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Wisdom Teeth

Wisdom teeth are the last teeth to erupt within the mouth. When they align properly, and gum tissue is healthy, wisdom teeth do not have to be removed. Unfortunately, this does not generally happen. The extraction of wisdom teeth is necessary when they are prevented from properly erupting within the mouth. They may grow sideways, partially emerge from the gum, and even remain trapped beneath the gum and bone. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to erupt successfully.

These poorly positioned impacted teeth can cause many problems. When they are partially erupted, the opening around the tooth allows bacteria to grow and may eventually cause an infection. The result – swelling, stiffness, pain, and illness. The pressure from the erupting wisdom tooth may move other teeth and disrupt the orthodontic or natural alignment of teeth. The most serious problem occurs when tumors or cysts form around the impacted wisdom tooth, resulting in the destruction of the jawbone and healthy teeth. Removal of the offending impacted tooth or teeth usually resolves these problems.

Early removal is recommended to avoid such future problems and to decrease the surgical risk involved with the procedure.

Benefits of Early Removal

Having your wisdom teeth removed while still in your teen age years, often before symptoms are present, provides many advantages to waiting until you are older. Among the more common advantages are:

Avoiding the discomfort and risk of infection associated with partially erupted wisdom teeth
More complete and faster healing
Decreased chance of post-operative problems such as infection, numbness from nerve injury, or injury to nearby teeth during surgery
Decreased chance of wisdom teeth causing crowding of your other teeth or cavities in the adjacent molars
Less disruption of school and work related

These things are possible due to the incomplete root development of the wisdom teeth at the time of their removal. Removing wisdom teeth prior to the roots being fully formed will allow your surgeon to provide you with the best possible treatment. Compare the x-rays below and note the difference in root formation and position of the wisdom teeth.

22 year old patient…Fully developed wisdom tooth roots placing the nerve at high risk for injury.
A cavity is present on the second molar.

20 year old patient with hooked roots on a fully developed lower wisdom tooth.
This increases the difficulty of surgery and the chance of surgical complications. The upper wisdom tooth has distorted the roots of the upper second molar, placing it at risk for injury during removal of the wisdom tooth.

25 year old patient… Horizontal impaction placing the second molar
at risk for poor healing due to loss of bone height.

Area of the lip and chin affected by the nerve.
To decrease the incidence of post-operative numbness the wisdom teeth should often be removed before full root formation.

What to expect during healing after Wisdom Tooth Surgery

Surgery to remove wisdom teeth is, many times, the first medical procedure for a young adult. The following information is provided to help you better understand what to expect after surgery. There are four basic consequences of any surgery, whether it be removing a wisdom tooth, or having your tonsils or appendix removed. These four consequences are discomfort, bleeding, swelling and a risk of infection. Because each patient is unique, a spectrum of different responses is expected, but the majority of patients will experience the following:

Discomfort
Every patient will experience some level of discomfort. You will usually be provided two different pain medicine prescriptions. Many patients report after the first few days that Ibuprofen manages their discomfort very well. Some patients have reported not needing any pain medicine after the first few days.

Bleeding
Expect mild oozing from the surgical area for about 24 hours. As you progress through the first week of healing, expect occasional, mild bleeding after eating soft foods. Many patients will experience an odd taste in their mouth during this week. This is normal.

Swelling
Swelling is the number one cause of discomfort after any surgery. Every patient can expect some degree of swelling, which may last up to a week or more. The swelling after wisdom tooth surgery may make your cheeks appear puffy and result in bruising of the cheeks. The swelling which occurs in the jaw muscles will cause them to feel stiff and sore resulting in difficulty opening your mouth wide. Ice for the first 24 hours will help decrease the amount of swelling, as will keeping your head elevated when lying down. After the first few days, moist heat packs may help alleviate the jaw stiffness.

Infection
As with any surgical procedure, the risk of developing an infection is possible. This is usually due to the trapping of food in the surgical area. By following the post-operative instructions, very few patients develop this problem. The most common time for an infection to develop is one to three weeks after the surgery. Treatment may require only an antibiotic. Some infections will require cleansing of the site by the doctor.

How Long will the Healing Take?
This depends on your age and how deep the wisdom teeth are impacted. The majority of patients under 25 years of age will experience the above consequences for about a week to ten days. At the post-operative check-up, patients under 25 are still a little sore and have some swelling still present, but feel like they are getting better. Patients older than 25 are more likely to experience a longer healing time and thus have a greater opportunity to develop problems during their healing. Sometimes they do not feel completely back to normal for up to 4 weeks. Rarely however, does this affect their work schedule for more than a few days.

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