0Just came back from National Dental Center after removing all my wisdom teeth... Yes... All four of them in a go. Now I think I'm looking like a panda. =P
Went for my usual dental checkup last year and took an xray as I was having some swelling at the back of my mouth. The xray revealed a partially erupted tooth on the left lower jaw and an horizontal impacted tooth on the lower right hand jaw. There wasn't any pain but was recommended to take both out to prevent further complications such as decay or pushing the lower jaw teeth together.
Rang up Queenstown Polyclinic (Note: You might have to ring a lot of times as there's only one person attending the phone and the reception.) Initially, they scheduled an appointment that's five month later! But after explaining to them that I'm going for a wisdom tooth checkup, they gave me an earlier schedule that's three weeks later.
Purpose of heading down to a polyclinic? Referral letter of course! Trust me, it's worth the trip... You will know why later....
Went down to National Dental Center for my first appointment. After taking another xray, I scheduled my wisdom tooth removal on 9th January 2009. There are three choices of anesthetic methods, local anesthesia, sedation and general anesthesia.
Initially I opted for GA as removing all four wisdom teeth sounds really scary to me. But after the doctor explain the procedures that GA will need to put a tube thru your nose to help breathing, fasting before operation and injection thru the wrist blahblahblah.... I got even freaked out. He was also explaining the increase risk of GA that low percentage of patient can be sensitive to anesthesia and could have more complications.
Sedation on the other hand is also using anesthesia injected thru the wrist and has the same risks as GA.
After weighing the risks and knowing that the technology nowadays is quite advance. I chosen local anesthesia.
The doctor who consulted me on my first consultation was allocated to be my surgeon. But after some consideration, I decided to be more "kaisu". I called up NDC to find out on the days where the senior surgeons are on duty. Monday morning, they said. Hence, I rescheduled my appointment to 19th January 2009, Monday morning. As a subsidized patient, I was not allowed to chose my surgeon.
Two senior surgeons were on duty, I was aiming for Mr Raymond Peck. But I was allocated Mr Asher Lim. Not too bad, both were consultant level.
Firstly, they will bring you to a dressing room where you put your bags in a locker. they will pass you the patient robe, hair cap, footwear cover.
Then they will show you to the operating room. The doctor will apply numbing cream before injection and inject anesthesia on multiple areas of your gums. Boy... The injection is pretty painful even though my pain threshold is pretty ok.
I had four areas that requires multiple injections, hence, I cant feel my lower jaw and my tongue feels numb even almost two hours after surgery.
After injection, the nurse will clean your face and mouth and put surgical robe and cover your eyes. The nurse also assure and explain to me that the doctor will be placing surgical tools on my chest and I will hear drilling sounds and pressure on my teeth.
The doctor starts with the wisdom tooth that requires the most effort to be extracted. My eyes were covered throughout the surgery but I could still feel the drilling and sawing of the teeth and pressure of twisting and extraction of the tooth.
The lower right hand tooth took the longest to be extracted as it requires cutting the tooth into two. The other teeth were pretty cooperative and came out pretty well. I didn't feel much when the doctor was taking out my left lower wisdom tooth and stitched it up already! Total time taken was around 45 mins.
After surgery, they guided me to the recovery area where the nurse will explain to you post surgical care procedures and how to take care of the gum area for the next few days.
I was pretty impressed with NDC, everything was quick and smooth. Sufficient information is all printed and given to me.
Typing out the patient information for impacted wisdom teeth surgery as follows:
Wisdom teeth (third molars) are the last of the molars to erupt between the ages of eighteen and twenty-four years. They may erupt normally into correct alignment and function or conversely are impacted.
Impacted wisdom teeth occur when they are prevented from complete eruption due to lack of space, obstruction or development in an abnormal position. They are often indicated for removal because of pericoronitis ie an infection of the gum overlying the partially erupted tooth, tooth decay and an increased risk of tooth decay and gym disease (leading to bone loss) in adjacent teeth. Less commonly, it is removed to prevent possible cyst formation and orthodontic problem in later life.
Impacted wisdom teeth surgery involves making an incision through the gum, removal of bone and/or sectioning of the tooth into smaller fragments to facilitate its removal. After the operation, it is common to experience pain, facial swelling, limitation in mouth opening, bruising and mild bleeding from the operation wound for three to five days.
The following is a list of known risks and complication, which can occur whenever surgery in any form is undertaken:
- Prolonged pain.
- Prolonged bleeding.
- Prolonged swelling due to oedema or blood clot.
- Prolonged period of disability (eg limitation in mouth opening).
- Acute / chronic / local / general infection.
- Medical problems arising during the post-operative recovery period.
- Unrecognised co-existing condition which requires additional unplanned surgery.
If a general anaesthetic is required to carry out the surgery, it is a separate medical procedure administered by a medical specialist known as a anaesthetist. This procedure has it own inherent risks which includes rare and unpredictable death.
The following is a list of known risk and complications associated specifically which impacted wisdom teeth surgery:
- Injury to adjacent teeth / hard / soft tissues.
- Numbness of the lower lip, chin and/or tongue (neurological dysfunction).
- Dry socket (alveolar islets).
- Bone infection (osteomyelitis).
- Radiation-induced bone infection (osteoradionecrosis) if you have received previous radiation treatment to the head and neck region.
- Jaw fracture.
- Presence of foreign body in surgical site eg broken instrument.
- Presence of portion of tooth intentionally left in socket.
- Presence of portion of tooth unintentionally left in socket.
- Displacement of tooth, tooth fragments or foreign bodies into adjacent anatomical sites (eg airway, gastrointestinal tract (gut), maxillary sinus, inferior alveolar canal, infratemporal fossa and adjacent soft tissue).
- Unnatural communication with the nasal or sinus cavity (oro-antral / oro-nasal fistula formation),
- Pain or discomfort (symptoms) arising from temporomandibular joint disease / disorder.
- Pain or discomfort (symptoms) arising from muscular disorders.
- Persistent or new disease (eg recurrent or residual cyst).
This brochure serves as a guide for you to discuss with your surgeon about your impending wisdom teeth surgery. He / she will be able to give you a better individual assessment of the possible risks and complications depending on the presence and severity of risk factors involved in your case.
Now the Post-operative instructions:
- After the surgery, it is inevitable that there will be some facial swelling and bruising on the face and sometimes down the neck.
- You should rest at home. Please avoid vigorous exercises, alcohol and very hot food or drink for the rest of the day to minimise the risk of excessive postoperative bleeding. Do not rinse your mouth unnecessarily on the day of the surgery as this may stimulate bleeding.
- A small amount of blood may ooze from he wound over the first few days following surgery. If active bleeding occurs, apply a clean folded gauze or handkerchief to the wound and bite on it firmly for a time 15 minutes. (I was recommended to bite it for 30 minutes and change gauze multiple times for the first day) If this persists after a few attempts, please return to this clinic during office hours or attend at the Department of Emergency Medicine (A&E), at Block 1 of the Singapore General Hospital after office hours. Please bring along your Identity Card/Passport and Outpatient Card if you are attending at the Department of Emergency Medicine. Please note that a service facility charge of about $90.00 is payable at the Department of Emergency Medicine.
- Please take your medicine at the prescribed frequency and dosage. Allergic reaction to medications used may occasionally occur. Should a rash or any other complication develop after taking the medicine, please return to this clinic during office hours or attend to the Department of Emergency Medicine after office hours. Alternatively, you may visit your nearest medical general practitioner for the problem.
- The surgery site should be cleansed by rinsing the mouth with saline (salt solution) or a prescribed mouthwash after meals and before going to bed. Brushing of teeth should resume the following day after surgery. (Do not brush teeth before bed on the day of surgery.)
- You should not apply a hot towel or hot compress to the facial skin area of the operative site because this tends to increase the size of the facial swelling.
- Soft food may be taken over the next few days. Chewing on the operative site(s) should be avoided during this time.
- If you have been given another appointment, please do not fail to attend.
- Should you have any question about the progress of your recovery, do feel free to contact us at the dental centre at telephone number : 6324-8836
As advice by nurse, the anaesthetic effect will wear off pretty soon, so take light food after surgery and quickly take the painkiller pills immediately! Do not rinse your mouth unnecessarily as you will need the blood clot to stop the bleeding and for the wound to heal.
It's around two hours after surgery now. Slight pain and panda swollen cheeks. Regaining sensation around the tongue and neck. And hopefully I will not have much pain!!!
Ok.... Now down to $$$ part.
| Description | Quantity | Full Rate | Amount Payable |
| Dental Treatment Extraction, Simple, Permanent | 2 | $120.00 | $64.00 |
| Drugs / Prescription / Injections Presciptions - DS | 1 | $8.90 | $8.90 |
| Consummables - OT Sterile Supplies, Surgical | 1 | $40.00 | $20.00 |
| Sterile Consummables, OT | 1 | $60.00 | $30.00 |
| Teeth (2 To 3), Impacted, Removal of Bone with Division of Teeth | |||
| Table T3C - Facility | $1,133.00 | $580.00 | |
| Table T3C - Surgeon | $500.00 | $0.00 | |
| Total Charges | $1,861.90 | ||
| Less: Government Grant | -$1,159.00 | ||
| Net Amount Payable | $703.52 | ||
| Medisave | $703.52 | ||
| Payment | $0.00 |
As you can notice, with a referral from polyclinic, you save more than 50% of the total bill and fully imburse by medisave.
Next appointment will be on 29th January 2009. Oh yes, even follow up check ups and preconsultantion are at least 50% subsidized.
Medical leaves? 5 Days.
Wisdom teeth! BYE BYE!!!!!
