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 and often erupt during a person’s late teens or twenties, a time traditionally associated with the onset of maturity and the attainment of wisdom.
A Short Video: Why We Don’t Need Wisdom Teeth
Oral Examination & Treatment Plan
With an oral examination and x-rays of the mouth, our dentists (Dr Cecilia So or Dr Patricia Wong) can evaluate the position of the wisdom teeth and predict if there are present or future potential problems. Studies have shown that early evaluation and treatment result in a superior outcome for the patient. Patients are generally first evaluated in the mid-teenage years by a dentist or by an oral and maxillofacial surgeon. All surgery is performed under appropriate anaesthesia to maximise patient comfort. Our doctors are trained, licensed, and highly experienced in providing various types of anaesthesia for patients. Special Arrangements can be made for patients who prefer to have treatment under IV Sedation or in Day Surgery under General Anaesthetic. Please speak with our dentist or staff if this is your preference. You can trust our experience in wisdom teeth surgery!
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
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 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.
- 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, among others.
- Complete Bony Impaction: There is NO space for the tooth to erupt. It remains embedded in the jaw bone or if even partially visible requires complex surgical techniques for removal.
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. 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:
- Damage to neighboring teeth and roots
- Tooth decay
- Periodontal disease
- Receding gums
- Loosened teeth
- Bone loss
- Tooth loss
More serious problems may occur if the sac surrounding the impacted tooth becomes filled with fluid and enlarges to form a cyst. As the cyst grows it may hollow out the jaw and permanently damage neighboring teeth and the surrounding bone and nerves. Rarely, if a cyst is not treated, a tumor may develop from its walls and surgery may be needed to remove it.
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 jaw bone more dense.When it is necessary to remove impacted wisdom teeth in your thirties, forties or beyond, the post-operative course can be prolonged and there is a higher complication rate. Treating these complications is often more difficult and less predictable than with a younger patient. Healing may be slower and the chance of infection can be increased. If your impacted wisdom teeth are not removed in your teenage years or early in your twenties and they are completely impacted in bone, it may be advisable to wait until a localised problem (such as cyst formation or localised gum disease and bone loss) develops. In general, you will heal faster, more predictably and have fewer complications if treated in your teens or early twenties.
When Should I Have My Wisdom Teeth Removed?
Every patient and every case is unique; therefore a decision regarding surgery must be made after:
- A careful examination of your mouth
- A radiographic examination involving x-rays or a CT scan and
- A discussion with your dentist and oral and maxillofacial surgeon
Depending on the results of your dental examination our surgeon may:
- Extract the complete tooth
- Partially remove the tooth (coronectomy); or
- Observe the tooth over time for changes in condition.
In general, dental professionals agree that third molars should be removed whenever there is evidence of:
- Periodontal disease
- Cavities that cannot be restored
- Cysts or tumors
- Damage to neighbouring teeth
Third molars may not require surgery if they are:
- Completely erupted and functional
- Free of cavities
- Disease free
- In a position that can be kept clean and healthy.
If after discussing your situation with our dentist or surgeon you decide to keep your wisdom teeth for the time being, it’s important to agree on a long term plan for monitoring the health and condition of these teeth and their surrounding gum tissue. Most oral surgeons recommend the following maintenance routine:
- Schedule a dental checkup at least annually
- X-rays or CT scans should be taken to see the wisdom teeth and surrounding bone
- A clinical examination should be performed annually to determine whether any disease is developing.
- Particular care must be taken to clean and floss the area as part of your daily oral healthcare regimen.
The Surgical Procedure
Surgery to remove your wisdom teeth is performed in the oral surgeon’s office under local anaesthesia/intravenous anaesthesia combination. Your surgeon will recommend the anaesthetic that is right for you. The time required for the surgery and the type of surgical procedure used depends on several factors including position of the teeth, length and curvature of the roots, thickness of the bone surrounding the teeth and your physical condition and health. If the teeth are fully erupted, it may be possible to simply remove each tooth intact from its socket in the bone, using instruments designed for this purpose. If gum tissue is covering the tooth, an incision will be required to turn back the gum and expose the tooth. If bone covers the tooth, the surgeon will remove sufficient bone to expose the tooth and allow its removal. If an incision is needed to remove the tooth, your surgeon may place some sutures to help the wound heal. Immediately following surgery you will rest for a time in the oral surgeon’s office before you leave for home with your escort.
After Your Surgery – What To Expect
Before leaving for home, your surgeon will give you specific post-surgical instructions and prescriptions for medications that will make your post-surgery experience more comfortable. Following are some additional suggestions you may find helpful:
- An ice pack may be used during the first 48-72 hours to help reduce temporary swelling and discoloration of the skin.
- Moist heat applied to the face may be helpful if your jaw is sore and you are unable to open your mouth as wide as usual.
- If bleeding is excessive after you return home of if you experience increased pain after the first 72 hours following surgery, contact your oral surgeon immediately for instructions.
- Gently open and close your mouth to help exercise the jaws and restore normal movement.
- Eat soft foods and drink fluids during the first two days after surgery, but avoid using straws as the suction could disturb clotting.
- Do not rinse your mouth vigorously until clotting is complete, although gentle rinsing with salt water may be recommended by your surgeon to aid in healing.
- Avoid eating hard or sticky foods that might damage your jawbone, particularly if bone was removed during surgery.
- Do not smoke as this may disturb blood clots and the healing process.
- Resume brushing your teeth the second day after surgery, but avoid disturbing blood clots with the toothbrush.
Medication prescribed your surgeon will help with any discomfort and you should generally be able to resume normal activities within a relatively short period of time.
What Will I Feel Like after Wisdom Teeth Removal Surgery?
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’t get any blood on it. Each individual’s reaction to surgery varies, and the sensation of pain can range from mild discomfort to severe pain. A variable amount of swelling can be expected following the surgery. This swelling usually peaks on the second day and should begin resolving on the third day. You can limit the amount of swelling you will have by using ice for the entire first day. The more ice you use the first day, the less swelling you are likely to have on the second day. Please remember to put ice on the first day even if it is somewhat uncomfortable to have the cold next to your skin. 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 face on the second and third day allowing your muscles to relax more and open wider. Most of the time you will want to limit your activities for a few days. We ask that you follow your post-operative instructions closely. Doing so will make you as comfortable as possible during the first few days following your procedure. 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.
Known Risks And Complications
Wisdom teeth surgery 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 your surgeon before surgery.
- Infection – any infection should be taken seriously and reported to your surgeon who will 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 – neighbouring teeth, filling material or bridge work located near the wisdom teeth may be damaged during extraction.
- Dry socket – if a blood clot prematurely dissolves or does not form properly in the empty 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 in the socket exposed to air, food and fluids. If you experience increases pain a few days after surgery, contact your surgeon. Steps can be taken to reduce discomfort while healing takes place.
- Numbness, or altered sensation – in some cases major sensory nerves are located near wisdom teeth, and it is possible that one or more of these nerves could be irritated during surgery. If this happens, you may experience altered or total loss of feeling in the lip, tongue, cheek, chin, gums or teeth, depending on the nerve that is involved. Although numbness beyond a relatively short period of time in any location is uncommon and usually temporary, it may be permanent in rare instances.
- Sinus complications – sometimes upper wisdom teeth are located near the large maxillary sinus and the roots may even penetrate into the sinus cavity. When removed, these wisdom teeth may leave an opening in the sinus that will usually heal without a problem. Rarely, drainage or sinus pain may occur following tooth removal. If these complications develop, contact your oral surgeon.
- Root fragments – occasionally tooth roots are extremely long or fragile and a piece may break off during surgery. Typically the fragment is removed, but if it is too close to a nerve or the sinus cavity, or if its removal would jeopardize adjacent teeth, the surgeon may decide to leave the fragment in place. This, rarely presents long-term problems, and the fragment 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. Care should be taken to avoid eating hard, crunchy foods that place undue stress on the jaws until healing is completed.
- Jaw joint pain or abnormal jaw function – while this is a rare occurrence, further treatment may be necessary if you experience such pain. Prior to surgery, be sure to inform your surgeon about any pre-existing joint problems in your jaw.
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