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Oral Surgery -->Wisdom Tooth Extraction

For most of us, problems with third molars or "wisdom" teeth, are a fact of life that come with the "wisdom" of maturity! That's why having them removed is often the best way to prevent problems.
Wisdom teeth, also known as third molars, are the last teeth to erupt in your mouth. This generally occurs between the ages of 17 and 25, a time of life that has been called the "Age of Wisdom."

Anthropologists note that the rough diet of early humans resulted in the excessive wear of their teeth. Normal drifting of the teeth to compensate for this wear ensured that space was available for most wisdom teeth to erupt by adolescence. The modern diet, which is much softer, and the popularity of orthodontic tooth straightening procedures produce a fuller dental arch, which quite commonly doesn't leave room for the wisdom teeth to erupt, thereby setting the stage for problems when the final four molars enter the mouth.

What is an Impacted Tooth?

A tooth becomes impacted when there is a lack of space in the dental arch and its growth and eruption are prevented by overlying gum, bone or another tooth. When a wisdom tooth is blocked from erupting or coming into the mouth normally, it is termed "impacted". A tooth may be only partially impacted, meaning it grows in crooked and breaks through the gum only partially, or it may fail to break through at all and thus remains totally impacted. Serious problems can develop from partially impacted teeth, such as pain, infection, and crowding of, or damage to, adjacent teeth. Besides serving no useful function, the impacted teeth will often cause damage because they cannot be cleaned properly and can collect food debris, bacteria and plaque around them. This can result in tooth decay, gum disease, infection and abscess of not only the wisdom teeth, but of the molars next door and of the surrounding gum tissue. The molars in front of the wisdom teeth are sometimes lost because of cavities and gum disease caused by the inability to clean the wisdom teeth properly.

 

Many problems with wisdom teeth can occur with few or no symptoms, so there can be damage without your knowing it. It is important to know that as wisdom teeth develop, their roots become longer and the jawbone more dense. Thus, as a person grows older, it becomes more difficult to remove wisdom teeth and complications can become more severe. In addition, as people age there is an increased chance of the symptoms mentioned above. For these reasons, we may recommend the removal of wisdom teeth even if they are not yet causing obvious problems, particularly for young adults.

Impacted wisdom teeth often grow at an awkward angle making their removal more difficult. As a person grows older the tooth becomes longer and the jawbone denser. Partially or fully impacted wisdom teeth are more likely to pose serious problems in older individuals.

Complications such as infection (fig. a) , damage to adjacent teeth (fig. b) and the formation of cysts (fig. c) may arise from impacted teeth.
(a) Infection
(b) Crowding, damage
(c) Cyst

 

 

How Serious is an Impacted tooth?

Impacted teeth can be painful and lead to infection.They may also crowd or damage adjacent teeth or roots.

More serious problems may occur if the sac surrounding the impacted tooth becomes filled with fluid and enlarges to form a cyst. As the cyst grows it may hollow out the jaw and permanently damage adjacent teeth, the surrounding bone and nerves. Rarely, if a cyst is not treated, a tumor may develop from its walls and a more serious surgical procedure may be required to remove it.

Despite the considerable concern regarding impacted third molars, a recent study sponsored by the American Association of Oral and Maxillofacial Surgeons and the Oral and Maxillofacial Surgery Foundation finds that third molars which have broken through the tissue and erupted into the mouth in a normal, upright position may be as prone to disease as those third molars that remain impacted.

Must the Tooth Come Out if it Hasn't Caused Any Problems Yet?

Not all problems related to third molars are painful or visible. Damage can occur without your being aware of it.

As wisdom teeth grow, their roots become longer, the teeth become more difficult to remove and complications become more likely. In addition, impacted wisdom teeth are more likely to cause problems as patients age.

No one can predict when third molar complications will occur, but when they do, the circumstances can be much more painful and the teeth more difficult to treat. It is estimated that about 85% of third molars will eventually need to be removed.

When Should I Have My Wisdom Teeth Removed?

It isn't wise to wait until your wisdom teeth start to bother you. In general, earlier removal of wisdom teeth results in a less complicated healing process. It is strongly recommended that wisdom teeth be removed by the time the patient is a young adult in order to prevent future problems and to ensure optimal healing.The researchers found that older patients may be at greater risk for disease, including periodontitis, in the tissues surrounding the third molars and adjacent teeth. Periodontal infections, such as those observed in this study, may affect your general health.

 

Wisdom Teeth Growth by Age
12 years 14 years
   
   
17 years 25 years
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. Removal of wisdom teeth 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 Surgery?

Before surgery, your oral and maxillofacial surgeon will discuss with you what to expect. This is a good time to ask questions or express your concerns. It is especially important to let the doctor know about any illness you have and medications you are taking.

The relative ease with which a wisdom tooth may be removed depends on several conditions, including the position of the tooth and root development. Impacted wisdom teeth may require a more involved surgical procedure.

Most wisdom tooth extractions are performed in the oral and maxillofacial surgery office under local anesthesia, intravenous sedation or general anesthesia. Your oral and maxillofacial surgeon will discuss the anesthetic option that is right for you.

What Happens after Surgery?

Following surgery, you may experience some swelling and mild discomfort, which are part of the normal healing process. Cold compresses may help decrease the swelling, and medication prescribed by your Oral and Maxillofacial Surgeon can help manage the discomfort. You may be instructed to modify your diet following surgery and later progress to more normal foods.

If removal of the wisdom teeth is indicated, the procedure is recommended in the late teenage years, before the roots are completely formed. Surgical procedures in general are better tolerated when one is young and healthy, and the gum tissues tend to heal better and more predictably when young. Most people experience minimal disruption of their normal routines, and time off from work or school is usually minimal.

When indicated, the removal of wisdom teeth can be of great benefit to your ultimate oral and general health.

Please contact us for a consultation if you are having problems with your wisdom teeth.

Click here for FAQ about wisdom teeth.

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Wisdom Tooth FAQ

Why are they called Wisdom Teeth?

The last teeth to develop and erupt into the jaws are called the third molars. Third molars usually erupt in the late teen years, which coincides with passage into adulthood and is referred to by some as the age of wisdom; hence "wisdom teeth". Unfortunately, the wisdom teeth are now usually trying to erupt into a jaw that is too small.

What Problems Can Wisdom Teeth Cause?

The tendency for wisdom teeth to become "impacted" or unable to move into their proper position is the cause of most problems. Impacted wisdom teeth grow in any way they can, such as sideways or at an angle. Some may partially break through the gum surface, while others remain trapped beneath the gum and bone, leading to a host of potential complications:

  • Infected gums
    When the tooth has only partially broken through the surface, bacteria can enter through the opening or flap around the tooth and cause the gum to become infected. This uncomfortable condition is best avoided by having the wisdom teeth removed before infection can develop.
  • Decay
    Because partially-emerged wisdom teeth are difficult to clean, plaque containing bacteria may form on the surface and create cavities in the wisdom tooth and adjacent teeth.
  • Crowding and structural damage to other teeth
    When teeth become crowded, they lose their proper position in the mouth. Thorough cleaning becomes more difficult and teeth may wear unevenly or prematurely with structural damage as a result. These are just a few problems that may occur.
  • Cyst formation
    When a wisdom tooth is impacted, the sac that surrounds the tooth can fill with fluid and form a cyst that is capable of damaging adjacent teeth, the jawbone and nerves

How do you keep my mouth open during surgery when I’m asleep?

A small rubber cushion is placed between your teeth before you go to sleep, and this holds your mouth open.

What is a " dry socket "?

Dry socket is a term that refers to a healing complication that used to be seen somewhat frequently, but is rarely a problem today. With current techniques we have all but eliminated "dry sockets", although we encourage you to call us if you experience anything postoperatively that is not improving day by day or just doesn’t feel right.

When can I go back to work or school?

Every individual has a different healing response to surgery, but on average there is not much disruption of one’s activities, and generally not for more than a few days. We frequently see people back at work or school on the day following surgery, even when all four wisdom teeth have been removed.

When can I brush my teeth after surgery?

Teeth can be brushed immediately, being careful to avoid the surgical areas for the first day or so.

When will my stitches dissolve?

Unless you are told otherwise, your stitches will dissolve after about a week.

When can I take the gauze out that I was biting on when I left your office?

The gauze may be removed when you get home; to be replaced with new gauze if significant bleeding continues, or if it feels better to have gauze in place. If the bleeding is not tapering off within a few hours of surgery, you should call our office. A small amount of blood on your pillow on the night following surgery is nothing to be alarmed about of there is no active bleeding.

When should I start the prescription mouth rinse?

The prescription mouth rinse should be used for the first time before you go to bed on the night following surgery. Rinse very gently, because your blood clots are still somewhat fragile. For your daily use, you can use Listerine.

If I’m a smoker, how long should I wait to smoke after surgery?

Smoking is harmful to the healing process and makes numerous complications more likely. Smoking in the first two weeks is especially harmful.

 

 

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Advanced Dental Care Centre

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