Wisdom Teeth

By the age of 18, the average adult has 32 teeth; 16 teeth on the top and 16 teeth on the bottom. Each tooth in the mouth has a specific name and function. The teeth in the front of the mouth (incisors, canine, and bicuspid teeth) are ideal for grasping and biting food into smaller pieces. The back teeth (molar teeth) are used to grind food up into a consistency suitable for swallowing.

The average mouth is made to hold only 28 teeth. It can be painful when 32 teeth try to fit in a mouth that holds only 28 teeth. These four other teeth are your third molars, also known as "wisdom teeth."

Why Should I Have My Wisdom Teeth Removed?

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. The extraction of wisdom teeth is necessary when they are prevented from properly erupting within 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. The 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 the impacted wisdom teeth, resulting in the destruction of the jawbone and 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.

Oral Examination

With an oral examination and x-rays of the mouth, Dr. Ibañez can evaluate the position of the wisdom teeth and predict if there are present or may be future problems. Studies have shown that early evaluation and treatment result in a superior outcome for the patient. Patients are generally first evaluated in the mid-teenage years by their dentist, orthodontist or by an oral and maxillofacial surgeon.

All outpatient surgery is performed under appropriate anesthesia to maximize patient comfort. Dr. Ibañez has the training, license and experience to provide various types of anesthesia for patients to select the best alternative.

Removal

In most cases, the removal of wisdom teeth is performed under local anesthesia, laughing gas (nitrous oxide/oxygen analgesia) or general anesthesia. These options, as well as the surgical risks (i.e., sensory nerve damage, sinus complications), will be discussed with you before the procedure is performed. Once the teeth are removed, the gum is sutured. To help control bleeding, bite down on the gauze placed in your mouth. You will rest under our supervision in the office until you are ready to be taken home. Upon discharge, your postoperative kit will include postoperative instructions, a prescription for pain medication, antibiotics, and a follow-up appointment in one week for suture removal. If you have any questions, please do not hesitate to call us at 434-295-0911.

Our services are provided in an environment of optimum safety that utilizes modern monitoring equipment and staff who are experienced in anesthesia techniques.

What 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.

Why Should I Have Them Removed?

Although most people develop and grow 32 permanent, adult teeth (16 in the upper and 16 in the lower jaw), many do not have enough room in their mouth for all of these teeth to completely erupt. Since the wisdom teeth are the last to develop, they will not have enough room to adequately erupt into the mouth to become fully functional teeth. This lack of room or space can result in a number of harmful effects on your overall dental health. When 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 jawbone 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.

Partial 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 others.

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 removal techniques.

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.

We 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.

So, Do I Really Have To Have Them Removed?

In most cases the absolute answer is no. Unless you have been told that you have a life-altering disease process (which is unlikely), you don’t have to do anything until or unless YOU chose to do so. This is not critical, life-saving, emergency medical treatment. It is elective. We understand, however, that we can identify problematic patients early in their teens and treat them when the impact of the surgery is minimal and their ability to recover is at its maximum.

What 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.

What 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.

If I Decide to Do It, When Should I Have Them Removed?

There is probably never a good time to undergo an elective procedure such as wisdom teeth removal. We recommend that the surgical appointment doesn’t conflict dramatically with school activities. The most ‘popular’ times for wisdom teeth removal is during the summer and school vacations. The bottom line is that with adequate preparation, any time will work for most people IF they have planned accordingly in advance.

What Happens On The Day They’re Removed?

First of all, you need to decide if you will be sedated (‘go to sleep’). Most people clearly prefer to be unaware of the experience when they have their Wisdom teeth removed. You will be provided with appropriate anesthesia options for you at your consultation.

On the day of your procedure, you will take medications to help minimize post-operative pain and swelling. We ask that a parent or responsible adult accompanies you to the office, where they must remain during the entire procedure and they should plan on staying with you the rest of the day. Your procedure will take about an hour and you will probably be in the office for 1 ½ -2 hours. Our surgical assistants will review your post-operative instructions. When you leave the office you will be comfortable and drowsy. Most patients prefer to go home and rest with no other physical or scholastic activities planned for a few days.

All outpatient surgery is performed under appropriate anesthesia to maximize your comfort. We have the training, license, and experience to provide various types of anesthesia to allow patients to select the most appropriate alternative. These services are provided in an environment of optimum safety, utilizing modern monitoring equipment and staff experienced in anesthesia techniques.

What Happens Afterwards - - - What Will I Feel Like?

Most of the time you will want to maintain a low profile for a few days. We ask that you follow your post-operative instructions closely as they will make you most comfortable during the first few days following your procedure. Please allow the time to let your body begin healing before resuming an active social, academic, or athletic schedule. Most patients feel like they are over the hump in 3-5 days.

Are There Any Problems?

As with any medical procedure, there can be complications or an unanticipated result that you should be aware of:

Anatomy

There 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 Novocaine. 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. We 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. The most common problem encountered following surgery of any kind is infection. 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.

Other temporary problems you may experience in the postoperative period include stiffness of the jaws, chafing around the corners of your lips, facial bruising, and blood oozing from the extraction sites. The postoperative instruction sheet we will provide should answer many of the questions related to these more common concerns. If not, don’t hesitate to call the office.

What Are Dry Sockets?

Dry sockets continue to be the most common problem people experience following wisdom tooth surgery. They arise due to premature loss of a blood clot in the empty tooth socket and affect approximately one out of five patients. This seems to occur with greater frequency in people who smoke or are taking birth control pills. While both jaws can be affected, they usually occur in the lower jaw on the third to fifth day. They cause a deep, dull, continuous aching on the affected side(s). Patients may first notice the pain starting in the ear radiating down towards the chin. It frequently begins in the middle of the night, and the Motrin medication usually doesn’t help. Treatment involves placing a medicated dressing in the “empty” tooth socket. This will help decrease the pain and protect the socket from food particles. The effectiveness in alleviating the pain lasts for 24-48 hours and usually will require dressing changes every day or two for five to seven days. Dressings usually are removed when you have been pain free for 2-3 days. The dressing doesn’t aid in healing. The only reason to place a dressing is for pain control. If Motrin® (ibuprofen) is controlling the pain, the socket will heal without a dressing. An irrigation device can be given to you to help keep food particles from lodging in the extraction site following removal of the dressing.

What Does It Cost - - -And Will My Insurance Cover It?

Because of the different types of impacted wisdom teeth, along with different anesthesia options, it is impossible to give you a realistic estimate of what our services will cost until we have reviewed your x-rays. Every insurance company has a different policy regarding the extent of coverage for a given surgical procedure. We encourage you to check with both your medical AND dental insurance carrier to determine your coverage and out of pocket liability.

What If I Have Questions Before Surgery?

We recognize that having your Wisdom teeth out is NOT something you really want to do. We also realize that with an active schedule there is never a really good time to have this done. If this information, combined with information you receive at your consultation appointment doesn’t answer all of your questions, please call our offices to speak to one of our Patient Care Coordinators.

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	Wisdom Teeth - To Be Or Not To Be Facts you need to know about these curiously named teeth. They are so-called because a moderate amount of wisdom is supposedly achieved at about the same time these teeth typically make their appearance. This article will review the problems associated with wisdom teeth and whether or not they should be removed... Read Article