A Close Look At The Wisdom Teeth

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Also known as the third set of molars or simply third molars, the wisdom teeth are the last set of teeth in the mouth to erupt, which normally happens around the ages of 17 – 25.

For many years, there has been a lot of controversy as to the need to remove these teeth.  Particularly between Orthodontists and Oral Surgeons.

If the teeth don’t cause any harm or pain, they are normally fine to stay in place.  But if they are in a bad position or cause you a lot of pain or discomfort, they will usually need to be removed.

When the wisdom teeth first begin to erupt, they will often be impacted.  This means that they are lodged in the jaw bone and not able to fully erupt into the mouth. They might be fully impacted or partially impacted.  Partially impacted (or erupted) wisdom teeth pose the most potential problems, due to their location, difficulty to clean and tendency toward infection.

You see, as mankind has evolved and moved toward a processed food diet, the jawbones have become smaller and less able to accommodate three sets of molars.  As a result, among a growing majority of people in developed countries, wisdom tooth removal is almost an automatic procedure.  However, in non-developed countries, it’s still very common for people to have plenty of room for all 32 of their teeth.

Normally, your dentist will recommend removal of impacted and especially, partially impacted wisdom teeth.  Sometimes they can be pulled, if enough of the tooth is visible and accessible in the mouth.  Although in most cases they need to be surgically removed by an Oral Surgeon.

When the time comes to have your wisdom teeth extracted, you’ll need to go to an Oral Surgeon and have a consultation first.  During the consultation, they’ll take one or more x-rays that will show the surgeon the exact positioning of the teeth, as well as all surrounding structures, like the bone and nerves.

The oral surgeon will review the films, perform a thorough oral, face and neck exam and go over the diagnosis with you, before presenting you with their recommendations and treatment options.

If they are going to either simply extract or surgically remove your teeth, you’ll most likely have the option of using only local anesthesia or going with IV sedation in addition to local anesthesia.   Some surgeons also offer nitrous oxide as an adjunctive anesthesia, rather than IV sedation.

IV sedation is the preferred way to have wisdom teeth extracted, as you’ll be so relaxed you won’t know what is going on.  If you decide to just use only local anesthesia, which fully numbs the affected areas, you’ll be fully aware of the procedure, but it will be pain-free.  You’ll also hear the popping and cracking involved, which can make you feel quite uncomfortable.

Another inherent benefit to IV sedation is the “amnesia effect”.   The drug combination normally causes you to forget the entire procedure after the drugs wear off.  For most people, this is excellent, since fear of the dentist is prevalent in the population.  They often wake up asking “are you done?” and have no recollection of the procedure, including all the sounds, smells and other sensations, like having their face manipulated for an hour or so.

Depending on the shape, size, and the formation of the wisdom teeth, the removal process can vary from easy to hard.  If the root tips are curved, for example, the removal process can be very time consuming.  Or, as is commonly the case, if the lower wisdom teeth are partially erupted and tilted horizontally toward the second molars, the wisdom teeth will have to be “sectioned”, meaning cut into pieces for easy removal.  This protects the second molars and normally also requires a channel of bone to be cut around the wisdom tooth.  The bone fills back in – including the hole left from the extraction – within a few months.

Rarely, the impactions will be so severe the surgeon will want to make use of an actual operating room to perform the procedure, rather than in their clinic.  In other words, using general anesthesia to completely “knock you out” while they grind, pry and pull on the offending teeth and surrounding bone.  While general anesthesia presents the greatest possibility for complications (including death), the benefits include a fully staffed medical team in case some complication does arise and of course, you being completely oblivious to what is going on.

Once the extractions have been completed, there is normally some degree of pain, swelling and bleeding involved once the local anesthesia wears off.  Your dentist will prescribe you some pain medicine, which you should use as soon as you arrive home and before the local wears off.

If you are going to use IV sedation, you’ll need to someone to accompany you, as you won’t be able to drive home afterward. Someone will also need to be with you for the first 24 hours, to make sure that you ok as the drugs wear off.

After the removal of your wisdom teeth, your dentist will go over with your escort (if you had IV sedation, because you probably won’t remember what was said) what you need to do to ensure the proper healing of your gums and mouth.  Normally, they will also give you written information to go over, to make sure that you experience no problems in the healing process.

Typically, the younger the patient, the faster they “bounce back” from the procedure.  That’s because of two things, primarily.  They have softer bone and they have a faster healing response.  Another consideration is how well developed the teeth are.  Partially developed teeth have unformed roots, which makes extraction much easier than those that have been “anchored” in the bone for several years.

Thousands of people have their wisdom teeth removed each month.  For the most part, it’s a normal part of growing up in the U.S. and other developed countries.  And quite often, it’s done as a prelude to orthodontics.  Procedures have been refined over the years so that removal is quick, non-traumatic and post-operatively unremarkable for the vast majority of patients.

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