't want to be put out for the molar extraction and bone graft...is that a bad decision? Thanks for all your help and your knowledge.