By the age of 18, the average adult has developed 32 teeth, 16 teeth in the top jaw (maxilla) and 16 teeth in the bottom jaw (mandible). Each tooth in the mouth has a specific name and function. The teeth in the front of the mouth (incisor, canine, and bicuspid teeth) are ideal for grasping and biting food into smaller pieces. The back teeth (molar teeth) are used to grind food into a consistency suitable for swallowing.
The size of the average mouth is able to hold only 28 teeth. It can be painful when 32 teeth try to fit in a mouth that holds only 28 teeth. The four other teeth are your third molars, also known as "wisdom teeth."
Wisdom teeth are the last teeth to erupt within the mouth. When they align properly and gum tissue is healthy, wisdom teeth do not have to be removed. Unfortunately, this does not generally happen. Extraction of wisdom teeth is necessary when they are prevented from properly erupting into the mouth. They may grow sideways, partially emerge from the gum, and even remain trapped beneath the gum and bone. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to successfully erupt.
These poorly positioned impacted teeth can cause many problems. When they are partially erupted, the opening around the teeth allows bacteria to grow and will eventually cause an infection. The result: swelling, stiffness, pain, and illness. Pressure from the erupting wisdom teeth may move other teeth and disrupt the orthodontic or natural alignment of teeth. The most serious problem occurs when tumors or cysts form around impacted wisdom teeth, resulting in the destruction of the jawbone and adjacent healthy teeth. Removal of the offending impacted teeth usually resolves these problems. Early removal is recommended to avoid such future problems and to decrease the surgical risk involved with the procedure.
In general, surgical risks increase with age. Your oral surgeon may recommend scheduled periodic clinical and radiographic exams if the risks of removing the wisdom teeth outweigh the risks of monitoring them.
Wisdom teeth that do not erupt properly can cause numerous problems. These problems include:
Gum Disease - A wisdom tooth that partially erupts through the gum tissue can harbor problem-causing bacteria in the space between the second and third molar, causing bone loss and damage to the second molar. The overlying gum tissue may also become swollen and irritated due to a localized minor infection - called pericoronitis.
Crowding - A wisdom tooth has eruptive force that can push on adjacent teeth causing them to become crooked.
Cavities - A wisdom tooth may be hard to clean due to partial gum tissue coverage or lack of space causing it or the adjacent second molar to become decayed.
Poor position - A poorly positioned wisdom tooth may rub on the cheeks causing irritation and pain.
Cyst development - All teeth develop from a hollow ball of tissue called a follicle. As the tooth erupts through the gum tissue, the follicle disappears. If the wisdom tooth remains impacted (“stuck” within the gum and bone), cysts and tumors can develop from the follicle. These cysts and tumors can destroy jawbone and teeth.
Most dentists will evaluate your wisdom teeth radiographically around 16 years of age. Depending on the development of these teeth and the anticipated lack of space, your dentist may refer you to an Oral and Maxillofacial Surgeon for consult and removal between 16 and 21 years of age. Around this time the roots are not completely developed and the jawbone is not as dense, making removal easier and with less risks. As a person ages, the teeth become anchored in the denser jawbone making extraction more difficult.
As with any surgery there are risks to wisdom tooth removal. The infection rate after routine wisdom tooth removal is less than 5%. Infections usually respond to treatment with antibiotics. There also is a risk of damage to teeth adjacent to the wisdom teeth. A tooth may be chipped or, in rare cases, a filling can be loosened. Small pieces of the tooth or root may be left behind if the doctor feels it would cause more trouble to remove the piece than to leave it.
In the upper jaw, the wisdom teeth form close to the sinus cavities adjacent to your nose. Removal of some wisdom teeth can leave a small opening between the sinus and the mouth. This opening will usually heal when assisted by careful postoperative care but in rare cases the gum tissue may need to be repositioned to close the opening.
The most common postoperative complication in the lower jaw is the development of a “dry socket”. A dry socket occurs when the tooth socket either fails to form a blood clot, or the clot disintegrates or becomes dislodged resulting in delayed healing. The specific cause of dry socket is not known. Dry sockets usually occur on the third to fifth postoperative day and will be associated with distinct persistent throbbing pain in the jaw that often radiates toward the ear and forward along the jaw. Dry sockets feel like an earache or may cause adjacent teeth to hurt. Symptoms may get worse at night, and pain medications seem to offer limited relief. If a dry socket occurs, treatment usually involves the placement of a medicated dressing into the tooth socket. The dressing needs to be changed every few days until the discomfort is gone.
In the lower jaw there is a small risk of numbness to your lip, chin, or tongue. The nerve which supplies feeling to your lip and chin runs within the lower jaw and can be located close to the roots of the tooth. Removal of lower wisdom teeth can cause tingling or numbness of the lip and/or chin in about 1 in 200 people. This condition will usually resolve within a few weeks to a few months. In very rare cases the condition could be permanent. In any case, please ask your doctor about any questions or concerns you may have.
All outpatient surgery is performed under appropriate anesthesia to maximize patient comfort and safety. The oral surgeons at Centrasota Oral and Maxillofacial Surgeons have specialized training, licensing, and experience to provide various types of anesthesia, allowing patients to select the best alternative. The anesthesia services are provided in an environment of optimum safety, utilizing modern monitoring equipment and staff experienced in all applicable anesthesia techniques.
Depending on the potential difficulty of necessary extractions and your medical health, there are several anesthetic options to use when you have your wisdom teeth removed. The majority of healthy patients receive intravenous (IV) sedation or a general anesthetic. IV medications are given to deeply sedate and induce sleep, making you comfortable and unaware of the procedure. Local anesthetic is also administered to keep you comfortable during and after the procedure. Recovery after an IV anesthetic may leave a patient drowsy for the majority of the day; therefore, patients are not allowed to drive a vehicle for 24 hours.
Nitrous oxide ("laughing gas") may be a recommended anesthetic option for patients who are medically compromised, or for patients with wisdom teeth that are less difficult to remove. This gas relaxes you and may take your mind off the procedure but does not put you to sleep. Local anesthetic will also be given to keep you comfortable during the procedure.
The option of receiving only local anesthesia may also be considered and effective in appropriate situations.
Your surgeon will recommend the technique which will ensure your comfort and safety, based on your age, health history and the perceived difficulty of your case.
In any case feel free to discuss these options with your oral surgeon.
If you are planning on IV anesthesia, you should have nothing to eat or drink, including water, for at least six (6) hours before the procedure.
Patients who are under age 18 need to have their parent or legal guardian be present for the informed consent.
A responsible adult needs to come with you, stay in the lobby for the entire procedure, be present for post-operative instructions, and drive you safely home.
Wear loose fitting clothing so your sleeves can easily be pulled up.
If you wear contact lenses, please wear your glasses the day of your appointment.
To provide you with a better understanding of wisdom teeth, we have provided the following multimedia presentation. Many common questions pertaining to wisdom teeth are discussed.
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For a brief narrated overview of the wisdom tooth removal process, please click the image below. It will launch our flash educational MiniModule in a separate window that may answer some of your questions about wisdom teeth.
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Our services are provided in an environment of optimum safety that utilizes modern monitoring equipment and staff who are experienced in anesthesia techniques.