Wisdom Teeth

Question: What problems can wisdom teeth cause?

Answer: Wisdom teeth, also known as third molars, are the last teeth to erupt in your mouth. This generally occurs between the ages of 17 and 25, a time of life that has been called the age “Age of Wisdom.”

Wisdom teeth have earned a reputation for causing trouble in this day and age when many of us have smaller jaws than our ancestors. Frequently when these third molars at the back of the mouth begin trying to emerge sometime during our late teens or early twenties, there’s not enough room for them and the potential for trouble begins, making a strong case for having them removed as soon as possible.

The tendency for wisdom teeth to become “impacted” or unable to move into their proper position is the cause of most problems. Impacted wisdom teeth grow in any way they can, such as sideways or at an angle. Some may partially break through the gum surface, while others remain trapped beneath the gum and bone, leading to a host of potential complications.

Potential Complications
Infected gums-when the tooth has only partially broken through the surface, bacteria can enter through  the flap around the tooth and cause the gum to become infected
Decay- due to difficulty cleaning these teeth cavities form easily on them and adjacent teeth.
Crowding and structural damage to neighboring teeth.
Cyst formation- when a wisdom tooth is impacted, the sac that surrounds the tooth can become filled with fluid and form a cyst that is capable of damaging adjacent teeth, the jawbone and nerves. These cysts can grow very large and transform into tumors that are very aggressive and destructive to the jawbone and neighboring teeth.
Severe pain- due to pressure on neighboring teeth as the wisdom teeth attempt to grow into the mouth.

The Surgical Procedure
-    Diagnosis is made via clinical exam and dental x-rays.
-    The actual procedure can be done with local anesthesia alone or in combination with nitrous oxide ( laughing gas), intravenous sedation or general anesthesia.
-    Once anesthesia have been administered, an incision is made in the gum to expose the tooth, usually it is necessary to remove bone and cut the tooth in multiple pieces to remove it, this is accomplished by using a surgical  handpiece (drill)
-    Once the tooth has been removed, the area is irrigated and sutures are used to reapproximate the gum tissue.
-    Antibiotics and pain medication are usually prescribed, usually enough for 7-10 days. Usually patient have significant swelling of the jaw which usually last 4-5 days depending on how difficult the procedure was. Wisdom teeth are classified as erupted , soft tissue impaction, partial bony impaction or full bony impaction. Full bony impaction are the most difficult and are associated with significant swelling and other possible complications.
-    Possible complications include dry socket, where the blood clot is lost and the socket does not heal properly. this results in significant pain this is treated by applying a medicated dressing to the socket. Numbness can occur, because the nerves near the wisdom teeth can be damaged during the procedure. In most cases the nerve readily repairs itself and the numbness is only temporary lasting usually 2-6 weeks. In severe cases, numbness can last beyond three months and may even be permanent in rare cases.

Recommendation:

The best time to remove wisdom teeth is between the ages of 16 and 19, before the roots become firmly anchored in the jaw. Also, the older we get, the denser our jaws become, making removal more difficult as time goes on. Oral and Maxillofacial Surgeons (oral surgeons) have 4-6 more years of training than general dentist and they are trained to diagnose and treat any possible problems associated with wisdom teeth and complications associated with their removal. Oral surgeons are also trained and licensed in administering IV sedation and general anesthesia in an office setting.
The removal of wisdom teeth by an experienced oral and maxillofacial surgeon versus an inadequately trained dentist can make a big difference as to how traumatic the experience is. An oral surgeon is trained to remove wisdom teeth in a painless and atraumatic fashion, unfortunately the postoperative course is usually associated with some swelling and discomfort. However if proper technique and medication are utilized, the procedure can be easily tolerated.