Wisdom Teeth

What are "Wisdom Teeth"?

Wisdom Teeth Growth by Age

12 years

14 years

17 years

25 years
Wisdom teeth are easier to remove when the patient is younger, since their roots are not completely formed, the surrounding bone is softer, and there is less chance of damaging nearby nerves or other structures. Removal of wisdom teeth at a later age becomes more complicated as the roots have fully developed (may involve the nerve), and the jawbone is denser.

Wisdom teeth are your third set of molars; most people have one in each corner of the mouth. Your third molars usually emerge or ‘erupt’ in your late teens or early twenties, and are your last teeth to come in. Early humans needed large jaws and more teeth because of a tougher diet, but modern humans have smaller jaws and often don’t have enough room for third molars to grow in.

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How do I know if I should have my Wisdom Teeth Removed?

Your dentist or orthodontist may recommend you have your third molars removed—either as a preventative measure, or because you are already experiencing symptoms from the erupting teeth. Your wisdom teeth can be removed by your general dentist if they are simple extraction's, but if there are any complications such as “impaction”, you may be referred to an oral surgeon to remove them.

Early removal is often recommended, because at a younger age, your wisdom teeth are less anchored in the jaw and therefore easier to remove, but they can be removed at any age if they become a problem.

Sometimes third molars don’t erupt at all, remaining below the gum surface in the jaw bones without causing any discomfort or crowding other teeth. Often however, they do begin to erupt, and because there is not enough room, they push against your other teeth, causing them to crowd together. Your third molars can also become ‘impacted’ or lodged in the jawbone and gums, which can become very painful and lead to infections in the bone and gums.

Potential problems with leaving third molars in place include:

· Gum disease: when a wisdom tooth erupts (breaks through the gum) only partially, bacteria can get under the flap of skin, causing an infection in the gum.

· Crowding: An impacted or erupting wisdom tooth can push on adjacent teeth, causing them to become crooked or even damaging them structurally.

· Decay: A wisdom tooth that is hard to clean because of its partial eruption or position far back in the mouth may become carious.

· Poor Position: A wisdom tooth that grows toward the cheek or in an abnormal direction can cause swelling, irritation to the inside of the mouth, or may even make it difficult to bite down.

· Cysts: If the sac that holds the crown of the tooth remains in the jawbone, it can fill with fluid and cause a cyst that destroys surrounding bone.

What is Impaction?

Complications from Impacted and Partially Impacted Wisdom Teeth
(a) Infection
(b) Crowding, damage
(c) Cyst
Complications may arise from partially impacted teeth (fig. a and b) and totally impacted tooth (fig. c).

“Impacted” wisdom teeth are teeth that have grown in an abnormal direction, or at an angle to other teeth. They can grow away (distoangularly), toward (mesioangularly), or in a vertical or horizontal position to other teeth, causing pain and/or swelling in the face and jaws.

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What happens during surgery?

Generally, wisdom tooth removal is a relatively simple process. Wisdom teeth can be removed using only a local anesthetic if they are uncomplicated, but impacted teeth may mean that general anesthesia (sleep) is necessary. You also may be anxious enough that you prefer to be “asleep” during the procedure. If you do decide to have general anesthesia, it is very important to follow the surgeon’s instructions carefully, particularly that you do not eat or drink for at least six hours before the surgery.

Before Surgery you may be given a sedative (by pill or IV), or nitrous oxide administered through a mask placed on your nose. Once you are fully relaxed, or asleep in the case of general anesthesia, you will be given a local anesthetic to numb the wisdom tooth area. Most patients feel little discomfort, reporting only pressure or tugging sensations if they have chosen to remain awake during the procedure.

Expect the procedure to take about an hour. If your teeth are impacted, you will have stitches in the back of your mouth to close the incision. You will need a friend or family member to drive you home, especially if you have been under a general anesthetic, and you may want to take some days off work or school to give yourself time to recover. You can expect some swelling and perhaps bruising after the surgery, which will subside over a week or two. You may be given a prescription for pain medication, or instructions to take over-the-counter pain medication. It’s important you follow your home-care instructions carefully to promote fast healing.

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How long does it take to heal?

The healing process begins immediately after surgery. The body sends blood to nourish the tooth socket. To control excessive bleeding you may be instructed to bite down on a piece of gauze, applying constant, direct pressure to the area. This helps a blood clot form in the socket—the empty space that the wisdom tooth used to occupy. Within a day or two after surgery, soft tissue begins to fill the open sockets, and bone tissue also begins to grow, becoming denser over the next two to three months.

It is important to follow your after-care instructions carefully—making sure to use the irrigation syringe if you have been given one, and to take your prescribed pain medication. It is normal, when the anesthesia wears off, to feel some discomfort, and for some swelling to occur in your cheeks and face. You can keep swelling to a minimum by placing ice packs on your cheeks during the initial 24 hours after surgery.

If you have any questions or concerns while you’re recovering from your surgery, don’t hesitate to call your oral surgeon.

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Tips for Healing

-apply pressure to stop bleeding by placing gauze directly over the extraction site.
-apply ice packs to your face to reduce swelling the day after surgery.
-eat soft foods, such as soups and blenderized meals, after the bleeding stops.
-drink lots of fluid after the bleeding stops.
-take antibiotics or pain medication, if prescribed.
-keep your mouth clean.

-chew hard or “crunchy” foods, such as carrots or popcorn in the area for 6 to 8 weeks.
-brush the teeth in the area of surgery until the day after surgery. Brush carefully.
-rinse your mouth or spit forcefully the day of surgery; it could loosen the blood clot.
-smoke after surgery. Inhaling creates suction, which could loosen the blood clot.
-overexert yourself.
-drink alcohol, drive or operate heavy machinery the day of your surgery.

Call Your Doctor If You Have…

· Excessive bleeding
· Excessive and persistent swelling
· Persistent and severe pain
· Fever
· Reaction to Medications

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After Surgery

Be sure to see your dentist or oral surgeon for your follow-up appointment, which is usually scheduled for two weeks after surgery. Your doctor may need to remove your stitches, and will want to make sure that the socket is healing properly.

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*some illustrations and tex t© 2005 American Association of Oral and Maxillofacial Surgeons (AAOMS). All rights reserved..


copyright 2008 Dr. Larry Moore DDS, MS all rights reserved
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