Third molars, commonly referred to as wisdom teeth, are usually the last four of 32 teeth to erupt (surface) in the mouth, generally making their appearance between the ages of 17 to 25. They are located at the back of the mouth (top and bottom), near the entrance to the throat. The term “wisdom” stems from the idea that the molars surface at a time typically associated with increased maturity or “wisdom”.
In most cases, inadequate space in the mouth does not allow the wisdom teeth to erupt properly and become fully functional. When this happens, the tooth can become impacted (stuck) in an undesirable or potentially harmful position. This is especially true after braces or in our Western society where our teeth are often in pristine condition and minimally worn – these factors decrease the space available for proper eruption of our teeth.
Reasons to remove wisdom teeth
While not all wisdom teeth require removal, wisdom teeth extractions are most often performed because of an active problem such as pain, swelling, decay or infection, or as a preventative measure to avoid serious problems in the future. If impaction of one or more wisdom teeth is present, and left untreated, a number of potentially harmful outcomes can occur, including:
Damage to nearby teeth: Second molars (the teeth directly in front of the wisdom teeth) can be adversely affected by impacted wisdom teeth, resulting in tooth decay (cavities), periodontal disease (gum disease and bone loss).
Disease: Although uncommon, cysts and tumors can occur in the areas surrounding impacted wisdom teeth.
Infection: Bacteria and food can become trapped under the gum tissue, resulting in an infection. The infection can cause considerable pain and possibly systemic (whole body) illlness.
Tooth Crowding: It has been theorized that impacted wisdom teeth can put pressure on other teeth and cause them to become misaligned (crowded or twisted). Although this theory makes sense, it isn’t universally accepted by all dental professionals, and it has not been validated by any scientific studies.
When should wisdom teeth be removed?
This depends on many factors such as your actual age and your “dental” age (i.e. how developed your teeth are) and whether or not you had braces. In general you should ask your dentist about your wisdom teeth in your mid-teenage years. On average 17-years-old seems to be the age where the recovery time is the fastest and the risks are the lowest.
Wisdom teeth examination:
Dr. Young will perform a clinical and radiographic examination to evaluate the position of your wisdom teeth and help you decide if and when you should have your wisdom teeth removed.
What does the removal of wisdom teeth involve?
Although several types of dentists remove wisdom teeth Oral and Maxillofacial Surgeons are considered to be the experts in most types of surgery, especially extractions. Wisdom tooth removal is the most common surgical procedure that Dr. Young performs.
Anesthetic modalities include local anesthesia (freezing), intravenous (IV) sedation, or general anesthesia. This is typically done in our outpatient surgical suites. Unlike the majority of Oral and Maxillofacial surgical suites, our preferred anesthetic modality is IV sedation. In Dr. Young’s experience this often the most pleasant and safest modality for the patient. Local anesthesia can be used if the surgery is straight forward, whereas general anesthesia is provided for very apprehensive patients or for complicated extractions.
The surgery does not require an overnight stay. One of our experienced nurses will fully discuss post-operative instructions with your care giver prior to your discharge and these will be provided in written form. Medication or prescriptions will be provided as appropriate. If you run into problems there is always an Oral and Maxillofacial surgeon on call to help you with emergencies.
What are the risks?
All operations carry risks. This is reduced by pre-operative appraisal of your medical history and present physical condition, and by the skill, experience and care of the surgeon, anesthesiologist and office personnel.
Pain – depending on your age and the difficulty of your surgery pain may be minimal or significant. You will be provided with a prescription for pain medication; most patients will take 1-2 days off after their wisdom teeth are removed.
Infections – are always a possibility given the bacterial load in our mouths. We typically use pre and postoperative antibiotics and if you are healthy, do not smoke, and the sites are kept clean an infection is unusual. If you do have an infection it is important to let our office know rather than visiting your general dentist, family doctor or emergency room.
Swelling and bruising – you are typically swollen for 4-5 days and bruising is uncommon. These signs vary between patients.
Bleeding – some postoperative bleeding is normal. Dr. Young will suture the surgical sites if required and you and your caregiver will be instructed on how to apply pressure to stop the bleeding.
Lower Wisdom Teeth - lower teeth are often near the sensory nerves of the lower jaw and tongue. A nerve may be involved if the roots of the wisdom teeth are close by during the extraction. The result will be numbness or tingling of the lower lip, chin, gums and teeth on that side of the mouth. It may also affect a part of the tongue. This does not last more than a few weeks in most cases, improving as the nerve recovers. It can very rarely be permanent. As with most things, the younger you are the lower your risk of this occurring. It is important to realize that the nerves involved are sensory and do not affect the movement of your mouth or face.
Roots of Upper Teeth - roots of upper teeth often are separated from the maxillary sinuses by only a thin layer of bone. Dr. Young uses great care during your surgery but occasionally when the tooth is removed a sinus opening may be left behind. If this opening is significant it will be sutured shut immediately. If this occurs you will be informed and instructed on things to avoid. When treated in this way these openings rarely cause problems. Very occasionally a second small surgery may become necessary to prevent air or fluid from passing between the mouth and sinus.
Small Tips of Roots - Small tips of roots occasionally break off deep in the socket as a tooth is removed. Dr. Young may elect to leave these small tips in place if removal would require extensive surgery which could endanger nearby nerves etc. Small, immobile root tips very rarely cause problems if left in place.
Fillings and Crowns - Weak or brittle fillings or crowns next to a tooth being removed may crack or fall out and may need to be replaced.