are Wisdom Teeth?
Wisdom teeth, officially referred to as third molars,
are usually the last teeth to develop. They are upper
and lower teeth whose function is to grind food as
part of the digestive process. 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. They usually complete development between
the ages of 15 and 20, a time traditionally associated
with the onset of maturity and the attainment of Wisdom.
Should I Have Them Removed?
the wisdom teeth are the last to develop, they will not have
enough room to adequately erupt into the mouth to become fully
functional and cleansable teeth. This lack of room or space
can result in a number of harmful effects on your overall
this occurs they are said to be impacted, indicating their
inability to erupt into an alignment which will allow them
to be able to function in the chewing process. There are several
types of impactions:
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 recede to allow adequate cleaning of the tooth.
Bony Impactions : There is enough space to
allow the Wisdom tooth to Partially erupt. It cannot function
in the chewing process and creates cleaning problems, among
Complete Bony Impactions:
There is NO space for the tooth to erupt. It remains totally
below the jawbone or if even partially visible requires complex
Unusually Difficult Complete Bony Impactions:
The impacted Wisdom tooth is in an unusual and difficult to
remove position. This situation can also arise when the shape
of the jawbone and other facial structures make removal of
this tooth significantly more difficult.
If you do not have enough room in your mouth for your third
molars to erupt and they become impacted, several detrimental
results can occur:
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 swallowing.
Damage: 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) or cavities (more appropriately known as dental
caries or decay).
Disease: Non-infectious diseases can also
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 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.
Crowding: Although controversial, many feel
that impacted wisdom teeth directly contribute to crowding
of your teeth which is most noticeable in the front teeth,
usually 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 teeth to crowd after braces or in early
adulthood and retained, impacted wisdom teeth are likely to
play a contributory role. Although wisdom tooth removal cannot
be recommended solely to avoid crowding, it can be recommended
to absolutely eliminate its possible role in future crowding
and other bite changes.
Unless you have an active problem at the time of your consultation,
the reason for removal is primarily preventative to avoid
long term problems.
will need to see you for a consultation before it is determined
IF you will benefit from Wisdom tooth removal. We will need
to take a special x-ray of your mouth
and jaws to determine how much room you have, if any,
for your Wisdom teeth to erupt.
is The Best Age To Have Them Removed?
If it is recognized that you do not have enough room in your
mouth for your third molars to erupt, it is advisable to have
them removed as soon as it is recognized. In some patients
it is as early as 11 or 12 whereas in others it may not be
until 17 or 18 years of age. You will heal faster, with more
predictable final healing, and have fewer complications than
an older patient.
If I Don’t Have Them Removed Now?
Many people, especially in years past, were told to take a
"wait and see" approach to wisdom teeth. Many who
did not have adequate room developed localized problems previously
mentioned. The problem with this approach is that IF it is
necessary to remove impacted wisdom teeth in your thirties,
forties, fifties, or beyond, it is clearly more difficult
for you as the patient. The post-operative course is usually
prolonged and there is a higher complication rate. Treating
these complications is more difficult than with a younger
patient. IF you do not have your impacted wisdom teeth removed
in your teenage years or early in your twenties, it may be
advisable to wait until or unless a localized problem (such
as cyst formation or localized gum disease and bone loss)
develops and then treat the affected area only. This is because
the predictability of healing decreases with age and the likelihood
of infection and delayed healing increases.
There Any Problems?
As with any medical procedure, there can be complications
or an unanticipated result that you should be aware of:
is a nerve, which supplies feeling to the lower lip, chin,
and tongue which is frequently very close to the roots of
the lower wisdom teeth. Having these teeth out between the
ages of 12 and 18 usually provides shorter roots so that the
nerve is not so close to the roots of these teeth. Occasionally,
when the teeth are removed, especially in older patients,
the roots have grown longer and become closer to the nerve
itself. This nerve can become irritated in the process of
removing the tooth. When local anesthesia wears off, you may
experience a tingling or numb sensation in the lower lip,
chin, or tongue. Should this occur, it is usually temporary
and will resolve gradually over a period of weeks or months.
RARELY , it can result in a permanent alteration of sensation
similar to the feeling of Novocain. We feel that you should
be aware of this before consenting to surgery.
The upper wisdom teeth are situated close to your sinuses,
and their removal can result in a communication between your
mouth and the sinus. Once again, if the teeth are removed
at an early age, the root formation is minimal, and this complication
is very unlikely to occur. Should this occur, it will usually
close spontaneously. We may give you special instructions
to follow if this is apparent at the time of surgery. I prefer
that you don’t blow your nose for two or three days
following the surgery. You can wipe your nose, but don’t
blow your nose. If you have to sneeze, you should sneeze with
an open mouth into a tissue - - you should not create any
pressure in the sinus area, which may dislodge the healing
blood clot. If you sense a communication occurring after the
surgery, please contact the office. RARELY, an additional
procedure may be necessary to close the communication.
Dry Socket - No Blood Clot
post-operative infections occur. This usually requires an
office visit and clinical examination. Many times, just placing
you on an antibiotic for one week will take care of the infection.
It will occasionally require drainage of the infected area,
which may have accumulated near the surgical site, and even
more rarely do the patients need to be admitted to the hospital
for intravenous antibiotics and further surgical drainage.