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 12-year molars.  They are called "wisdom teeth" because they usually appear during a person's late teens or early twenties, which has been called the age of wisdom.  Today, wisdom teeth cause more problems than any other teeth.

WHAT ARE IMPACTED WISDOM TEETH?

When a wisdom tooth is blocked from erupting into the mouth normally, it is termed impacted.  A tooth may be only partially impacted, meaning it grows in crooked and breaks through the gum only partially, or it may be totally impacted.  Nine out of ten people have at least one totally impacted wisdom tooth resulting from a lack of space in the mouth.    Partially impacted teeth can lead to such problems as pain, infection, crowding of, or damage to, adjacent teeth.  In the case of totally impacted teeth, more serious problems can occur if the sac that surrounds the impacted tooth fills with fluid and enlarges to form a cyst.  The cyst can hollow the jaw and result in permanent damage to adjacent teeth, jawbone or nerves.  Don't wait until your wisdom teeth begin to bother you.  The American Association of Oral and Maxillofacial Surgeons (AAOMS) strongly recommends  you have them removed when the patient is a young adult BEFORE roots can develop.

PRIOR TO YOUR SURGERY

Before surgery you will have a consultative appointment with one of our surgeons.  The exam will include x-rays and, depending on your particular case, possibly other tests as well.  These will show the presence and position of the impacted teeth and reveal such important features as curved roots, proximity of the tooth roots to nerves and other vital surgical information that cannot be determined by visually inspecting the mouth. 

A complete medical history will be taken, with particular attention to allergies, medications or health problems that might affect surgery and/or the administration of anesthesia.

PREPARING FOR YOUR SURGERY

1. Clothing- Wear loose, comfortable clothing with sleeves  that can be easily rolled up. 
2. Transportation-If IV sedation is used, arrange to have someone accompany you to your surgery appointment, drive you home afterward and stay with you until the effects of the anesthesia have worn off.  Driving yourself home after anesthesia is unsafe.
3. Diet-If IV sedation is to be administered DO NOT EAT OR DRINK FOR AT LEAST 6 HOURS PRIOR TO SURGERY.  If you are not getting general anesthesia you may eat or drink normally.
4. Medications-Adhere to any medication schedule prescribed by your surgeon prior to surgery.

WHAT TO EXPECT DURING SURGERY

Anesthesia:  During surgery, one or more of the following is used to control pain and anxiety - local anesthesia that numbs the surgical area, nitrous oxide-oxygen (laughing gas) for analgesia to relax you;  intravenous sedation for increased relaxation; and general anesthesia that puts you to sleep.  Our surgeons are specifically trained and experienced in the administration of local and intravenous anesthesia and the treatment of anxiety.  They have received extensive training in anesthesia throughout their four or more years of hospital-based residency and are able to provide the anesthetic that is most appropriate for you.  Each of our doctors is adept at handling complications that may arise from the administration of anesthesia.

The Surgical Procedure:  The method used to remove your wisdom teeth will depend on various factors, including the position of the teeth; the length an curvature of the tooth roots; the thickness of bone surrounding the teeth and so on.  If the teeth have fully erupted, it may be possible to simply remove each tooth intact from its socket.  If gum tissue is covering the tooth, an incision will be required to turn back the gum and expose the tooth.  Likewise, if bone covers the tooth, the surgeon will remove sufficient bone to expose the tooth and allow its removal.  If an incision is needed, the surgeon may place some sutures (stitches) to hold the tissue together and aid healing.  These sutures may dissolve on their own after surgery or you may have to return to the office for their removal.

Immediately Following Surgery:  You will be taken to one of our recovery rooms to rest for some time before you are driven home by your companion.  During this "recovery" time the surgeon or an assistant will monitor your condition and make sure you are ready to leave.

AFTER YOUR SURGERY

What to expect:  You will be given 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 bruising, which should disappear in a few days.  Medication prescribed by your doctor will help alleviate any discomfort, and you should generally be able to resume normal activities within 3 to 5 days.  If bleeding is excessive after you return home, or if you experience increased pain after the first 72 hours following surgery, contact our office immediately for instructions.

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 to aid healing.  Avoid eating hard or stick foods that might damage your jawbone.  Smoking can disturb blood clots and the healing process.  Resume brushing your teeth the second day after surgery but avoid disturbing blood clots with your toothbrush.

RISKS AND COMPLICATIONS

The removal of wisdom teeth is a common procedure that usually produces few, if any, serious complications.  However, as with any surgical procedure, you should be aware of the following possible complications and discuss them with one of our surgeons during consultation.

Infection:  Any time surgery is performed, there is a slight chance of infection setting in afterwards.  Any infection should be taken seriously and be reported to your surgeon.  He or she will then prescribe appropriate antibiotics to treat the problem.  Signs of infection include:  fever, abnormal swelling and pain, salty or prolonged bad taste and pus formation.

Injury:  Adjacent teeth, filling material or bridge work may be in close proximity to the wisdom teeth and can suffer damage during extraction.

Dry Socket:  This term is used to describe a condition that can develop in the empty tooth socket when normal blood clotting is disturbed following surgery.  If a blood clot prematurely dissolves or does not form properly in the socket, for example due to smoking or food impaction, the socket remains "dry" for a period of time and heals more slowly than usual.  A dry socket can be quite painful because it leaves the bone within the socket exposed to air, food and fluids.  If you experience such increased pain a few days following surgery, contact your surgeon.  Steps can be taken to reduce your pain while healing takes place.

Numbness:  In some cases major sensory nerves serving the mouth are located in close proximity to wisdom teeth and it is possible that one or more of these nerves could be irritated during surgery.  If this happens, you could experience altered or total loss of feeling in the areas served by the nerve.  This numbness can affect the lip, tongue, cheek, chin, gums or teeth, depending on the nerve that is involved.  Numbness beyond the first 24 hours in any location is rare and usually temporary, but may be permanent in rare cases.

Sinus Complications:  Sometimes upper wisdom teeth are near the large maxillary sinus, and the roots may even penetrate into the sinus cavity.  An opening into the sinus may occur, but will typically heal without incident.  While rare, drainage or sinus pain may occur following tooth removal.  If these develop, contact our office.

Root Fragments:  Occasionally roots are extremely long or fragile and a pice of root may break off during surgery.  Typically, the root is removed, but if it is close to a nerve or the sinus cavity, the surgeon may leave the root fragment in place.  This rarely presents a problem and can be monitored with x-rays.

Jaw Fracture:  In VERY rare cases, the removal of wisdom teeth can weaken the jawbone, particularly if the jaw is thin and the teeth are severely impacted.  If a fracture occurs, x-rays will reveal the location and your surgeon can treat the problem. 

TMJ (Jaw Joint):  Pain or abnormal function is rare following wisdom teeth extraction, but if it does occur, further treatment may be necessary.  Be sure to inform your doctor about any pre-existing problems with the TMJ.