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Wisdom Teeth

Wisdom teeth, also known as third molars, are the last teeth to erupt in your mouth. This generally occurs between the ages of 16-20. Problems with infected or impacted wisdom teeth are very common, and usually cause dull pain that is felt in the mouth or jaws and sometimes up into the ear. These infections are not only uncomfortable, but can irreversibly damage adjacent teeth. Nearly every person eventually requires extraction of the wisdom teeth. Early removal during teen years is always the best because healing is uncomplicated and the potential damage to adjacent teeth is avoided.

Problems Caused by Wisdom Teeth

Wisdom teeth problems are very common. For most people, the jaw bone is actually not big enough to fit all 32 permanent teeth. Since wisdom teeth are the last to develop, they are often crowded out of their proper eruption position, becoming impacted. Even if there is enough space, some wisdom teeth become impacted by being blocked by the overlying bone or gums or by another tooth. Finally, some uncooperative teeth just refuse to erupt properly for no apparent reason.

(a).
(b).
(c).

Complications such as infection (fig. a) , damage to adjacent teeth (fig. b) and the formation of cysts (fig. c) may arise from impacted teeth.

When the wisdom teeth finally try to erupt, usually in the late teens or early 20s, there often begins a recurrent cycle of pain and infection of the gums. If the tooth begins to show but does not smartly erupt completely, damage to an adjacent tooth begins to take place. As time goes by, impacted teeth can cause problems such as periodontal disease, cysts, tumors, or orthodontic crowding.

Impacted teeth can be painful and lead to infection. They may also crowd or damage adjacent teeth or roots. This crowding problem is particularly discouraging if you have already gone through the trouble and expense of orthodontic treatment to align your teeth, and now you may require retreatment.

More serious problems occur if the sac surrounding an impacted tooth becomes filled with fluid and enlarges to form a cyst. If a cyst is not treated, it can permanently damage adjacent teeth or bone or nerves, and can even transform into a tumor.

Scientific studies show that wisdom teeth that erupt are as prone to disease as those that remain impacted. Oral hygiene is very difficult in the far reaches of the mouth, and wisdom teeth are often quickly attacked by the bacteria that cause decay or gum infections. There are also times where a wisdom tooth erupts, but has no tooth opposing it. Such a tooth will often erupt excessively and need to be removed.

Because of these many common problems, a very high proportion (85-90%) of wisdom teeth will eventually need to be removed. Link to the AAOMS white paper study.

When Should Wisdom Teeth be Removed?

The ideal time for removal is at about age 16. When the roots of the teeth are still immature, surgical removal is rather simple and a young person is capable of optimal healing. Wisdom teeth can be removed as early as age 11-12, usually in combination with orthodontic treatment that requires other teeth to be extracted. Extraction after the teen years is frequent, but is associated with higher complication rates.

Wisdom Teeth Growth by Age
12 years
14 years
17 years
25 years

Not all wisdom teeth problems are painful or visible, and there is risk to a "wait and see" approach to teeth that don’t hurt yet. As wisdom teeth grow their roots become longer, the bone becomes dense, and the teeth are more difficult to remove. Waiting until adult years results in a prolonged recovery and a higher chance of infection, sinus problems, or nerve injury in the jaw. Delayed treatment may also cause irreversible damage to innocent adjacent teeth.

The best course is to have an evaluation at about age 16, including a panoramic or 3-dimensional x-ray of the jaws, to determine if your wisdom teeth should be removed. If you are older and seem to be encountering trouble in the wisdom teeth, then an immediate examination is best.

Your Surgical Procedure

The surgery to remove wisdom teeth is done in our office surgery center with the aid of intravenous sedation anesthesia. We start by placing sensors to monitor your vital signs; then we start an intravenous line and supplemental oxygen. It only takes about 30 seconds for the medication to work, and we won’t begin your procedure until you are comfortably asleep.

Some teeth are already exposed and more easily removed. For those that are impacted, an opening is made into the gum tissue and a small amount of surrounding bone is removed. The tooth can then be carefully removed. Sometimes dissolving sutures (stitches) are needed to close the wound. It takes about 30-45 minutes for the actual procedure.

When you have finished your treatment, you will awaken from the sedation rather quickly (It feels like only 3-4 seconds have elapsed). You will be comfortable since the area will be numb from the local anesthetic. Once you are stable and recuperating well you can return home, where you should keep your activity light for several days.

We will make sure you are comfortable during your recuperation. Most patients require prescription pain medication. There is often some swelling and stiffness of the jaw, and a soft diet for several days is advised. You can advance your diet to more normal foods after a few days as long as your comfort permits.