What Are Wisdom Teeth?
Wisdom teeth, also known as third molars, typically develop last and are found at the back of the mouth behind the second molars. They usually finish developing during the teenage years or early twenties, a period often linked with maturity and gaining wisdom.
What Is An Impacted Tooth?
Most individuals typically grow 32 permanent adult teeth, but often their jaws are too small to fit the four wisdom teeth. When there isn't enough space for these teeth to come in properly, they become impacted, meaning they cannot erupt into the correct position for chewing and cleaning.
Types Of Impactions
We require a consultation to assess whether wisdom tooth removal would be beneficial for you. A panorex x-ray of your mouth and jaws will be taken to determine if your wisdom teeth are impacted, if there is enough space for them to come through, and the level of difficulty in removing them.
- Soft Tissue Impaction: The gum tissue does not have enough space to retract for proper cleaning of the tooth.
- Partial Bony Impaction: The wisdom tooth can partially erupt but cannot function properly in chewing and causes cleaning issues.
- Complete Bony Impaction: The tooth is completely embedded in the jawbone or requires complex surgical techniques for removal. It may be in a difficult position to remove due to jawbone and facial structure issues.
Why Should I Have My Wisdom Teeth Removed?
If your mouth does not have sufficient space for your third molars to properly come in, it can lead to various issues. It is recommended to have impacted wisdom teeth removed before their roots are fully formed, which can happen as early as 12 or 13 for some patients, while others may not need removal until their early twenties. Problems tend to arise more frequently after the age of 30. Not removing your wisdom teeth can result in potential issues such as:
Infection:
The most common clinical issue we face is pericoronitis, a gum infection that occurs around the wisdom tooth. When there is insufficient space for the tooth to fully emerge, the surrounding gum tissue can become inflamed and infected, causing ongoing pain, swelling, and challenges with eating and swallowing.
Cyst Formation:
Non-communicable diseases can also develop due to an impacted wisdom tooth. Cysts are fluid-filled sacs that form in the jawbone as a result of impacted teeth, gradually causing damage to nearby jawbone and sometimes teeth. Treatment can be challenging if wisdom teeth are not removed during adolescence. While uncommon, tumors can also be linked to the delayed removal of wisdom teeth.
Possible Crowding:
Having impacted wisdom teeth can lead to crowding of your teeth, especially in the front, particularly the lower front teeth. This is often seen after a patient has had braces. There are various reasons why teeth may become crowded after braces or in early adulthood, and impacted wisdom teeth could be one of them. Even if you are not currently experiencing any issues, it is recommended to have them removed to prevent potential long-term damage to your teeth, gums, and jawbone.
Damage to Adjacent Teeth:
When there isn't enough space to properly clean around the wisdom tooth, it can negatively impact the tooth in front of it, the second molar. This can lead to gum disease, bone loss around the tooth, and decay.
What If I Don’t Have My Wisdom Teeth Removed As A Teenager Or Young Adult?
As wisdom teeth continue to grow, the roots lengthen and the jawbone becomes denser. Removing impacted wisdom teeth in your thirties, forties, or later can result in a longer recovery time and a higher risk of complications. Managing these complications can be more challenging and less predictable compared to younger patients. Healing may be slower and the likelihood of infection may increase.
If your impacted wisdom teeth are not extracted during your teenage years or early twenties and they are fully impacted in the bone, it may be best to wait until a localized issue arises, such as cyst formation or localized gum disease and bone loss. Generally, you will experience a quicker, more predictable recovery with fewer complications if you undergo treatment in your teens or early twenties.
What Happens On The Day They Are Removed?
Most individuals opt to be sedated during the removal of their wisdom teeth to avoid experiencing the procedure. Anesthesia options will be discussed during your consultation to ensure your comfort during outpatient surgery. Our office staff is trained and experienced in providing various types of anesthesia in a safe environment with modern monitoring equipment.
On the day of your procedure, you will receive medications to reduce post-operative pain and swelling. It is important to have a parent or responsible adult accompany you to the office and stay with you for the rest of the day. The procedure typically takes 30 to 60 minutes, with a total office visit lasting about 90 minutes.
Advancements in medicine and technology allow for a quicker healing process and minimal discomfort after wisdom tooth removal. Strict sterilization and infection control measures are always followed.
Before your surgery, it is crucial to refrain from eating or drinking (except for prescription medications with a sip of water) for at least 6 hours. Failure to follow these guidelines may result in rescheduling your procedure.
You may receive a prescription for pain medication at your consultation, which can be filled in advance for your convenience. If sedation is required, an IV will be placed in your arm for optimal medication delivery. Local anesthesia will be administered for comfort before you travel home to rest.
Stitches, if needed, will dissolve on their own in 3 to 5 days. Swelling and gum sensitivity are normal and will subside in a few days. Pain medication may be necessary once the local anesthesia wears off, starting with non-narcotic options like ibuprofen. Clear liquids are recommended for your post-operative diet, avoiding dairy products to prevent nausea.
If antibiotics are prescribed and you take birth control pills, be aware that the pills may become less effective. Take necessary precautions to prevent pregnancy.
What Happens Afterwards – What Will I Feel Like?
After surgery, you may experience some minor bleeding and pain on the first day. It is recommended to cover your pillowcase to avoid getting blood on it. Pain levels can vary from mild discomfort to severe pain depending on the individual's reaction to surgery.
Swelling is expected after surgery, peaking on the second day and starting to resolve on the third day. Using ice on the first day can help reduce swelling. Even if it is uncomfortable, it is important to apply ice to your face on the first day.
On the third day, you may notice stiffness in your jaw muscles and difficulty opening your mouth normally. Applying moist heat on the second and third day can help relax your muscles. It is advisable to limit activities for a few days and follow post-operative instructions closely for comfort during the initial recovery period.
Allow your body time to heal before resuming a busy schedule. Most patients start feeling better and on the road to recovery within 3 to 5 days.
Are There Any Problems?
It is important to be aware that complications or unexpected results can occur with any medical procedure, including Wisdom Tooth Extraction. Some potential complications include damage to the sensory nerve, sinus communication, infections, and dry sockets.
Following the procedure, our team will provide you and your escort with post-operative instructions. It is crucial to closely follow these instructions to ensure your comfort during the recovery process. If you were sedated, you may feel drowsy when leaving the office.
Most patients find it beneficial to rest at home without engaging in physical or academic activities for a few days after the procedure. It is important to note that unexpected results such as delayed healing, infection, or post-operative numbness or tingling in the lip, chin, or tongue may occur. Your oral surgeon will discuss any relevant post-operative events and address any concerns during your follow-up visit.
Damage to Sensory Nerve:
One of the main concerns during wisdom teeth removal is the proximity of a nerve in the lower jawbone that provides feeling to the lower lip, chin, and tongue. This nerve is often close to the roots of the lower wisdom teeth. Removing these teeth between the ages of 12 and 18 can result in shorter roots, reducing the risk of nerve damage. However, in some cases, especially with older patients, the nerve may still be injured during extraction.
After the local anesthesia wears off, you may experience tingling or numbness in the lower lip, chin, or tongue. This is usually temporary and will gradually improve over weeks or months. In rare cases, there may be a permanent alteration in sensation similar to the effects of local anesthesia. It is important to be aware of this possibility before undergoing surgery.
Sinus Communication:
The upper wisdom teeth are located near the sinuses, and removing them can sometimes create a connection between the mouth and sinus. This is more likely to happen if the teeth are removed at a young age when the roots are not fully formed. In most cases, this opening will close on its own, but we may provide specific instructions, such as avoiding blowing your nose for a few days after the surgery. Instead, you can gently wipe your nose if needed.
If you need to sneeze, do so with your mouth open into a tissue to prevent putting pressure on the sinus area, which could disrupt the healing process. If you notice any issues with the healing process, please contact our office. In rare cases, an additional procedure may be necessary to close the opening.
Dry Sockets:
Dry sockets remain the most frequent issue patients face after dental surgery. They occur when the blood clot in the empty tooth socket is lost prematurely. This is more common in smokers and those on birth control pills. Typically, dry sockets occur in the lower jaw between the third and fifth day after surgery, causing a persistent, deep ache on the affected side. Patients may initially feel the pain in the ear, spreading down towards the chin.
Symptoms often start in the middle of the night and your pain medication may not be effective. Treatment may involve changing your prescription or using a medicated dressing in the empty tooth socket to reduce pain and protect it from food particles. The dressing can provide relief for 24-48 hours and may need to be changed every day or two for 5-7 days. Dressings are usually removed once you have been pain-free for 2-3 days.
The dressing is not for healing, but only for pain control. If medication is managing the pain, the socket will heal without a dressing. After the dressing is removed, an irrigation device may be given to prevent food particles from getting stuck in the extraction site.
Infection:
Sometimes, post-surgery infections can occur. In such cases, you may need to come in for an office visit and clinical examination. Often, a one-week course of antibiotics can effectively treat the infection. If it persists, the affected area may need to be drained and cleaned. Other temporary issues you may encounter after surgery include jaw stiffness, chafing around the lips, facial bruising, and slight bleeding from the extraction sites. Our post-operative instruction sheet should address many of these common concerns. If you have any other questions or concerns, please do not hesitate to contact our office.
What Does The Procedure Cost And Is It Covered By Insurance?
During your consultation, we will discuss your specific situation in more detail. Feel free to ask any questions you may have. If you have new questions after the consultation, please contact the doctor's office to speak with one of the patient care coordinators.
Oral Examination
An oral examination and x-rays of the mouth can be used by Dr. Khayat to assess the position of wisdom teeth and identify any potential issues. Early evaluation and treatment have been shown to lead to better outcomes for patients, typically starting in the teenage years. All outpatient surgeries are performed with appropriate anesthesia for patient comfort, and Dr. Khayat is skilled and experienced in providing different types of anesthesia.
Removal
The extraction of wisdom teeth can be done using local anesthesia, laughing gas, or general anesthesia. Before the procedure, we will discuss these options and any potential risks, such as nerve damage or sinus complications. After the teeth are removed, the gums will be sutured, and you will be given gauze to control bleeding. You will be monitored in our office until you are ready to go home. Upon discharge, you will receive postoperative instructions, pain medication, antibiotics, and a follow-up appointment for suture removal. If you have any questions, please call us at Wisdom Oral Surgery & Dental Implants Office. Our services prioritize safety, with modern monitoring equipment and experienced staff in anesthesia techniques.
