Oral Surgery
Wisdom Tooth Extraction
Oral Surgery Wisdom Tooth Extraction
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Anthropologists note that the rough diet of early humans resulted in the excessive wear of their teeth. Normal drifting of the teeth to compensate for this wear ensured that space was available for most wisdom teeth to erupt by adolescence. The modern diet, which is much softer, and the popularity of orthodontic tooth straightening procedures produce a fuller dental arch, which quite commonly doesn't leave room for the wisdom teeth to erupt, thereby setting the stage for problems when the final four molars enter the mouth.
What is an Impacted Tooth?
A tooth becomes impacted when there is a lack of space in the dental
arch and its growth and eruption are prevented by overlying gum, bone
or another tooth. When a wisdom tooth is blocked from erupting or
coming into the mouth normally, it is termed "impacted". A tooth may
be only partially impacted, meaning it grows in crooked and breaks
through the gum only partially, or it may fail to break through at all
and thus remains totally impacted. Serious problems can develop
from partially impacted teeth, such as pain, infection, and crowding
of, or damage to, adjacent teeth. Besides serving no useful function, the impacted teeth will often cause damage because they cannot be cleaned properly and can collect food debris, bacteria and plaque around them. This can result in tooth decay, gum disease, infection and abscess of not only the wisdom teeth, but of the molars next door and of the surrounding gum tissue. The molars in front of the wisdom teeth are sometimes lost because of cavities and gum disease caused by the inability to clean the wisdom teeth properly.
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Many problems with wisdom teeth can occur with few or no symptoms, so there can be damage without your knowing it. It is important to know that as wisdom teeth develop, their roots become longer and the jawbone more dense. Thus, as a person grows older, it becomes more difficult to remove wisdom teeth and complications can become more severe. In addition, as people age there is an increased chance of the symptoms mentioned above. For these reasons, we may recommend the removal of wisdom teeth even if they are not yet causing obvious problems, particularly for young adults.
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Impacted wisdom teeth often grow at an awkward angle making their removal more difficult. As a person grows older the tooth becomes longer and the jawbone denser. Partially or fully impacted wisdom teeth are more likely to pose serious problems in older individuals.
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Complications such as infection (fig. a) , damage to adjacent teeth (fig. b) and the formation of cysts (fig. c) may arise from impacted teeth.
Infection
Crowding, damage
Cyst
How Serious is an Impacted tooth?
Impacted teeth can be painful and lead to infection.They may also crowd or damage adjacent teeth or roots.
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More serious problems may occur if the sac surrounding the impacted tooth becomes filled with fluid and enlarges to form a cyst. As the cyst grows it may hollow out the jaw and permanently damage adjacent teeth, the surrounding bone and nerves. Rarely, if a cyst is not treated, a tumor may develop from its walls and a more serious surgical procedure may be required to remove it.
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Despite the considerable concern regarding impacted third molars, a recent study sponsored by the American Association of Oral and Maxillofacial Surgeons and the Oral and Maxillofacial Surgery Foundation finds that third molars which have broken through the tissue and erupted into the mouth in a normal, upright position may be as prone to disease as those third molars that remain impacted.
Must the Tooth Come Out if it Hasn't Caused Any Problems Yet?
Not all problems related to third molars are painful or visible. Damage can occur without your being aware of it.
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As wisdom teeth grow, their roots become longer, the teeth become more difficult to remove and complications become more likely. In addition, impacted wisdom teeth are more likely to cause problems as patients age.
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No one can predict when third molar complications will occur, but when they do, the circumstances can be much more painful and the teeth more difficult to treat. It is estimated that about 85% of third molars will eventually need to be removed.
It isn't wise to wait until your wisdom teeth start to bother you. In general, earlier removal of wisdom teeth results in a less complicated healing process. It is strongly recommended that wisdom teeth be removed by the time the patient is a young adult in order to prevent future problems and to ensure optimal healing.The researchers found that older patients may be at greater risk for disease, including periodontitis, in the tissues surrounding the third molars and adjacent teeth. Periodontal infections, such as those observed in this study, may affect your general health.
When Should I Have My Wisdom Teeth Removed?
Wisdom teeth are easier to remove when the patient is younger, since their roots are not completely formed, the surrounding bone is softer, and there is less chance of damaging nearby nerves or other structures. Removal of wisdom teeth at a later age becomes more complicated as the roots have fully developed (may involve the nerve), and the jawbone is denser.
Wisdom Teeth Growth by Age
Before surgery, your oral and maxillofacial surgeon will discuss with you what to expect. This is a good time to ask questions or express your concerns. It is especially important to let the doctor know about any illness you have and medications you are taking.
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The relative ease with which a wisdom tooth may be removed depends on several conditions, including the position of the tooth and root development. Impacted wisdom teeth may require a more involved surgical procedure.
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Most wisdom tooth extractions are performed in the oral and maxillofacial surgery office under local anesthesia, intravenous sedation or general anesthesia. Your oral and maxillofacial surgeon will discuss the anesthetic option that is right for you.
What Happens During Surgery?
Following surgery, you may experience some swelling and mild discomfort, which are part of the normal healing process. Cold compresses may help decrease the swelling, and medication prescribed by your Oral and Maxillofacial Surgeon can help manage the discomfort. You may be instructed to modify your diet following surgery and later progress to more normal foods.
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If removal of the wisdom teeth is indicated, the procedure is recommended in the late teenage years, before the roots are completely formed. Surgical procedures in general are better tolerated when one is young and healthy, and the gum tissues tend to heal better and more predictably when young. Most people experience minimal disruption of their normal routines, and time off from work or school is usually minimal.
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When indicated, the removal of wisdom teeth can be of great benefit to your ultimate oral and general health.
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Please contact us for a consultation if you are having problems with your wisdom teeth.
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Click here for FAQ about wisdom teeth.
What Happens after Surgery?
Wisdom Tooth FAQ
The last teeth to develop and erupt into the jaws are called the third molars. Third molars usually erupt in the late teen years, which coincides with passage into adulthood and is referred to by some as the age of wisdom; hence "wisdom teeth". Unfortunately, the wisdom teeth are now usually trying to erupt into a jaw that is too small.
Why are they called Wisdom Teeth?
The tendency for wisdom teeth to become "impacted" or unable to move into their proper position is the cause of most problems. Impacted wisdom teeth grow in any way they can, such as sideways or at an angle. Some may partially break through the gum surface, while others remain trapped beneath the gum and bone, leading to a host of potential complications:
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Infected gums : When the tooth has only partially broken through the surface, bacteria can enter through the opening or flap around the tooth and cause the gum to become infected. This uncomfortable condition is best avoided by having the wisdom teeth removed before infection can develop.
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Decay : Because partially-emerged wisdom teeth are difficult to clean, plaque containing bacteria may form on the surface and create cavities in the wisdom tooth and adjacent teeth.
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Crowding and structural damage to other teeth : When teeth become crowded, they lose their proper position in the mouth. Thorough cleaning becomes more difficult and teeth may wear unevenly or prematurely with structural damage as a result. These are just a few problems that may occur.
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Cyst formation : When a wisdom tooth is impacted, the sac that surrounds the tooth can fill with fluid and form a cyst that is capable of damaging adjacent teeth, the jawbone and nerves
What Problems Can Wisdom Teeth Cause?
A small rubber cushion is placed between your teeth before you go to sleep, and this holds your mouth open.
How do you keep my mouth open during surgery when I’m asleep?
Dry socket is a term that refers to a healing complication that used to be seen somewhat frequently, but is rarely a problem today. With current techniques we have all but eliminated "dry sockets", although we encourage you to call us if you experience anything postoperatively that is not improving day by day or just doesn’t feel right.
What is a " dry socket "?
Every individual has a different healing response to surgery, but on average there is not much disruption of one’s activities, and generally not for more than a few days. We frequently see people back at work or school on the day following surgery, even when all four wisdom teeth have been removed.
When can I go back to work or school?
​Teeth can be brushed immediately, being careful to avoid the surgical areas for the first day or so.
When can I brush my teeth after surgery?
Unless you are told otherwise, your stitches will dissolve after about a week.
When will my stitches dissolve?
​The gauze may be removed when you get home; to be replaced with new gauze if significant bleeding continues, or if it feels better to have gauze in place. If the bleeding is not tapering off within a few hours of surgery, you should call our office. A small amount of blood on your pillow on the night following surgery is nothing to be alarmed about of there is no active bleeding.
When can I take the gauze out that I was biting on when I left your office?
​The prescription mouth rinse should be used for the first time before you go to bed on the night following surgery. Rinse very gently, because your blood clots are still somewhat fragile. For your daily use, you can use Listerine.
When should I start the prescription mouth rinse?
Smoking is harmful to the healing process and makes numerous complications more likely. Smoking in the first two weeks is especially harmful.