Wisdom Teeth

A 16 year old patient with wisdom teeth at an ideal age for extraction.

Wisdom teeth, also known as third molars, are the last teeth to erupt into the mouth, generally between the ages of 16-20. Most people’s jaw bones just aren’t big enough to hold all 32 teeth. Because wisdom teeth are the last to develop, they are often blocked from eruption by other teeth or overlying bone and gum tissue. In some cases, wisdom teeth erupt normally and act as functioning teeth. But far more often, there isn’t enough room and the wisdom teeth erupt only partially or not at all. When a tooth fails to erupt and gets stuck in the wrong position, it is said to be impacted.

An impacted wisdom tooth causing infection of the gums
Impacted wisdom teeth impinging on neighboring teeth.
Painful infection and cheek biting around an erupting wisdom tooth.

Wisdom teeth problems are very common. Over 90% of people experience at least one impacted wisdom tooth. The most common symptom of impacted wisdom teeth is a painful infection of the overlying gums. Infected wisdom teeth cause dull pain that is felt in the back of the mouth or jaws and sometimes up into the ear or down into the neck. Other problems with wisdom teeth are difficulty chewing, accidental cheek biting, and swollen lymph nodes in the neck. If an impacted wisdom tooth is left in place for many years, it can damage or even destroy the adjacent healthy tooth.

An impacted lower wisdom tooth developed a severe gum infection, destroying the adjacent tooth.
Note also the hyper-eruption of the upper wisdom tooth on the opposite side.
More serious problems occur if the tissue surrounding an impacted tooth enlarges to form a cyst or tumor.

Wisdom teeth are also associated with crowding of lower incisor teeth in late teens and early twenties. Crowding caused by wisdom teeth may cause a need for orthodontic treatment, or retreatment of prior orthodontics.

Even when wisdom teeth do erupt fully, scientific studies show that they are as prone to disease (and likely extraction) as those that remain impacted. Oral hygiene is difficult in the far reaches of the mouth, and wisdom teeth are often quickly attacked by bacteria that cause decay or gum infection. If they were not taken out during the teen years, a high proportion of wisdom teeth will eventually need to be removed in later years. You can avoid all of these painful problems by having your wisdom teeth removed at the right time during teenage years!

A large dark-appearing cyst has developed surrounding the lower impacted wisdom tooth.
Lower incisor crowding associated with impacted wisdom teeth.

When should wisdom teeth be removed?

Wisdom teeth start to develop about age 10, and can soon be seen on x-rays. They continue developing until about age 20-22. The ideal time for removal is around age 16, when the roots of the teeth are still immature. Surgical removal at this ideal stage is rather simple and poses very low risk of complications.

Age 12
Age 14
Age 17
Age 25
In impacted wisdom tooth left in place now presses on the nerve below.

It is best to have wisdom teeth evaluated at about age 16, even if there are no symptoms. With an exam and x-rays of the jaws, it is possible to determine if they should be removed. If you are older and encounter wisdom teeth trouble, then an immediate examination is best. Wisdom teeth can be removed as early as age 11, but the best time is generally around the mid-to-late teens, often right after completion of orthodontic treatment.

Not all wisdom teeth problems are painful or visible, and there is risk to a “wait and see” approach for 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 adjacent teeth.

Contact us today to schedule an appointment. It is best to have wisdom teeth evaluated at about age 16, even if there are no symptoms, to determine if they should be removed. If you are older and encounter wisdom teeth trouble, then an immediate examination is best. Dr. Stout is the best oral surgeon to help determine the best timeline for you (or your loved one) to have wisdom teeth comfortably removed at our office.

Procedure to Extract Wisdom Teeth

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 will not begin your procedure until you are comfortably asleep.

Some teeth are already exposed and can be 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. The procedure takes about 45 minutes to complete.

When you have finished your treatment, you will awaken from the sedation rather quickly (It feels like only a few seconds went by). You will be comfortable because we will give you numbing anesthetic while you are asleep. Once you are awake 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 at home. 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. We will call you later in the day to make sure you are doing fine, and we are available 24/7 if there are any problems.

Click here for more complete pre-operative instructions.
Click here for more complete post-operative instructions.