What are wisdom teeth?
Third molars are commonly referred to as wisdom teeth. They are usually the last teeth to develop and are located in the back of your mouth, behind your second molars. Their development is usually completed between the middle teenage years and early twenties.
Wisdom Teeth Management Presentation Video
To learn about wisdom teeth management, please see the video below.
What is an impacted wisdom tooth?
Although most people develop and grow 32 permanent adult teeth, most people have jaws that are too small to accommodate the four wisdom teeth. When inadequate space prevents the teeth from erupting they are called impacted. This indicates their inability to erupt into the proper position for chewing and cleaning.​​
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We will need to see you for a consultation to determine if you will benefit from wisdom tooth removal. A special x-ray of your mouth and jaws (panorex) will be taken to determine if your wisdom teeth are impacted, if there is room for them to erupt, and how difficult it will be to have them removed. There are different types of impactions:
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Soft Tissue Impaction: There is not enough space to allow the gum tissue to retract for adequate cleaning of the tooth.
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Partial Bony Impaction: There is not enough space to allow the wisdom tooth to fully erupt out of the bone and gum. It is still partially within the bone and gum. The tooth cannot function properly in the chewing process, and creates cleaning problems, among others.
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Complete Bony Impaction: There is NO space for the tooth to erupt. It remains embedded in the jaw bone. The impacted wisdom tooth may also be in an unusual position and difficult to remove.
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Why should I have my wisdom teeth removed?
If you do not have enough room in your mouth for your third molars to fully erupt, several problems can happen. Impacted wisdom teeth should be removed before their root structure is fully developed. In some patients, it is as early as 12 or 13, and in others it may not be until the early twenties. Problems tend to occur with increasing frequency after the age of 30. Some of the possible problems related to not removing your wisdom teeth include:
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Infection - The most frequent clinical problem we see is pericoronitis (a localized gum infection). Without enough room for total eruption, the gum tissue around the wisdom tooth is difficult to clean and can become irritated and infected, resulting in recurrent pain, swelling, and problems with chewing and/or swallowing.
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Cyst Formation - Rarely, non-infectious diseases may also arise in association with an impacted wisdom tooth. Cysts are fluid-filled “balloons” inside the jaw bone that develop as a result of impacted teeth and slowly expand destroying adjacent jaw bone 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.
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Possible Crowding - Impacted wisdom teeth may contribute to crowding of your teeth. This is most noticeable with the front teeth, primarily the lower front teeth. There are a number of factors that cause teeth to crowd after braces or in early adulthood. Retained, impacted wisdom teeth may be a contributing factor. Sometimes wisdom teeth will be extracted to reduce the risk of crowding.
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Cavities and Periodontal Disease - 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 cavities, bone loss around the tooth and periodontal disease. Sometimes the bone loss can be significant resulting in a loose second molar tooth. If a cavity in the second molar tooth is too deep, the dentist may not be able to fill the tooth and instead it may need to be extracted. If a cavity develops in the second molar or wisdom tooth, pain may also occur.
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As wisdom teeth develop, the roots become longer and the jaw bone becomes more dense. When it is necessary to remove impacted wisdom teeth in your thirties, forties or beyond, the post-operative healing can be prolonged (more pain and swelling). In general, you will heal faster, more predictably and have fewer complications if treated in your teens or early twenties.
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Overview of Treatment
The consultation
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With an oral examination and x-rays of the mouth, your doctor can evaluate the position of the wisdom teeth and determine if there are present or future potential problems. Patients are generally first evaluated in the mid-teenage years by their dentist, orthodontist, or by an oral and maxillofacial surgeon. At the consultation appointment our doctors will discuss with you if removal of the wisdom teeth is advised, the benefits and risks of treatment or no treatment, and the alternative treatments if available.
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Anesthesia
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In most cases, the removal of wisdom teeth is performed under either intravenous sedation or general anesthesia.
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What does Wisdom Tooth Removal Cost and is it Covered by Insurance?
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The fee for your treatment is determined by a number of factors. These include the difficulty involved in removing your teeth and which type of anesthesia is best for you. During your consultation appointment, your doctor will need to review your x-rays, complete an examination and determine the best option for anesthesia, before an accurate estimate can be provided. Every insurance company has a different policy regarding the extent of coverage for a given surgical procedure. Our staff will help you obtain the maximum insurance coverage for your treatment.
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What If I Have Questions Before Surgery?
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At the time of your consultation, your specific situation will be discussed in greater detail. We encourage you to ask any questions you may have. If new questions arise after your consultation, please call our office.​
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After Extraction of Wisdom Teeth
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After extraction of wisdom teeth, the gum is usually closed with stitches. If the tooth was already erupted, stitches probably will not be placed since the gums cannot be closed. The gums will naturally close over the extraction socket over 2-4 weeks. To help control bleeding bite down on the gauze placed over the extraction socket. 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 if needed, extra gauze to take home, and possibly a plastic syringe to help with cleaning in the mouth.
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What Will I Feel Like after Wisdom Teeth Removal Surgery?
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On the first day after surgery, you may experience some minor bleeding and pain. You should cover your pillowcase with something so that you don not get any blood on it. Each individual’s reaction to surgery varies, and the sensation of pain can range from mild discomfort to rarely severe pain. A variable amount of swelling can be expected following the surgery. This swelling usually peaks on the second day or third day and then will start going down over the next 5-7 days. You can limit the amount of swelling by applying an ice pack to the side of your jaw for the first 2 days.
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On the third day, you will notice that your jaw muscles are stiff, and it is difficult to open your mouth normally. You can apply moist heat to your jaw on the third or fourth day to help your muscles to relax and open wider. We recommend to limit strenuous exercise for the first two days after the surgery. We ask that you follow your post-operative instructions closely. Doing so will make you as comfortable as possible. Please allow time for your body to begin healing before resuming an active social, academic, or athletic schedule. Most patients feel like they are over the hump and on their way to recovery in 3 to 5 days.
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Please view the postoperative instructions for more information after removal of teeth.
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