Wisdom Teeth

Overview

Third molars are commonly referred to as wisdom teeth. They are usually the last teeth to develop and are located in the back of your mouth, behind your second molars. Their development is usually completed between the middle teenage years and early twenties, a time traditionally associated with the onset of maturity and the attainment of wisdom.

Impacted Teeth

Although most people develop and grow 32 permanent adult teeth, many times their jaws are too small to accommodate the four wisdom teeth. When inadequate space prevents the teeth from erupting they are called impacted. This indicates their inability to erupt into the proper position for chewing and cleaning.

Types of Impactions

We will need to see you for a consultation to determine if you will benefit from . Special radiograph(s) of your teeth and jaws will be taken to determine if your wisdom teeth are impacted, if there is room for them to erupt, and how difficult it will be to have them removed.

  • Soft Tissue Impaction: There is not enough room to allow the gum tissue to retract for adequate cleaning of the tooth.
  • Partial Bony Impaction: There is enough space to allow the wisdom tooth to partially erupt. However, the tooth cannot function properly in the chewing process, and creates cleaning problems, among others.
  • Complete Bony Impaction: The wisdom tooth remains embedded in the jaw bone or if even partially visible requires complex surgical techniques for removal. The impacted wisdom tooth may also be in an unusual position and difficult to remove. This situation can also arise when the shape or size of the jaw bone and other facial structures make removal of this tooth significantly more complex.

Soft Tissue

Partial Bony

Complete Bony

Wisdom Teeth Removal

Oral Examination

With an oral examination and x-rays of the mouth, we can evaluate the position of the wisdom teeth and predict if there are present or future potential problems. Patients are generally first evaluated in the mid-teenage years by their dentist, orthodontist, or by an oral and maxillofacial surgeon for indications for removal.

All outpatient surgery is performed under appropriate anesthesia to maximize patient comfort. We are trained, licensed, and highly experienced in providing various types of anesthesia for patients.

Why Should I Have My Wisdom Teeth Removed?

If you do not have enough room in your mouth for your third molars to fully erupt, a number of problems can happen. Some of the possible problems related to not removing your wisdom teeth include:

Infection

The most frequent clinical problem we see is pericoronitis, (a localized gum infection). Without enough room for total eruption, the gum tissue around the wisdom tooth can become irritated and infected, resulting in recurrent pain, swelling, and problems with chewing and/or swallowing.

Cyst Formation

Non-infectious diseases may also arise in association with an impacted wisdom tooth. Cysts are fluid-filled “balloons” inside the jaw bone that develop as a result of impacted teeth and slowly expand destroying adjacent jaw bone and occasionally teeth. They can be very difficult to treat if your wisdom teeth are not removed in your teenage years. Although rare, tumors can be associated with the delayed removal of wisdom teeth.

Damage to Adjacent Teeth

If there is inadequate room to clean around the wisdom tooth, the tooth directly in front (the second molar) can be adversely affected resulting in gum disease, bone loss around the tooth, and/or decay.

What Happens on the Day Wisdom Teeth Are Removed?

On the day of your procedure, you will take medications to help minimize post-operative pain and swelling. We ask that a parent or responsible adult accompanies you to the office and plans to stay with you the rest of the day. The procedure will take about 30 to 60 minutes and you will probably be in the office for about 90 minutes.

On the morning of your surgery, it is essential that you have nothing to eat or drink (excluding prescription medications with a sip of water) for at least 8 hours. Having anything in your stomach can increase the risk for serious anesthetic complications. When you are seated in the surgical room, we will make every effort to make you as comfortable as possible. If you are going to be sedated, we usually will place an IV in your arm. This is a quick and nearly painless procedure that ensures optimal delivery of your medication. Local anesthesia is given to you afterwards to ensure comfort, and allow adequate time to travel home and rest. You will be sleepy for a significant portion of the day.

What if I Have Questions Before Surgery?

At the time of your consultation, your specific situation will be discussed in greater detail. We encourage you to ask any questions you may have. If new questions arise after your consultation, please call our office to speak to one of our patient care coordinators.

After Extraction of Wisdom Teeth

In most cases, the removal of wisdom teeth is performed under local anesthesia, laughing gas (nitrous oxide/oxygen analgesia), or general anesthesia. These options, as well as the surgical risks (i.e., sensory nerve injury, sinus complications), will be discussed with you before the procedure is performed. Once the teeth are removed, the gum is sutured. To help control bleeding bite down on the gauze placed in your mouth. You will rest under our supervision in the office until you are ready to be taken home. Upon discharge your postoperative kit will include post-operative instructions and prescription medications.

What Will I Feel Like After Wisdom Teeth Removal Surgery?

On the first day after surgery, you may experience some minor bleeding and pain. You should cover your pillowcase with something so that you don’t get any blood on it. Each individual’s reaction to surgery varies, and the sensation of pain can range from mild discomfort to severe pain. A variable amount of swelling can be expected following the surgery. This swelling usually peaks on the second day and should begin resolving on the third day.

You can limit the amount of swelling you will have by using ice for the entire first day. The more ice you use the first day, the less swelling you are likely to have on the second day. Please remember to put ice on the first day even if it is somewhat uncomfortable to have the cold next to your skin.

On the third day, you will notice that your jaw muscles are stiff, and it is difficult to open your mouth normally. You can apply moist heat to your face on the second and third day allowing your muscles to relax more and open wider. Most of the time you will want to limit your activities for a few days. We ask that you follow your post-operative instructions closely. Doing so will make you as comfortable as possible during the first few days following your procedure.

Please allow time for your body to begin healing before resuming an active social, academic, or athletic schedule. Most patients feel like they are over the hump and on their way to recovery in 3 to 5 days.

Are There Any Problems After Extraction of Wisdom Teeth?

As with any medical procedure, there can be complications or an unanticipated result. Some complications that patients undergoing Wisdom Tooth Extraction may experience include: injury to the sensory nerve that supplies sensation to the lip, chin and tongue, sinus communication, dry socket and infection.

After the procedure, our assistants will review your post-operative instructions with your escort. We ask that you follow these instructions closely, as they will make you most comfortable following your procedure. If you were sedated, you will be comfortable and drowsy when you leave the office. Most patients prefer to go home and rest with no other physical or scholastic activities planned for a few days. With any medical procedure, there can be unexpected results. We will review relevant post-operative events with you and answer any questions during your office visit.

Injury to Sensory Nerve

A primary concern is a nerve within the lower jaw bone that supplies feeling to the lower lip, chin, and tongue. This nerve is frequently very close to the roots of the lower wisdom teeth. Having these teeth out between the ages of 12 and 18 usually provides shorter roots so that the nerve is not so close to the roots of these teeth. Occasionally, when the teeth are removed, and especially in older patients, the nerve can become injured. When local anesthesia wears off, you may experience a tingling or numbing sensation in the lower lip, chin, or tongue. Should this occur, it is usually temporary and will resolve gradually over a period of weeks or months. On rare occasions it can result in a permanent alteration of sensation similar to having local anesthesia. We feel that you should be aware of this possibility before consenting to surgery.

Sinus Communication

The upper wisdom teeth are situated close to your sinuses, and their removal can result in an opening between your mouth and the sinus. Once again, if the teeth are removed at an early age, the root formation is minimal, and this complication is very unlikely. However, if it does occur, it will usually close spontaneously, but we may give you special instructions to follow, such as avoid blowing your nose for two or three days following the surgery. You can wipe your nose, but don’t blow your nose. If you have to sneeze, you should sneeze with an open mouth into a tissue. Pressure should not be created in the sinus area, which may dislodge the healing blood clot. If you sense this condition occurring after the surgery, please contact the office. An additional procedure may RARELY be necessary to close the opening.

Dry Socket

Dry socket continues to be the most common problem people experience following oral surgery. They arise due to premature loss of a blood clot in the empty tooth socket. This seems to occur with greater frequency in people who smoke or are taking birth control pills. While both jaws can be affected, they usually occur in the lower jaw. They cause a deep, dull, continuous aching on the affected side(s). Patients may first notice the pain starting in the ear radiating down towards the chin.

Occasionally it is helpful to place a medicated dressing in the empty tooth socket. This will help decrease the pain and protect the socket from food particles. The effectiveness in alleviating the pain lasts for 24-48 hours and may require dressing changes every day or two, for five to seven days. Dressings usually are removed when you have been pain free for 2 to 3 days.

The dressing doesn’t aid in healing. The only reason to place a dressing is for pain control. If medication is controlling the pain, the socket will heal without a dressing. Following removal of the dressing, an irrigation device may be provided to help you to keep food particles from lodging in the extraction site.

Infection

Occasionally, post-operative infections occur. This usually requires an office visit and clinical examination. Many times, just placing you on an antibiotic for one week will take care of the infection. If it persists, the area will have to be drained and cleaned. Other temporary problems you may experience in the post-operative period include stiffness of the jaws, chafing around the corners of your lips, facial bruising, and blood oozing from the extraction sites. The post-operative instruction sheet we will provide should answer many of the questions related to these more common concerns.