WISDOM TEETH
WHAT ARE WISDOM TEETH AND HOW TO CARE FOR THEM?
Wisdom teeth are a name commonly given to third molars, which are usually the last teeth to develop. They emerge in the back of your mouth behind the second molars. They develop fully during the middle teenage years or early twenties. The idea was that this time in a person’s life signaled the onset of maturity and the gaining of wisdom.
WHAT IS AN IMPACTED TOOTH?
Most people develop 32 permanent adult teeth. However, in many cases their jaws are too small to accommodate the four wisdom teeth. If these final teeth cannot erupt due to inadequate space, we call them impacted. In other words, they could not erupt into the property position for chewing and cleaning.
VARIOUS KINDS OF IMPACTIONS
A dental surgeon can determine whether you would benefit from wisdom teeth removal, using a panorex – a special x-ray of your mouth and jaws. This will reveal whether the wisdom teeth are impacted, whether there is room for them to erupt normally, and how difficult removal would be.
We categorize these as follows:
Soft Tissue Impaction – When this happens the gum tissue cannot retract for cleaning the tooth adequately because of a lack of room.
Partial Bony Impaction – The tooth can partially erupt, but not sufficiently to function as it should in the chewing process. It also presents cleaning difficulties.
Complete Bony Impaction – The jaw lack any space at all for the tooth to erupt, and it remains embedded in the jawbone, or might be only partially visible. These require complex surgical technique to remove. In certain cases the impacted wisdom tooth by lie in an unusual position and become difficult to remove. Sometimes the shape or the size of the jawbone and other facial structures complicate removal greatly.
WHY SHOULD PEOPLE HAVE THEIR WISDOM TEETH REMOVED
Not having enough room in your mouth for the third molars to erupt completely can cause a number of problems. It is much better to have impacted wisdom teeth removed before the root structure has developed fully. That might be as 12 or 13 years of age for some or may not happen until the early twenties for others. A number of problems arise much more frequently after the age of 30 if the wisdom teeth are not removed, including:
Infection:
Pericoronitis is a localized gum infection and the most frequent clinical problem we encounter. Lack of enough room for the tooth to erupt totally causes the gum tissue around the tooth to become irritated and infected; the result is recurrent pain, swelling and problems with chewing or swallowing – or both.
Cyst Formation:
Impacted wisdom teeth can bring non-infectious diseases, as well. Cysts – fluid-filled sack that develop inside the jawbone. Over time they expand and destroy adjacent jawbone and can even harm teeth on occasion. These cysts become very difficult to treat in the case the wisdom teeth are not removed during the teenage years. Rare incidents of tumors can be associated with a delay in the removal of wisdom teeth.
Possible Crowding:
Impacted wisdom teeth create a situation of crowding of your teeth. Unfortunately this is most clearly seen in the front teeth, mostly on the lower row of teeth. This is especially noticeable after a patient has had braces. Crowding of teeth after braces or in early adulthood stems from a number of factors, primarily from non-extracted wisdom teeth. Outside of an active problem, the reason for removal is to prevent long-term damage to your teeth, gums and jawbone.
Damage to Adjacent Teeth:
Insufficient room to clean around the wisdom because it pushes against the tooth in front affects the second molar adversely and can lead to gum disease, bone loss around the tooth along with decay.
WHAT HAPPENS WHEN PEOPLE DON’T HAVE WISDOM TEETH REMOVED EARLY ENOUGH?
Normal tooth growth, particularly with molars, involves lengthening of the roots while the jaw bone becomes more dense. When extraction of impacted wisdom teeth have to be removed later than age 30, the post-operative procedure lasts longer and can involve increased complication rates. Clearly complications cause more difficulties than with younger patients and the course becomes less predictable. Recovery and healing take longer with a greater chance of infection.
In general healing is more rapid and more predictable with fewer complications when extraction is done in the teens or early twenties.
If you have not had impacted wisdom teeth removed by your early twenties and they are now completely impacted in bone, you probably ought to wait until a localized complication arises, such as cyst formation or localized gum disease with bone loss. An oral surgeon can consult with you to advise you whether postponing removal is in your best interest.
WHAT HAPPENS WHEN THEY ARE REMOVED
As you consult with the surgeon you will see the various options for anesthesia to choose from. Many patients want to be unaware of the experience while having wisdom teeth removed and choose to be totally sedated.
The office staff at Desert Valley Oral Surgery has superlative training, licensing and experience to provide all types of anesthesia, offered in the safest environment possible, using the most modern monitoring equipment. The Board of Dental Examiners inspects the Surgical Care Team, our office facilities and doctors on a regular basis to ensure the highest level of safety and competence.
Medications for minimizing post-operative pain and swelling will be available on the day of your procedure. You should have a parent or responsible adult accompany you to the office and stay with you for the remainder of the day. You will spend around 90 minutes in the office, with the procedure taking between a half hour and an hour to complete. Technology and medical knowledge have advanced to the point that you undergo wisdom tooth removal with rapid healing and minimal post-operative discomfort. We use state of the art sterilization and infection control techniques throughout.
It is essentially important that you eat or drink nothing at least six hours or longer prior to the surgery – other than necessary prescription medications with a sip of water. If you have anything in your stomach you increase your risk for serious anesthetic complications such as nausea and vomiting. You should not attempt to cut this close by having a large meal exactly six hours prior. If you have eaten too much too recently we will have to reschedule the procedure.
At the time of your consultation appointment we may write a prescription for pain medication that you can fill in advance of the surgery to have it ready when you might need it.
We will make sure you are as comfortable as possible from the beginning. If you will be sedated, we generally place the IV in your left arm in a nearly painless procedure that creates best delivery of your medication. You will receive local anesthesia afterwards to make your recovery as comfortable as possible as you travel home to rest. You will be sleepy for most of the rest of the day.
ON THE DAY OF YOUR TREATMENT:
You will need to have an adult with you when have your wisdom teeth removed and with you for the remainder of the day – someone who can drive you home following the surgery and care for you as you recover.
THE DAY OF TREATMENT
It is very important that you do not eat or drink anything prior to your surgery. Anything in your stomach increases the risk for serious anesthetic complications.
Any stitches used in your surgery will dissolve within three to five days on their own without you needing to have them removed. During normal recovery you might experience a sensation of your gums feeling swollen, or pulling away from your teeth. This will only last a few days.
The local anesthesia we give you following surgery will wear off in a few hours. You should use non-narcotic anti-inflammatory medications like ibuprofen first in case they treat your pain well enough. If that is not enough you can use the prescription pain medication. In some cases the local anesthesia might last until the following day; you don’t need to worry about injury to a nerve, this is an individual response to the anesthesia.
Your diet following the surgery is best when you start with clear liquids such as jello and broths. You can gradually increase to more substantial food as your body permits. However, dairy products on the day of surgery may cause nausea and vomiting as they interact with the anesthetic and pain medication. You will want to avoid yogurt, ice cream or milkshakes until the day after.
Please note that birth control pills might become ineffective if you take antibiotics; if you are taken them, you will want to take appropriate precautions.
WHAT HAPPENS AFTERWARDS – WHAT WILL I FEEL LIKE?
For the first or second day after surgery you may notice minor bleeding and pain. If so, placing a towel over your pillowcase will help prevent getting blood on it. Each person reacts differently to surgery, and post-operative pain can range from mild discomfort to severe pain.
You will probably experience swelling following the surgery, which, if it occurs, will be largest on the second day and begin to go down from there. Putting ice on your jaws on the first day will reduce the amount of swelling you experience. Even if having the icepack next to your skin is uncomfortable, you will enjoy much less swelling over the next few days. Of course you don’t put ice directly on your skin, but use it in a covering such as a commercially available icepack, a towel or some other cloth.
On the third day you will find that your jaw muscles are stiff, making it difficult to open your mouth normally. Applying moist heat to your face when this happens will allow your muscles to relax so that you can open wider.
It might be good to limit your activities for a few days and focus on rest and relaxation for better recovery. Please follow the post-operative instructions we give you closely. This will help you remain as comfortable as possible during the first days as you recover. Normally three to five days allows enough healing to resume normal social, academic or athletic activities. There will be, of course, individual differences, but three to five days works for most people.
ARE THERE ANY PROBLEMS?
Our assistants will review your post-operative instructions with your escort following the procedure (you will not be feeling up to it). It is important that you follow these instructions closely: doing so will make you most comfortable over your recovery period. With anesthesia you will feel comfortable and drowsy after the procedure, which is why you have an escort. You will want to go home and rest with no physical or school activities scheduled for a few days.
After the procedure, our assistants will review your post-operative instructions with your escort. We ask that you follow these instructions closely, as they will make you most comfortable following your procedure. If you were sedated, you will be comfortable and drowsy when you leave the office. Most patients prefer to go home and rest with no other physical or scholastic activities planned for a few days.
Complications or unanticipated results can arise in any medical procedure. In the case of wisdom tooth extraction, these can include damage to the sensory nerve that lets you feel with your lips and tongue, sinus communication, infections and dry sockets. Possible delayed healing, infection and post-operative numbness or tingling in your lip, chin, or tongue can occur. The oral surgeon will review relevant post-operative events with you and answer any questions during your follow-up office visit.
Sensory Nerve Damage:
A nerve within the lower jawbone supplies feeling to your lower lip, chin and tongue, and often lies close to the roots of the lower wisdom teeth. Between the ages of 12 and 18 these roots are shorter and not so close to the nerve. On occasion the nerve can be injured – especially with older patients. You may notice a tingling or numbness in the lower lip, chin or tongue. This is usually temporary and will cure itself over a period of weeks or months. Rarely does this result in a permanent condition, but we want you to be aware of this possibility before consenting to surgery.
Sinus Communication:
Your sinuses lie close to your upper wisdom teeth and removing the teeth might create an opening between your mouth ant the sinus. As with the lower teeth, removal at an earlier age when the roots are not fully developed reduces the chances of this happening. If an opening appears it will usually close spontaneously, but you will want to follow our instructions, such as not blowing your nose for a couple of days following the surgery – wipe but don’t blow. If you have to sneeze, keep your mouth open and do it into a tissue. You want to avoid any pressure to the sinus area, which may dislodge the healing blood clot. If you find this condition occurring following surgery, please contact us. Only rarely will an additional procedure be necessary to close the opening
Dry Sockets:
The most common problem following dental surgery is dry sockets, which arises due to premature loss of a blood clot in the empty tooth socket. Evidence indicates this happens most often with people who smoke or are taking birth control pills. This condition can affect both jaws but occur most often in the lower jaw on the third to the fifth day. If so, you would feel a deep, dull, continuous aching in the affected area or areas. You might notice it first starting in the ear as it radiates down toward the chin.
The symptoms often begin in the middle of the night and the pain medication you are taking may not help. To treat this, we might change your prescription. It might also help to place a medicated dressing in the empty tooth socket to decrease the pain and protect the open socket from food particles. One dressing is usually good for reducing pain for a day or two, so you would change the dressing as needed for five to seven days. When you have bee pain free for two or three days, you can discard the dressings.
The dressings do not accelerate healing, they are for pain control. The socket will heal on its own, but the medication alleviates the pain. Possibly you will receive an irrigation device to help you keep food particles from lodging in the socket when you are finished with the dressings.
Infection:
As with any surgery, post-operative infections can occur. If so, contact us to schedule an office visit and clinical examination. Quite often a one-week course of antibiotics will resolve the situation. If not, we will drain and clean the area.
Other temporary problems following extraction might include stiffness in the jaws, chafing around the corners of your lips, facial bruising and blood oozing from the extraction sites.
Reading the post-operative instruction sheet we give you will answer most questions – otherwise, please feel free to call us.
COST OF THE PROCEDURE AND INSURANCE COVERAGE
A number of factors determine the fee for your treatment, including how difficult it is to remove your teeth and the kind of anesthesia will work best for you. The surgeon will review your x-rays during your consultation appointment and create an examination to determine the best option for anesthesia. Only then can we provide you an accurate estimate.
As for insurance, every company works with a different policy regarding the how much coverage is available for surgical procedure. We will work to help you get maximum insurance coverage for your treatment.
GETTING QUESTIONS ANSWERED BEFORE IT STARTS
During your consultation we will discuss your specific situation in detail. Please ask any questions you may have. If following the consultation you have new questions, you are welcome to call the doctor’s office to discuss them with any of the patient care coordinators.
ORAL EXAMINATION
The oral examination and dental x-rays allows the surgeon to evaluate the position of the wisdom teeth and pinpoint any present or potential problems in the future. Early evaluation and treatment results in much better outcomes, a fact verified by scientific studies. This first evaluation should come in the mid-teenage years and can be made by their dentist, orthodontist or by and oral maxillofacial surgeon.
We perform all outpatient surgery under medically appropriate anesthesia for greatest patient comfort. Our surgeons are trained, licensed and have long-time experience in applying various kinds of anesthesia or patients.
REMOVAL
Typically wisdom teeth are removed under local anesthesia, nitrous oxide/oxygen analgesia (laughing gas) or general anesthesia. We will discuss these options as well as the surgical risks as discussed earlier on this page. Following tooth extraction you receive sutures in the gum. When you bit down on the gauze place in your mouth you help control the bleeding. You will then rest until offer staff determines you are ready to be taken home. The postoperative kit you receive upon discharge includes instructions, a prescription for pain medication, antibiotics and a scheduled follow-up appointment for a week out.