Wisdom Teeth

What Are Wisdom Teeth?

Wisdom teeth, officially referred to as third molars, are usually the last teeth to develop. They are located in the very back of your mouth, next to your second (or twelve year) molars and near the entrance to your throat. Third molars are usually completely developed between the ages of 15 and 18, a time traditionally associated with the onset of maturity and the attainment of "wisdom."

By the age of eighteen, the average adult has 32 teeth; 16 teeth in the upper jaw and 16 teeth in the lower jaw. Unfortunately, the average adult mouth is only large enough to accommodate 28 teeth. It can be painful when 32 teeth try to fit in a mouth that holds only 28 teeth.

Why Do We Even Have Wisdom Teeth?

Anthropologists theorize that back in the “cave days” our diet was much coarser than it is today. Also, there were not any dentists around to help us keep and maintain our teeth, and finally, there was not any fluoride in the water. So by the time we reached our late “cave teens”, we most likely had already lost several of our teeth due to trauma or decay. With the loss of adjacent teeth, the third molars now had space to erupt into our mouths, and therefore actually served a purpose – to replace lost teeth and help us chew better.

In modern times we have great general dentists to help us keep our teeth, a softer diet, and fluoride in our water. So we tend to keep most, if not all, of our teeth. Therefore, wisdom teeth commonly do not have enough room to erupt fully into our mouths. Even if the wisdom teeth do fully erupt, their posterior location makes it extremely difficult to keep them clean and healthy over the course of a lifetime. Removing wisdom teeth later on in life is much more difficult, the recovery period is longer and less predictable, and most importantly, wisdom tooth removal later in life is associated with increased risks and complications.

Why Should I Have My Wisdom Teeth Removed?

Wisdom teeth commonly do not have enough room to properly erupt into our mouth where they can become fully functional and cleansable teeth. This lack of space can result in a number of harmful effects on your overall dental health. When a tooth cannot erupt into proper alignment, we call it impacted, which simply means “stuck” in an improper position. There are several types, or degrees, of impaction:

• Soft Tissue Impactions – There is adequate jaw bone to allow the wisdom tooth to erupt, but not enough room to allow the gum tissue to be properly positioned and attached to the tooth. This causes tremendous problems because it is not possible to keep the area clean. Infection commonly occurs, resulting in swelling and pain.
• Partial Bony Impactions – There is enough space to allow the wisdom tooth to partially erupt, but it cannot function in the chewing process. The tooth remains partially covered by bone and soft tissue. Once again, keeping the area clean is impossible and problems commonly develop.
• Complete Bony Impactions – There is no space for the tooth to erupt. The tooth is completely covered by bone, or if it is partially exposed through the bone, it requires complex removal techniques.
• Unusually Difficult Complete Bony Impactions – The impacted wisdom tooth is in an unusual and difficult position to remove.

If you do not have enough room in your mouth for your wisdom teeth to erupt into proper position they can cause a multitude of problems, such as:

• Infection – Without enough room for total eruption, the gum tissue around the wisdom tooth can become irritated and inflamed, resulting in recurrent pain, swelling and problems with chewing and swallowing.
• Damage to Adjacent Teeth – If there is inadequate room to clean around the wisdom tooth, the tooth directly in front of the wisdom tooth, the second molar, can be adversely affected resulting in gum disease (bone loss) or cavities (caries or decay).
• Disease – Non-infectious diseases also can arise in association with an impacted wisdom tooth. Cysts are fluid-filled “balloons” inside the jawbone which are associated with impacted wisdom teeth and slowly expand, destroying adjacent jawbone and occasionally adjacent teeth. Although rare, certain tumors can be associated with impacted teeth. Both of these conditions can be very difficult to treat.
• Crowding – Although controversial, many feel that impacted wisdom teeth directly contribute to crowding, or shifting, of your teeth. This crowding is usually most noticeable in the lower front teeth. This is most commonly seen after a patient has had braces. There are most likely a number of factors that cause our teeth to shift and impacted wisdom teeth may play a contributory role. Although wisdom tooth removal cannot be recommended solely to avoid crowding, it can be recommended in order to absolutely eliminate any possible role in future crowding and other bite changes.

So Do I Really Have To Have My Wisdom Teeth Removed?

There is no “magic rule book” in life that says you must have your wisdom teeth removed. In other words, removal of these teeth has nothing to do with you living to be 70 instead of 65. In almost all cases wisdom tooth removal is elective surgery. Very rarely could it be considered a critical, life-saving procedure. You don't have to do anything until YOU choose to do so. Unless you have an active problem such as pain, swelling, infection, or soreness, the removal of your wisdom teeth is best viewed as a preventive measure, designed to keep you from having problems in the future. And although we cannot predict the future any more than you can, it is possible to identify potential future problems and make appropriate recommendations.

At your consultation visit we will examine your mouth and review your x-ray with you in great detail to determine IF you will benefit from having your wisdom teeth removed. Based on our findings, we will make certain recommendations and we will certainly answer all your questions. It is important to us that you are well informed and that you understand all your options.

What Is The Best Age To Have Your Wisdom Teeth Removed?

If you do not have enough room in your mouth for your wisdom teeth to erupt into proper position it is best to have them removed before the wisdom teeth are fully developed. For some patients this may be as early as 13 or 14, for others it may be as late as 17 or 18 years old. Without a doubt, younger patients (teenagers) heal faster, and in a more predictable fashion, and with fewer complications than older patients.

What If I Don't Have Them Removed Now?

Many patients, especially in years past, were told to take a “wait and see” approach regarding their wisdom teeth. Many patients who did not have adequate room for their wisdom teeth developed problems previously mentioned. The problem with taking a “wait and see” approach is that if it becomes necessary to remove a wisdom tooth in your thirties or beyond, it is much more difficult for you as the patient. For patients older than thirty the post-operative course is usually more prolonged, and the potential complications are much greater.

If you do not have your impacted wisdom teeth removed in your teenage years or early twenties, it may be advisable to take a “wait and see” approach and treat each wisdom tooth on an individual basis, removing only that one individual wisdom tooth if problems such as cyst formation, gum disease, bone loss, decay, infection, swelling or pain develop. Certainly a “one size fits all” approach does not apply to wisdom tooth removal. At your consultation appointment we will make recommendations based on your individual situation.

When Is the Best Time To Schedule My Surgery?

When you schedule your surgery is entirely up to you. Of course, there is never a good time to have to have your wisdom teeth removed. Life is busy and having your wisdom teeth removed is going to interrupt your schedule and be an inconvenience, but obviously there are certain times that are less inconvenient than others. Summer and school vacations are popular times for our school age patients, and long weekends tend to work best for our older patients. With proper planning we can minimize the inconvenience and maximize the time you have to recover. We will work closely with your individual schedule and find a time that is best for you.

What Are My Anesthesia Options?

Wisdom teeth are typically removed under IV sedation.

IV Sedation offers a very safe, predictable, pain free and memory free experience for patients having their wisdom teeth removed. Therefore, most patients prefer to be sedated during their surgery. All our sedated patients are continuously monitored both during and after their surgery. Our surgical staff has the training, experience, and license to provide a variety of anesthesia options for our patients in an environment of optimum safety. We will thoroughly discuss your anesthesia options with you at the time of your consultation. Please remember that if you will be receiving IV sedation for your surgery you may not have anything to eat or drink for 6 hours prior to your surgery, and you must be accompanied by a responsible adult who can drive you home after your surgery.

Getting Ready For Your Surgery.

We will prescribe any necessary medications for you at your consultation appointment. We will also review and discuss any medications that you are presently taking. Please be sure to bring a list of your medications with you to your consultation appointment.

Be sure you follow all the instructions we provide at your consultation appointment:

• Nothing to eat or drink for 6 hours prior to your surgery.
• An escort must come with you who can drive you home.
• Loose-fitting, comfortable clothing.
• No contact lenses or jewelry. No finger nail polish.

What Happens On The Day Of My Surgery?

Recent advances in medicine and technology allow patients to undergo wisdom tooth removal in a manner which promotes rapid healing and minimal post-operative discomfort. We use state of the art sterilization and infection control techniques at all times, including the use of sterile water for irrigation during surgery.

The day of your surgery you will be seated in one of our private Surgical Rooms. We will make sure that you are comfortable and then we will gently place a very small IV in your hand or arm. We will then begin giving you small increments of medications that will allow you to comfortably drift off to sleep. You will be breathing on your own during the procedure, but you will not be able to feel or remember anything. Once your surgery has been completed you will transported to one of our private recovery rooms.

In the recovery room we will go over post-operative instructions with you and your escort in great detail. All the instructions will be given to you in a written form to take home with you and are also included below. We will also make sure you have our after hours emergency phone numbers in case you need us for any reason.

When you leave the office you will be comfortable and drowsy. You will not be in any pain, because we will have injected local anesthesia around the surgical sites while you were asleep. We commonly use a long acting local anesthetic which is designed to keep your mouth numb for several hours after the surgery. The numb feeling normally wears off within 5 to 7 hours, but may last as long as 12 hours. Sometimes the numbness may last into the first night and as you go to sleep your lip and tongue may still be “tingling”. This is not a complication, but rather a blessing, because the longer your mouth stays numb the more comfortable you will be.

Are There Any Problems Associated With Wisdom Tooth Removal?

Risks and potential complications associated with wisdom tooth removal are very few, but just like any surgical procedure there are certain potential complications that you need to be aware of:

Nerve Damage

Although extremely rare, the major complication associated with removal of a lower wisdom is the possibility of nerve damage. There is a sensory (feeling) nerve which supplies sensation to our lower lip, chin and tongue that travels close to the roots of our lower wisdom teeth. As our third molars develop, the roots become longer. The longer and more developed the roots become, the closer they come in contact with this underlying nerve. Most patient's third molars are fully developed by the age of 18. Therefore, having your wisdom teeth removed before they are fully developed is very important in decreasing the potential risk of nerve damage. As a general rule, the possibility of permanent nerve damage, resulting in a permanent numbness to the lower lip and chin region for a teenage patient is typically less than 1.0%. However, depending on the position of the wisdom tooth and its relationship to the underlying nerve, the possibility of permanent numbness in an adult patient can be as high as 10 to 12%. This is why we normally recommend the removal of impacted third molars in our teenage population, even though the teeth may not yet be causing problems. It is best to remove these teeth, if indicated, while you are young and healthy, at a time in your life when you will heal quickly and in a more predictable fashion, and while the potential complication of nerve damage is as low as it can be. The type of x-ray which we take in our office, called a panorex, will clearly show the position and development of your wisdom teeth, and their location to the underlying nerve so that we can make appropriate recommendations and answer all your questions.

Sinus Exposure

The roots of our upper wisdom teeth are typically located very close to our maxillary sinuses. The maxillary sinuses are located behind our cheek bones. Removal of upper wisdom teeth can result in a communication between your mouth and your sinus. Once again, if the teeth are removed at an early age, before complete root formation, this complication is very unlikely to occur. Even in our adult population this is a rare complication, and if it does occur, the opening normally will close spontaneously without any further treatment. Should the opening persist, additional surgery would be necessary to permanently close the opening. If we do detect a sinus exposure at the time of surgery we may give you special post-operative “sinus instructions” to help the area heal in an uneventful fashion. Even if there is not a sinus exposure, the tissue between the tooth extraction socket and the sinus is commonly very thin and porous, which commonly allows blood to pass from the socket site into the sinus. Therefore, you may notice a small amount of blood in your nose the first few days following upper wisdom tooth removal.

Dry Sockets

A dry socket is not a true complication, but rather a delayed healing response. None-the-less, dry sockets continue to be the most common problem people experience following dental surgery. When a tooth is removed, the remaining socket is initially filled with a blood clot. The blood clot is the first step of the healing process. If the blood clot is lost prematurely, the socket walls are no longer covered and protected. Obviously, the socket is not “dry”, because fluid (saliva) is still in the socket, but the bony walls of the socket are no longer protected by the blood clot. So we call the socket “dry”. Without the blood clot, the bony walls of the socket are exposed to the environment and this can cause extreme discomfort. Although we don't know exactly what causes dry sockets, they tend to occur more frequently in patients who smoke and in patients taking birth control pills. While both jaws can be affected, dry sockets occur more commonly in the lower jaw. If a dry socket does occur, it will typically arise on the third to fifth day following your surgery – just when you are ready to start to feel better. A dry socket will cause a deep, dull, continuous pain on the affected side that can radiate to the ear, mimicking an earache. The pain can even persist after taking narcotic pain medication. Fortunately, we can greatly decrease the pain caused by a dry socket. Treatment involves placing a medicated dressing in the empty (dry) tooth socket. The medication will not bring back, or regenerate, the lost blood clot, but rather the medication is design to help control the pain. The dressing will also protect the socket from food particles which can further irritate the area and delay the healing. Again, the dressing does not aid in the healing process. The only reason to place a dressing in the socket is for pain control. Typically, the dressing is placed and the patient begins to feel better immediately. The medicated dressing is usually effective for 3 to 7 days. We will ask you to return to the office during that time so we can re-evaluate the area and replace the dressing with a new one if necessary. Treating the area one time is usually all that is required.

Infection

Occasionally, post-operative infections do occur. This usually requires an office visit and clinical examination. Many times, just placing the patient on a antibiotic for one week will take care of the infection. Sometimes, the infection may require drainage along with antibiotic therapy. Very rarely is hospitalization required.

What Does It Cost? And Does My Insurance Cover Wisdom Removal?

Because of the different types of impacted wisdom teeth, it is impossible to give you a realistic estimate of what your surgery will cost until we have examined you and reviewed your x-rays. Every insurance company is different, and there can be different plans within the same insurance plan. Please check with both your medical and dental insurance carrier to determine your coverage and out of pocket liability. Our Treatment Coordinators are very knowledgeable and are at your service to answer all your insurance questions. Please remember to bring your insurance information with you to your appointment so that we can help you file immediately for reimbursement.

If you have any questions please call us at 404-378-2331.
It is our goal to exceed your expectations every step along the way.
We look forward to being of service to you.

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