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, a time traditionally associated with the onset of maturity and the attainment of wisdom.
What Is An Impacted Tooth?
Although most people develop and grow 32 permanent adult teeth, many times their jaws 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.
Types Of Impactions
At the consultation appointment with Dr. Kilkuts, he will inform you if your wisdom teeth need to be removed. A special x-ray of your mouth and jaws (panorex), will be taken to see if your wisdom teeth are impacted.
- Soft Tissue Impaction: There is not enough room to allow the gum tissue to retract for adequate cleaning of the tooth.
- Partial Bony Impaction: There is enough space to allow the wisdom tooth to partially erupt. However, the tooth cannot function properly in the chewing process, and creates cleaning problems, and can cause infection, and damage adjacent teeth.
- Complete Bony Impaction: There is NO space for the tooth to erupt, the tooth remains embedded in the jawbone. The impacted wisdom tooth may also be in an unusual position and difficult to remove.
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, a number of problems can happen. Impacted wisdom teeth should be removed before their root structure is fully developed. Problems tend to occur with increasing frequency as we get older. Some of the possible problems related to not removing your wisdom teeth include:
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 can become irritated and infected, resulting in recurrent pain, swelling, and problems with chewing and/or swallowing.
Non-infectious diseases may also arise in association with an impacted wisdom tooth. Cysts are fluid-filled “balloons” inside the jawbone that develop as a result of impacted 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.
Impacted wisdom teeth may contribute to crowding of your teeth. This is most noticeable with the front teeth, primarily the lower front teeth and is most commonly seen after a patient has had braces. 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. Unless you have an active problem when you see the oral surgeon, the reason for removal is primarily to prevent long-term damage to your teeth, gums and jawbone.
Damage to Adjacent Teeth:
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 around the tooth, and/or decay.
What If I Don’t Have My Wisdom Teeth Removed As A Teenager Or Young Adult?
As wisdom teeth develop, the roots become longer and the jawbone more dense. When it is necessary to remove impacted wisdom teeth when we are older, the post-op course can be prolonged and there is a higher complication rate. Healing may take longer. If your impacted wisdom teeth are not removed in your teenage years, it may be advisable to wait until a localized problem (such as cyst formation or infection) develops.
What Happens On The Day They Are Removed?
Most patients are sedated for the removal of their wisdom teeth. You will be provided with appropriate anesthesia options at your consultation. Our office staff has the training, licensing, and experience to provide various types of anesthesia. These services are provided in an environment of optimum safety, utilizing modern monitoring equipment.
On the day of surgery, it is very important that you DON’T eat or drink anything for at least 8 hours before surgery. Having food or beverages in your stomach can increase the risk of serious anesthesia complications. A parent or responsible adult accompanies you to the office and should stay with you for the rest of the day.
What Happens Afterwards – What Will I Feel Like?
Wisdom Teeth Presentation
To provide you with a better understanding of wisdom teeth, we have provided the following multimedia presentation. Many common questions pertaining to wisdom teeth are discussed.
After the procedure, you will probably have some minor bleeding, discomfort, and swelling. Your assistant will review the post-op instructions with you and your escort after surgery. We ask that you follow these instructions closely, as they will help make you most comfortable following your surgery.
As with any surgery, sometimes post-operative concerns can arise after having your wisdom teeth removed. The boxes below will help you understand some of the possible post-operative complications.
Damage to Sensory Nerve:
A primary concern is a nerve within the lower jawbone that supplies feeling to the lower lip, chin, and tongue. This nerve 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, and especially in older patients, the nerve can become injured. When local anesthesia wears off, you may experience a tingling or numbing 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. On rare occasions it can result in a permanent alteration of sensation similar to having local anesthesia. We feel that you should be aware of this possibility before consenting to surgery.
The upper wisdom teeth are situated close to your sinuses, and their removal can result in an opening 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. However, if it does occur, it will usually close spontaneously, but we may give you special instructions to follow, such as avoid blowing 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. Pressure should not be created in the sinus area, which may dislodge the healing blood clot. If you sense this condition occurring after the surgery, please contact the office. An additional procedure may RARELY be necessary to close the opening.
Dry sockets continue to be the most common problem people experience following dental surgery. They arise due to premature loss of a blood clot in the empty tooth socket. 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.
The symptoms frequently begin in the middle of the night, and your pain medication regimen may not help. Treatment can involve changing your prescription. Occasionally it is helpful to place 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 may require dressing changes every day or two, for five to seven days. Dressings usually are removed when you have been pain free for 2 to 3 days.
The dressing doesn’t aid in healing. The only reason to place a dressing is for pain control. If medication is controlling the pain, the socket will heal without a dressing. Following removal of the dressing, an irrigation device may be provided to help you to keep food particles from lodging in the extraction site.
Occasionally, post-operative infections occur. 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. If it persists, the area will have to be drained and cleaned. Other temporary problems you may experience in the post-operative period include stiffness of the jaws, chafing around the corners of your lips, facial bruising, and blood oozing from the extraction sites. The post-operative 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 Does The Procedure Cost And Is It Covered By Insurance?
The fee for your treatment is determined by the difficulty involved in removing your teeth and the type of anesthesia that is best for you. During your consultation appointment, Dr. Kilkuts will 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 policies regarding the extent of coverage for wisdom teeth extractions, so our office staff will help you obtain maximum insurance coverage for your treatment.
With an oral examination and x-rays of the mouth, Dr. Kilkuts can evaluate the position of the wisdom teeth and inform you 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 Surgeon.
In most cases, the removal of wisdom teeth are performed with general anesthesia. Anesthesia options will be reviewed with you on the consultation day.