Wisdom teeth, formally known as third molars, are the four teeth
farthest back in the mouth -- one on each side of the upper
and lower jaw. Not everyone has wisdom teeth. About 85 percent
of people between the ages of 16 and 20 have all four, some or
all of which may be impacted, and 95 percent have at least
one. The wisdom teeth are the last to come through. Nowadays
people often have jaws that are too small for all 32 teeth -
28 are often the most we have room for. So if all the other
teeth are present and healthy there may not be enough space
for the wisdom teeth to come through properly.
Why don't wisdom teeth grow in
right?
The shape of the modern
human jaw is often too small to accommodate wisdom teeth,
which make their first appearance in young adults between the
ages of 16 to 25. Over the course of time in the evolutionary
process, humans learned to harness fire for cooking foods and
developed blade tools to better process food before
consumption, they reduced the need for strong jaws to chew
food.
What does impacted mean?
When wisdom teeth don't
have room to grow or they haven't reached their final position
by age 25, they are considered impacted. Third molar impaction
is the most prevalent medical developmental disorder.
Scientists say third molars are probably an evolutionary
leftover from prehistoric humans, who had larger jaws. Today,
many people's jaws are too small to comfortably accommodate a
third set of molars. The result is that a developing wisdom
tooth's path is often blocked by bone, gum or another tooth --
in which case the tooth is considered to be
impacted.
Can you ever keep your wisdom
teeth?
Mother nature is generous
when it comes to our teeth. First we get baby teeth, then
permanent teeth, and finally around age 16 or 17, we start
getting a set of molars called wisdom
teeth. Often times, wisdom teeth
become trapped or impacted in the jawbone, or simply fail to
erupt. This can cause crowding or displacement of other teeth,
or lead to the development of localized tooth decay,
infection, or gum disease. It probably is true that
wisdom teeth cause more problems than any other tooth in the
mouth. They will either partially break the gum tissue and
grow in crooked or remain underneath the gum. In nine out of
ten people, at least one tooth remains impacted, causing
symptoms of future problems of varying degrees. However,
all that does not mean that we have to take all of the wisdom
teeth out. There are certain patients that do not
require their wisdom teeth to be removed. In some
cases we only take the approach of wait and watch as long as
the patients will return for the bi-annual
evaluation.
Do they always cause
problems?
No. If there is enough
room they will usually come through into useful position and
cause no more problems than any other tooth. Often there will
be some slight discomfort as they come through, but this is
only temporary and will disappear once the tooth is fully in
position
Are there different
types of impacted wisdom tooth?
Some teeth are fully
impacted, failing to break through, or "erupt," at all, while
others are partially impacted, with part of the tooth poking
out through the gums. Sometimes an impacted tooth lies in the
jaw at an angle instead of sitting straight up.
Impaction is a term used
in dentistry when a tooth is stuck under the gum and
jawbone. It could be because it does not have enough
space or it is positioned in such a way that is impossible to
erupt in your mouth. Lack of space occurs because our
jaws have become smaller (through evolution), we do not loose
teeth through decay as frequently as in the past, and our diet
is such that our teeth do not wear down as much. An
impacted tooth could be completely or partially covered with
bone, hence called bony impaction or it could be under the
gum, and then it is called soft tissue impaction.
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Horizontal
Bony
Impacted Tooth |
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Vertical Bony
Impacted
Tooth |
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Angular Bony
Impacted
Tooth |
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Partial Bony
Impacted
Tooth |
What problems should I
be prepared for?
If part of the wisdom
tooth has appeared through the gum and part of it is still
covered, the gum may become sore and perhaps swollen. Food
particles and bacteria can collect under the gum edge, and it
will be difficult to clean effectively.
Your dentist will advise
you whether this is a temporary problem that can be dealt with
by using mouthwashes and special cleaning methods (and
possibly antibiotics), or whether it is better to have the
tooth removed.
What are the common signs of wisdom
teeth problems?
What problems occur
with impacted wisdom teeth?
From our past experiences we have learned that if
impacted wisdom teeth left untreated they can potentially
cause serious dental problems such as cysts or tumors.
Basically, teeth develop in sacs resting deep in the bone. The
sac disappears when the tooth comes through the jaw normally.
If the tooth is impacted the sac can fill with fluid (like a
water balloon) and enlarge, forming a cyst, which can grow,
possibly unnoticed. As the cyst expands it pushes
against the bone and roots of other teeth as well as the
nerves in the area causing major harm. In rare instances, a
tumor can develop in the wall of the cyst and may require more
complicated surgery.
Potential For Trouble: Silent Danger
or innocent victim!
Although surgeons
have seen many complications with wisdom teeth and millions
are removed every year because of the following reasons as
described bellow, but we are at present time studying to see
if there is a scientific basis to predict the possibility of
these condition happening in future. We are now looking
to see if we can avoid removing many wisdom teeth by just
observing them for many years to come.
Reasons for wisdom teeth to be
removed:
-
Constant
pain
-
Recurrent infection
(Pericoronitis)
-
Tooth
decay
-
Abscess
-
Associated
cysts
-
Tumors
-
Diseases of tissues
around the tooth, (decay in adjacent teeth, periodontal
problems)
-
They may be in the way of
planned future surgery
What can I do to help
myself?
Warm salted water or a
warm mouthwash could help to clean around your gum and teeth
and reduce the inflammation. Swish the solution around the
tooth; trying to get it into the areas your toothbrush cannot
reach. An antibacterial mouthwash such as Peridex can also be
very useful to reduce the inflammation. Over the counter pain
medications including Tylenol, Motrin, Alive, Advil, Ibuprofen
can also be useful for short-term use. But you must be seen as
soon as you can to check the problem.
But what if it
does not help?
If the pain does not go
away or if you find it difficult to open your mouth, you
should see a dentist. They will be able to see the cause of
the problem, and advise you accordingly. It may be useful to
clean around the tooth very thoroughly, and an antibiotic may
be prescribed.
Are x-rays needed?
The dentist will
usually take x-rays to see the position of the root, and to
assess whether there is room for the tooth to come through
into a useful position.
Are wisdom teeth difficult to
take out?
It all depends on the
position and the shape of the roots. Your dentist will advise
you as to how easy or difficult each tooth will be to remove
after looking at the x-rays. Upper wisdom teeth are often more
straightforward to remove than the lower ones, which are more
likely to be impacted. Your dentist will advise you whether
you should be referred to a specialist (oral surgeon) at a
hospital. Very occasionally there is a possibility of some
numbness of the lip after the removal of a lower tooth - your
dentist will tell you if it is possible in your
case.
Will it make
any difference to my face or mouth?
Removing wisdom teeth may
produce some swelling for a few days but as soon as the area
is healed, there will be no difference to your face or
appearance. Your mouth will feel more comfortable and less
crowded, especially if the teeth are impacted.
When should
wisdom teeth be removed?
Wisdom teeth should be
removed before the age of 24, according to a clinical study
conducted by five Detroit area oral surgeons. The study,
published in the Journal of Oral and Maxillofacial
Surgery, involved 9,500 patients ranging in age from 12 to
83 and more than 16,000 impacted third molars. Basically, it
showed that incidence of complications was four times higher
among patients older than 24 years. In most cases, the
extraction of wisdom teeth is a simple procedure. Patients can
expect to resume their normal activities in a day or so.
Is there a
need for consultation before my surgery?
Certainly. After
all, even if your teeth are impacted they dont have to be
removed. It is our standard to meet with the patient
(and parents if applicable) prior to the surgery date. At that
time the patient is evaluated for those contributing factors,
which might weigh in the decision as to the most appropriate
setting for the surgery. Additionally, the meeting allows us
to evaluate the x-rays and discuss the surgical procedure.
Meeting the doctor fact to face prior to the surgery also
allows the patient to establish a comfort level with the
doctor and staff which is hard to do minutes before the actual
performance of the anesthesia surgery.
Who can a person see if they are
concerned about their wisdom teeth?
Oral and
maxillofacial surgeons are specialists in the diagnosis and
treatment of health problems associated with the mouth, jaw,
joint and jawbone and are qualified to handle wisdom teeth
complications. Regular visits to the dentist can assure early
detection of possible wisdom teeth problems. At that time,
proper treatment can be determined depending upon the
individual case.
What are the
most common reasons to have wisdom teeth
removed?
1. Tooth
Decay:
As a partially impacted tooth tries to erupt the gum lifts and
if the tooth stays in that position for a long period the
saliva, bacteria and food particles can collect around it,
causing decay in it, or the next tooth to it. It is very
difficult to remove such decay. Pain and infection will
usually follow.
2. Gum Infection (Pericoronitis):
When a wisdom tooth is partially erupted, food and bacteria
collect under the gum causing a local infection. This may
result in bad breath, pain, swelling and trismus (inability to
open the mouth fully). The infection can spread to involve the
cheek and neck. Once the initial episode occurs, each
subsequent attack becomes more frequent and more
severe.
3. Pressure Pain:
Pain may also come from the pressure of the
erupting wisdom tooth against other teeth. In some cases this
pressure may cause the erosion of these teeth.
4. Orthodontic
Reasons: Many younger patients have had prolonged
orthodontic treatment to straighten teeth. Wisdom teeth may
cause movement of teeth (particularly the front teeth) when
they try to erupt and this will compromise the orthodontic
result.
5. Prosthetic
Reasons:
Patients who are to have dentures constructed
should have any wisdom tooth removed. If a wisdom tooth erupts
beneath a denture it will cause severe irritation and if
removed, the patient will need to have a new denture
constructed, as the shape of the gum will have changed.
6. Cyst
Formation:
A
cyst (fluid filled sac) can develop from the soft tissue
around an impacted wisdom tooth. Cysts cause bone destruction,
jaw expansion and displacement or damage to nearby teeth. The
removal of the tooth and cyst is necessary to prevent further
bone loss. Rarely, tumors may develop within these cysts or
the jaw may fracture spontaneously if the cyst grows very
large.
7. Travel to Inaccessible
Places:
If you are going to an area where specialist
dental services are not available and your wisdom teeth are
impacted, it may be advisable to have them removed
beforehand.
When is the Best
Time to have my Wisdom Teeth Removed?
It is now recommended by specialists
that impacted wisdom teeth be removed between the ages of 14
and 22 years whether they are causing problems or not. Surgery
is technically easier and patients recover much more quickly
when they are younger. What is a relatively minor operation at
20 can become quiet difficult in patients over 40. Also the
risk of complications increases with age, and the healing
process is slower.
Should a Wisdom
Tooth be Removed When an Acute Infection (Pericoronitis) is
Present?
Generally no. Surgery in
the presence of infection can cause infection to spread and
become more of a serious problem. The infection must be
controlled by antibiotics first before rushing to extract an
infected tooth. Sometimes the extraction of the opposing
wisdom tooth may be needed first.
How do you keep
my mouth open during surgery when Im 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
doesnt 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 ones 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 does not taper 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 if 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.
If Im 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.
Are there
any reasons to remove my fully erupted wisdom teeth?
Erupted wisdom
teeth may also be indicated for removal. The dentist may
recommend this if the tooth is non-functional, interfering
with the bite, badly decayed, involved with or at risk for
periodontal disease, or interfering with restoration of an
adjacent tooth. Once again, every case is different and only
your dentist can determine if there is a reason for you to
have a tooth removed.
What should I do to prepare myself for surgery?
The
following are tips to help you prepare for your surgical
appointment.
1.
You may need to take a day
or two off work or school to give yourself time to
recover.
2.
Make sure not to eat or
drink anything six hours before your surgery.
3.
Arrange for a responsible
adult to drive you home after surgery. An escort is
mandatory for surgery. The patient must be escorted to the
office and the escort must stay at the office during the
surgery.
4.
Advise us if you have any
major medical problems or you are taking any
medications.
5.
Stop taking aspirin and
any other blood thinner after you consult with your primary
physician.
6.
Continue to take any blood
pressure medication, antibiotics, thyroid medications and so
on.
7.
Please advise us if you
are taking insulin or are diabetic for specific
instructions.
8.
Clothing - Wear loose,
comfortable clothing with sleeves that are easily rolled
up.
9.
Jewelry - Remove watches
and bracelets.
10.
Specific post-operative
instructions will be given to you after your surgery.
11.
A follow-up visit should
be scheduled one week after the surgery date to check your
healing progress.
How long is the surgery?
Expect the procedure
itself to last about an hour. But allow a two hours time
in our center. This time is allocated for preparation
and recovery as well.
How is the surgery done?
Wisdom tooth surgery is
usually performed with an IV anesthetic technique in our
center. Our state of the Art facility allows us to
perform almost all our impacted teeth removal in an office
setting. After medicines are given intravenously the
surgeon pushes the gum tissue out of the way thereby exposing
the tooth and the bone overlying it. Since the art to the
science is to remove the tooth with as little brute force as
necessary, the surgeon will carefully remove any bone in the
way. This is done with a high-speed instrument under water
irrigation. After the tooth is exposed, it usually requires
sectioning into pieces to be removed. Once again, the tooth is
removed with as little force as necessary and with as little
bone removal as possible. Sectioning the tooth accomplishes
this goal and protects important surrounding structures
(nerves and blood vessels). After the tooth is removed,
the gum tissue is repositioned back into it's proper place and
sutured. Sutures are dissolvable and do not require removal.
What should I
expect after a wisdom tooth is taken out?
The amount of discomfort
will depend on how easy the removal of the tooth was. There is
usually some swelling and discomfort for a few days
afterwards, and it is important to follow any advice you will
be given about mouthwashes etc, to help with the healing. Some
people also find homeopathic remedies helpful in reducing
discomfort. Usual pain-killers such as Tylenol, Advil, Motrin
or ibuprofen will usually deal with any pain. It is best to
stay fairly quiet and relaxed for 24 hours afterwards to make
sure there are no bleeding problems. There may be some
stitches to help the gum heal over - your dentist will
probably want to see you again about a week later to check on
the healing, and to remove any stitches.
What does it
cost?
Every procedure has a
different fee. The cost of surgery generally ranges from
about $265 to $350 per tooth, depending on whether a tooth is
covered by soft tissue or bone; more complicated extractions
can cost more. Add at least another $150 if the surgery is
done under general anesthesia. Dental insurance typically
covers at least part of the cost of surgery. Please make sure
to ask our staff prior to your appointment. It is also
your responsibility to bring any dental as well as major
medical insurances (if in US) with you. It is important
that you discuss costs and payment methods with our staff
before starting treatment.
What should I do
after surgery?
We'll ask you to rest for
15-20 minutes after your surgery in our center to be certain
all bleeding is under control. You may be given a prescription
for pain, swelling and antibiotics as well as instructions for
home recovery. Plan to rest at home for the remainder of the
day.
Do I need a
second opinion?
Many oral & maxillofacial surgeons as
well as general dentists say impacted, disease-free wisdom
teeth completely covered by bone and gum should be monitored,
not removed. Most also say there's no reason to remove wisdom
teeth that are completely erupted into normal position and not
causing problems. If you have good teeth, you should keep
them, as long as a dentist keeps an eye on your wisdom teeth.
Dont wait for them to hurt you before your next exam
appointment. If you have any doubts or lingering
concerns, get a second opinion. Opinions and expertise vary
among practitioners, and another dentist may very well give
different advice, such as monitoring the teeth for problems
rather than removing them.
Sometimes your wisdom
teeth are healthy and well positioned. But frequently they can
bring problems. Sometimes your dentist may recommend that you
have your wisdom teeth extracted even before problems develop
-- and the sooner, the better. That's because the younger you
are, the less likely there'll be complications with the
extraction.
If your dentist isn't
sure that your wisdom teeth will cause problems or if you
decide against having them removed, your dentist probably will
recommend that you have them evaluated and x-rayed
periodically -- just to be on the safe side.
Did our ancient
ancestors have as much impacted teeth?
Probably no. They
certainly did not todays means to take them out!
According to some scientist the human jaws are becoming
smaller over time. This is happening because the
children are maturing much faster today than in the past. An
excavation in 1990 of some graves in Griswold, Connecticut,
dated to the late 1600sl700 seems to confirm their research.
There were 13 children's remains discovered. Only one was
found with initials on the wood of the coffin. It read NB age
13 and was written in brass tacks.
When the teeth of the
lower jaw were examined at the Armed Forces Institute of
Pathology (AFIP) in Washington, D.C., the root and crown
development indicated that, by todays standards, these teeth
should have belonged to a female child of 9 1/2 years, or a
male child of 10 years, yet the child was 13. This may mean
that 300-400 hundred years ago a child took 13 years to reach
the stage that our children today do in 9 1/2 to 10 years.
This points to a rapid maturation today.
Wisdom teeth need more
space than can develop in our shortened jaw growth period.
Children are taller today, and mature earlier, probably
because of improved early nutrition. But the facial
bones need more than nutrition they need time.
It is this fact, that the
wisdom teeth are trying to erupt into a jaw space too small
for them, which causes many of the problems. Scientists
believe that there are other problems also with the eruption
of wisdom teeth, and that many people do not even develop
wisdom teeth today.
The Effect of
Wisdom Teeth (Third Molars) on the Bottom
Teeth
The effect of wisdom teeth on the lower
teeth is a topic of debate amongst dental professionals.
During the 1980's, the wisdom teeth were often blamed for
tooth movement after the braces were removed. In 1990, Dr.
Amin Ades, and several other authors published a research
article in the American Journal of Orthodontics and
Dentofacial Orthopedics 1990; 97: 323-35, called A long-term
study of the relationship of third molars to changes in the
mandibular dental arch. This article studied people who had
been out of retainers for an average time of 13 years and
concluded that the recommendation for lower third molar
removal with the objective of alleviating or preventing
mandibular lower front incisor irregularity may not be
justified. Recurring infections in the wisdom
tooth area, inadequate space on the jawbone for the wisdom
tooth itself, and wisdom teeth that are impacted or stuck
under the bone and pose a problem are still valid candidates
for removal.
Make your appointment online now
for consultation & evaluation!
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