Wisdom Teeth Extractions

Removal of Wisdom Teeth:

Wisdom teeth, or third molars, are the last teeth to develop and appear in your mouth. They come in between the ages of 17 and 25, a time of life that has been called the "Age of Wisdom."

What is an Impacted Tooth:

When a tooth is unable to fully enter the mouth, it is said to be "impacted." In general, impacted teeth are unable to break through the gums because there is not enough room. Nine out of ten people have at least one impacted wisdom tooth.

How serious is an impacted wisdom tooth:

• Impacted wisdom teeth may damage neighboring teeth, or become infected.
• Gum Disease, because the third molar area of the mouth is difficult to clean, it is a site that invites the bacteria that leads to gum disease.
• Oral bacteria may travel from your mouth through the bloodstream, where it may lead to possible systemic infections and illnesses that affect the heart, kidneys and other organs.
• Once periodontal disease is established in the third molar areas, the problem is persistent and progressive, but may improve following extraction of the teeth.
• In some cases a fluid-filled cyst or tumor may form around the base of the untreated wisdom tooth. As the cyst grows it may lead to more serious problems as it hollows out the jaw and damages surrounding nerves, teeth and other structures.
• Complications such as infection (fig. a) , damage to adjacent teeth (fig. b) and the formation of cysts (fig. c) may arise from impacted teeth.

Must the tooth come out if it hasn't caused any
problems yet:

Many people believe that as long as they are not in pain, they do not have to worry about their wisdom teeth. However, pain free does not mean disease or problem free. In fact, wisdom teeth that come in normally may still be prone to disease, according to a study by the American Association of Oral and Maxillofacial Surgeons and the Oral and Maxillofacial Surgery Foundation. AAOMS strongly recommends that third molars be evaluated by an oral and maxillofacial surgeon by the time a patient is a young adult in order to assess the presence of third molars, disease status, and to suggest management options ranging from removal to a monitored retention plan to ensure optimal patient-specific outcomes.

In general, dental and medical professionals agree that wisdom teeth removal is indicated in the following instances:

• infections and/or periodontal disease;
• cavities that cannot be restored;
• pathologies such as cysts, and tumors, and
• damage to neighboring teeth.

Wisdom teeth that are completely erupted and functional, painless, cavity-free, in a hygienic environment with healthy gum tissue, and are disease-free may not require extraction. They do, however, require regular, professional cleaning, annual check-ups and periodic radiographs to monitor for any changes.

Advantages of wisdom teeth removal at a younger age:

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.

Wisdom teeth removal at a later age becomes more complicated as the roots have fully developed (may involve the nerve), and the jawbone is denser.

What happens during Wisdom teeth removal:

Before surgery, your oral surgeon will discuss the procedure with you and tell you what to expect. This is a good time to ask questions. Also talk to your surgeon about any concerns you have. Be sure to let your doctor know about any illness you have and medications you are taking.

There are several conditions that affect how easy it will be to remove a wisdom tooth. These conditions include how the tooth is positioned and the stage of root development. If the wisdom teeth are impacted the surgery might be more complicated. Most of the time third molars can be removed with little or no pain.

Tips to make you feel better after wisdom teeth removal:

In most cases, the recovery period lasts only a few days. Take painkillers as prescribed by your dentist. The following tips will help speed your recovery.

• Bite gently on the gauze pad periodically, and change pads as they become soaked with blood. Call your dentist if you still have bleeding 24 hours after your surgery.
• While your mouth is numb, be careful not to bite the inside of your cheek or lip, or your tongue.
• Do not lie flat. This may prolong bleeding. Prop up your head with pillows.
• Try using an ice pack on the outside of your cheek for the first 24 hours. You can use moist heat-such as a washcloth soaked in warm water and wrung out-for the following 2 or 3 days.
• Relax after surgery. Physical activity may increase bleeding.
• Eat soft foods, such as gelatin, pudding, or a thin soup. Gradually add solid foods to your diet as healing progresses.
• Do not use a straw for the first few days. Sucking on a straw can loosen the blood clot and delay healing.
• After the first day, gently rinse your mouth with warm salt water several times a day to reduce swelling and relieve pain.
• Do not smoke for at least 24 hours after your surgery. The sucking motion can loosen the clot and delay healing. In addition, smoking decreases the blood supply and can bring germs and contaminants to the surgery area.
• Avoid rubbing the area with your tongue or touching it with your fingers.
• Continue to brush your teeth and tongue carefully.

Risks of wisdom teeth extraction:

After a wisdom tooth is removed, you may experience:

• Pain and swelling in your gums and tooth socket where the tooth was removed
• Bleeding that won't stop for about 24 hours
• Difficulty with or pain from opening your jaw (trismus)
• Slow-healing gums
• Damage to existing dental work, such as crowns or bridges, or to roots of a nearby tooth
• A painful inflammation called dry socket, which happens if the protective blood clot is lost too soon
• Numbness in your mouth and lips after the local anesthetic wears off, due to injury or inflammation of nerves in the jaw
• Rare side effects, including:
  - Numbness in the mouth or lips that does not go away
  - A fractured jaw if the tooth was firmly attached to the jaw bone
  - An opening into the sinus cavity when a wisdom tooth is removed from the upper jaw

What if I decide to keep my wisdom teeth:

If after discussing your situation with your family dentist or oral and maxillofacial surgeon, you decide to keep your wisdom teeth, be sure to take particular care in cleaning and flossing your teeth, especially the molars. Your third molars must be professionally examined regularly and x-rays of your wisdom teeth should be taken every year to make sure that the health of your teeth and gum tissue does not change.