What Are Wisdom Teeth?
In the dental field, “wisdom teeth” are commonly referred to as third molars. They are usually the last teeth to develop and are located in the back of your mouth, behind your second molars. Their development is typically completed between the middle teenage years and early 20’s, a time traditionally associated with the onset of maturity and the attainment of wisdom, hence the nickname.
What Is An Impacted Tooth?
While most people develop and grow 32 permanent adult teeth, sometimes the jaws are too small to accommodate the four wisdom teeth. When lack of space prevents teeth from erupting, they are called impacted. Impacted teeth cannot move into proper position for chewing and cleaning. Infection, pain and decay may result.
Types Of Impactions
An examination and special type of x-ray (panoramic or pan) are required to determine if you will benefit from wisdom tooth removal. The pan will also reveal how difficult the impacted teeth will be to remove.
- Soft Tissue Impaction: Insufficent space prevents adequate cleaning of the tooth.
- Partial Bony Impaction: Enough space exists to allow the wisdom tooth to erupt partially. However, the tooth cannot function properly in the chewing process and creates hygiene problems.
- Complete Bony Impaction: There is NO space for the tooth to erupt. It remains embedded in the jawbone, or even if partially erupted, requires complex surgical techniques for removal. The impacted wisdom tooth may also be in an unusual position which makes removal more difficult.
WHY SHOULD I HAVE MY WISDOM TEETH REMOVED?
If you don’t have enough room in your mouth for your third molars to fully erupt, a number of problems can develop. In the case of impacted wisdom teeth, removal is easier and safer before their root structure is fully developed. In some patients, this can be as early as age 12 or 13. Others may not have fully developed roots until their early 20s. In general, problems related to wisdom teeth tend to occur with increasing frequency after the age of 30. As wisdom teeth develop, the roots grow longer and the jawbone becomes more dense. Impacted tooth removal among older patients (those in their 30’s, 40’s and beyond) may result in slower healing with an increased chance of complications including infection. If impacted wisdom teeth are not removed during the teenage years or early 20’s, it may be advisable to wait until a localized problem (such as cyst formation, gum disease or bone loss) develops.
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.
Non-infectious diseases may also arise in association with an impacted wisdom tooth. Cysts are fluid-filled “balloons” inside the jawbone that develop as a result of impacted teeth and slowly expand destroying adjacent jawbone 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.
Impacted wisdom teeth may contribute to crowding of your teeth. This is most noticeable with the front teeth, primarily the lower front teeth and is most commonly seen after a patient has had braces. There are a number of factors that cause teeth to crowd after braces or in early adulthood. Retained, impacted wisdom teeth may be a contributing factor. Unless you have an active problem when you see the oral surgeon, the reason for removal is primarily to prevent long-term damage to your teeth, gums and jawbone.
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 CAN I EXPECT ON THE DAY OF EXTRACTION?
Most patients prefer to be unaware of the experience and choose to be sedated. We will discuss the available sedation options during your initial consultation and examination appointment.
For those patients choosing sedation, it is essential that you have nothing to eat or drink for at least six hours prior to your appointment time. Your surgeon may allow you to take certain prescription medications with a tiny sip of water. (This will be discussed during your initial consultation appointment.) Having anything in your stomach (even water) can increase the risk for serious anesthetic complications including nausea and vomiting. Your procedure will be rescheduled if you have not heeded these guidelines. Smoking marijuana prior to anesthesia may result in even more serious complications including issues with the heart. We also advise patients undergoing anesthesia to refrain from alcohol consumption the evening prior to treatment.
You may be prescribed medication to help you feel relaxed when you arrive for your appointment. Our doctors will also administer the most appropriate medications to minimize post-operative discomfort and swelling. After your procedure, expect to feel sleepy for a significant portion of the day. We require that a parent or responsible adult accompanies you to your appointment, remains on site for the duration of your treatment and stays with you at home the rest of the day. Wisdom teeth extractions typically take about 30 to 60 minutes, occasionally longer for more difficult cases. You will probably be in the office for roughly 90 minutes total. While you may be given a prescription medication to keep you comfortable afterward, the vast majority of patients experience rapid healing and minimal post-operative discomfort. Non-narcotic options are available. We encourage you to discuss this with your surgeon during the consultation appointment if this is a concern. We recommend that all patients first try over-the-counter anti-inflammatory medications, such as ibuprofen (Advil®), to see if that adequately treats any discomfort. The long-lasting numbing medication used during surgery may last until the following day, and should not be confused with nerve injury.
Patients are encouraged to resume eating later that same day. We recommend starting your post-operative diet with clear liquids, such as Jell-O and broths, gradually increasing in substance as your body permits. Do not take ibuprofen or prescription medications on an empty stomach as vomiting and stomach upset are likely to occur. We also suggest avoiding dairy products that first day as these may also cause stomach upset. If you are prescribed antibiotics, those patients taking birth control pills are advised to take appropriate precautions in order to prevent pregnancy.
The Day of Treatment
Minors must be accompanied to their appointment by a parent or legal guardian who must remain on site for the duration of the procedure. Regardless of age, those undergoing sedation must have a driver who remains on site during treatment. Make plans to have a parent or responsible adult stay with you for the rest of the day.
If your surgery requires stitches, they are usually the type that dissolve in three to five days and do not require removal. You may also notice a sensation of your gums feeling swollen and pulling away from your teeth. This is all part of normal recovery, and will subside in several days.
What Will I Feel Like after surgery?
Wisdom Teeth Presentation
To provide you with a better understanding of wisdom teeth, we have provided the following multimedia presentation. Many common questions pertaining to wisdom teeth are discussed.
On the first day after surgery, you may experience some minor bleeding and discomfort. Everyone reacts a bit differently to surgery, and the sensation of pain can range from mild discomfort to severe. A variable amount of swelling can be expected following the surgery. This swelling usually peaks on the second day and should begin resolving on day 3. Applying ice to your cheeks on that first day will help minimize swelling. The more ice you use on day 1, even if it is somewhat uncomfortable on your skin, the less swelling you are likely to experience on day 2. We also suggest sleeping elevated (in a reclining chair is ideal) for the first 2 to 3 nights to minimize swelling and discomfort. By day 3, you will likely notice your jaw muscles are stiff. Opening your mouth fully may be difficult. Applying moist heat to your face on days 2 and 3 may help muscles relax. We recommend limiting activities for a few days after surgery. While most patients are able to return to work or school in about 2 days, please allow time for your body to heal before resuming an active social, academic or athletic schedule. It is essential to follow all post-operative instructions closely. Most patients feel like they are over the hump and on their way to recovery within three to five days. If your surgery requires stitches, they are usually the type that dissolve in three to five days and do not require removal. You may also notice a sensation of your gums feeling swollen and pulling away from your teeth. This is all part of normal recovery, and will subside in several days.
what are the potential complications?
As with any surgical procedure, complications sometimes occur. Most often, these are quite minor and include stiffness of the jaws, chafing around the corners of the lips, facial bruising and oozing from the extraction sites. The post-operative instruction sheet provided to surgery patients should answer most questions related to these more common concerns. Some of the less common complications are discussed below. Carefully following the after-care instructions may help minimize the likelihood of such occurrences. Prior to undergoing treatment, please discuss any concerns with your surgeon.
Damage to Sensory Nerve:
A primary concern is a nerve within the lower jawbone 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 removed between the ages of 12 and 18 usually means shorter roots so the nerve is not so close to the roots. Occasionally, especially with older patients, the nerve can become injured. Once the numbing medication wears off, you may experience a tingling or sense of numbness in the lower lip, chin or tongue. Usually, this is only temporary and will resolve gradually over a period of weeks or months. On rare occasions, a sensation of numbness may be permanent.
The upper wisdom teeth are situated close to your sinuses. In some instances, their removal can result in an opening between the mouth and the sinus. If these teeth are removed at an early age, (when tooth root formation is minimal) this complication is unlikely. Should this occur, these openings generally close on their own. In rare circumstances, an additional procedure may be necessary to close the opening.
A dry socket is the most common complication which patients experience following wisdom teeth extractions. A dry socket arises when the blood clot in the empty tooth socket is lost prematurely. This is seen most commonly with patients who smoke or take birth control pills. While both jaws can be affected, a dry socket occurs with greater frequency in the lower jaw around the third to fifth day after surgery.
Symptoms often start in the ear with discomfort radiating down toward the chin along with a deep, dull, continuous aching on the affected side(s). Frequently, discomfort will begin in the middle of the night, and the pain medication regimen may not help. Your surgeon may change your prescription or place a medicated dressing in the empty tooth socket.
On rare occasions, post-operative infections may occur. This usually requires an office visit and examination. Most often, a one week course of antibiotics is sufficient to resolve the issue. 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. If not, don’t hesitate to call the office.
What Does The Procedure Cost & Is It Covered By Insurance?
Treatment fees are determined by a number of factors. These may include the difficulty involved in removing your teeth, the type of anesthesia used and length of the procedure. During your initial consultation and examination appointment, your surgeon will review your medical history, perform a thorough examination, review your x-rays and create a treatment plan. We will then provide an estimate of what we anticipate your benefit plan to cover and what portion will be your responsibility. Our team will work with you to maximize your available benefits and discuss payment options.
What If I Have Questions Before Surgery?
The Day of Treatment
Please do not eat or drink anything prior to your surgery. Having anything in your stomach can increase the risk for serious anesthetic complications.