What are Wisdom Teeth?
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| Joseph Wilkes, is an Oral and Maxillofacial Surgeon at the Kenmore location. |
By Joseph Wilkes, DMD
Wisdom teeth are the last teeth to develop and come through the gums. Normally there are four, one in each back corner of the mouth. Sometimes the wisdom teeth develop but fail to emerge, remaining stuck in the gum tissue behind the other molars. Wisdom teeth are the third molars. They are referred to as ‘wisdom teeth’ because they most commonly start to cause symptoms about age eighteen-the age of “achieving adult wisdom.”
Why Do Wisdom Teeth Need to be Removed?
Wisdom teeth can come into a normal position in the mouth and be useful teeth. If this happens and they do not become decayed or infected they can often be left in place and maintained as functioning teeth. The key in such a case is monitoring with dental check ups every six months to watch for any developing problems, and good home care to keep them clean and free of decay. If this succeeds it is possible that they can be maintained indefinitely. If they become decayed or infected, your dentist will determine if it is worth saving the tooth.
The arrows point to the four impacted wisdom teeth.
Third molars that fail to emerge into a normal position are referred to as impacted. This term is only a description of their position under the gum and bone tissue of the jaw. If third molars are impacted, they may need to be removed if they are causing symptoms. These symptoms include pain, infection or decay and gum disease in the adjacent molar tooth. If you are not able to keep the wisdom tooth clean your dentist may suggest that it be removed before decay and infection start. Dentists, orthodontists, and other dental professionals refer patients to oral surgeons for consultation to determine if third molars need removal. Dental professionals have varying approaches to this decision. Some believe that most third molars should be removed to prevent the possibility of future problems. However, not all third molars become problematic and there is no evidence to support the notion that they will cause crowding of the front teeth. The oral surgeons at Harvard Vanguard Medical Associates approach each patient’s case individually. If the third molars are erupted and disease-free, or completely covered under bone without symptoms or disease, they will sometimes recommend leaving them in place, monitor them, and remove any that develop future problems. The reason is that, like all surgical procedures, there are possible complications involved with removal. Such complications include infection, delayed healing, and decreased feeling in the lower lip and side of the tongue.
What to Expect When You Consult With an Oral Surgeon
During a third molar consultation, the oral surgeon will ask you if you have any history of third molar problems and review your medical and dental history. The oral surgeon will examine the third molars by looking in the mouth and taking a Panoramic X-ray (like illustration above). This x-ray shows the entire jaw and gives a more comprehensive picture than the small dental x-rays taken inside the mouth. The oral surgeon will discuss the situation with the patient, make a recommendation about removal, and explain the options. The patient can then decide with the oral surgeon whether to have the third molars removed. If you have a significant problem the Harvard Vanguard oral surgeons will consult with your primary care physician to provide the appropriate medical care for you.
How Are Wisdom Teeth Removed?
The usual method is to remove wisdom teeth with local anesthesia and sedation using nitrous oxide gas (‘laughing gas’) alone or with intravenous sedation medications. Some patients prefer local anesthesia alone. All of these methods work well and can be performed in the office setting.
The decision to have any medical treatment is an important one. Patients are encouraged to ask their oral surgeon questions and make an informed decision about third molar removal. Patients under age eighteen must come with a parent or legal guardian so that any treatment decisions meet the requirements of a legally informed decision.
If a decision is made to remove the third molars, a subsequent appointment will be scheduled for the amount of time needed and method to be used, as determined at the consultation.
What Happens on the Day of Surgery?
On the day of surgery, patients having intravenous sedation must have had nothing to eat or drink for six hours before surgery. If you would normally take medications during this period, check with your oral surgeon beforehand. You must come with an adult to drive you home. Patients having local anesthesia with or without nitrous oxide gas are encouraged to have a ride home as well. All patients under eighteen must be accompanied to the surgery appointment by a parent or legal guardian. At the completion of the surgery, the oral surgeon and assistant will give you written and verbal post-operative care instructions. Prescriptions for an antibiotic and pain medication will also be given. Usually, a follow up visit with the oral surgeon will be scheduled to assess healing.
What Can I Expect After Surgery?
After surgery, there is normally some oozing of blood from the sockets where the third molars were removed. This lasts for a few hours but there can be spotting of blood for up to twenty-four hours. Biting firmly on gauze over the sockets will normally control the bleeding. Soft foods may be eaten post-operatively. After twenty-four hours, rinsing with warm salt water helps keep the sockets clean. Rinsing before that time risks prolonging the bleeding. Facial swelling normally increases for two to three days, and then begins to decrease. Using ice packs on the face during the first twenty-four to thirty-six hours can help limit the swelling. After twenty-four hours, placing warm packs on the sides of the face can reduce established swelling. Temporary bruising on the sides of the face and upper neck is common and normal. Nausea and vomiting sometimes happens from the medications or from swallowing small amounts of blood. Drinking small amounts of cola or ginger ale that has been allowed to go flat or apple juice may calm this. If any of these symptoms continue longer or are severe, or if other concerns arise, an Harvard Vanguard Medical Associates oral surgeon is on-call twenty-four hours per day through the Urgent Care telephone number. Stitches are placed in each extraction site and dissolve on their own in a few days.
While the idea of taking out wisdom teeth makes many patients anxious, the approaches offered by the oral surgeons at Harvard Vanguard are designed to allay anxiety. Our oral surgeons and their staff are used to caring for apprehensive patients and will work with patients to provide a comfortable experience in a safe environment.