What are Wisdom Teeth?

         Wisdom teeth, or third molars, are the last teeth to develop and appear in the mouth behind the upper and lower second, or 12-year, molars. They are called “Wisdom teeth” because they usually appear during a person’s late teen or early twenties, which has been called the “age of wisdom.”

Impacted Wisdom Teeth

     When a wisdom tooth is blocked from erupting or coming into the mouth normally, it is termed “impacted.” Nine out of ten people have at least one impacted wisdom tooth resulting from a lack of space in the mouth.

Impacted teeth can lead to such a pain infection (fig. a) and crowding of, or damage to, adjacent teeth (fig. b). More serious problems can occur if the sac that surrounds the impacted tooth fills with fluid and enlarges to form a cyst (fig. c). This enlargement can hollow out the jaw and result in permanent damage to the adjacent teeth, Jawbone and nerves. In rare cases, if the cyst is not treated, a tumor may develop from the walls of the cyst and a more involved surgical procedure may be required to remove it.

Many problems with wisdom teeth can occur with few or no symptoms, so there can be damage even without your knowing it. A recent study sponsored by the American Association of Oral and Maxillofacial Surgeons and the Oral and maxillofacial Surgery Foundation finds that wisdom teeth which have broken through the tissue and erupted into the mouth in a normal, upright position may be as prone to disease as those wisdom teeth that remain impacted.

Treatment of impacted wisdom teeth involves their removal using special surgical techniques appropriate for each individual case. Your oral maxillofacial Surgeon is the dental specialist trained in the removal of wisdom teeth. Following dental school, oral and maxillofacial Surgeons complete four or more years of training in a hospital based surgical residency that includes rotations through multiple Specialties that may include internal medicine, general surgery, anesthesiology, otolaryngology and others.

 

Most wisdom tooth extractions are performed in the oral and maxillofacial surgery office under local anesthesia. Your oral and maxillofacial surgeon will discuss the anesthetic option that is right for you.

The relative ease with which a wisdom tooth may be removed depends on several conditions, including the position of the tooth and root development. Impacted wisdom teeth may require more involved surgery. Usually surgery will take up to one hour, although this varies by case. After surgery you will spend some time “in recovery” before going home. Generally normal activities can b resumed within a few days, depending on the degree of impaction and the number of teeth removed.

It isn’t wise to wait until your wisdom teeth start to bother you. The AAOMS/OMSF study strongly recommends that to prevent further problems, wisdom teeth be removed by the time the patient is a young adult. The researchers found that older patients may be at greater risk for the development of disease, including periodontitis, in the surrounding the wisdom teeth and adjacent teeth.

It is important to know that, as wisdom teeth develop, their roots become longer and the jawbone denser. Thus, as a Person ages, it becomes more difficult to remove the wisdom teeth and complications are more apt to occur. While such complications are impossible to predict the longer the wisdom teeth remain in your mouth, the more likely they are to cause problems. When they do, these complications may be more difficult to treat in a patient who is older.

For example, periodontal infections, such as those observed in the AAOMS/OMSF study, may affect your general health.

After Your Surgery

What to Expect

You’re Oral and Maxillofacial Surgeon and/or the office staff will give you specific post-surgical instructions. Immediately following surgery you may be asked to bite on some gauze to stop any bleeding, and an ice pack may be used during the first 48 to 72 hours to help reduce swelling. In addition to swelling there may be some discoloration of the skin, which should disappear in a few days. Medication prescribed by your Oral and Maxillofacial Surgeon will help alleviate be able to resume normal activities within three to five days. If bleeding is excessive after you return home, or if you experience increased pain after the first 72 hours following surgery, contact your Oral and Maxillofacial Surgeon immediately for instructions.

As your mouth heals, your jaw may be sore and may not open as wide as usual. After a few days, moist heat applied to the face may be helpful, and gentle opening and closing of the mouth can help exercise the jaws and restore normal movement.

Diet

For the first two days following surgery, eat soft foods and drink fluids, but avoid using straws as the suction could disturb clotting. The formation of a blood clot in the extraction sites following surgery is important for the healing process, so be careful not to disturb this clot when eating.

Do not rinse your mouth vigorously until clotting is complete, although gentle rinsing with salt water may be recommended by your surgeon to aid healing. Avoid eating hard or sticky foods that might damage your jawbone, particularly if bone was removed during surgery. And remember – smoking can disturb blood clots and the healing process. Resume brushing your teeth the second day after surgery, but avoid disturbing blood clots with the toothbrush.