Generally a tooth is removed when it is too badly damaged to be repaired. This can be the result of an accident, abuse or neglect. Teeth should not be used to open bottles, tear open packages or crack nuts. This type of abuse will eventually crack the teeth. Poor dental hygiene will result in periodontal disease, which can cause enough bone loss that teeth need to be extracted.


The exception is wisdom teeth. Your wisdom teeth, or third molars, are the last teeth to emerge from your gums during your late teens, or “age of wisdom”, which gives them their name. But wisdom teeth are not really so wise. They often become impacted or trapped in the jaw bone and gums and fail to erupt as straight and fully functioning teeth. Impacted wisdom teeth nearly always have to be removed. Example of impacted wisdom teeth can be seen in the following graphics

 

Why do we have wisdom teeth at all if they have to be removed so often? Human beings once had tougher diets. As our diets became softer and more refined, we no longer needed jaws for strenuous chewing. The jaws failed to develop, leaving little room for third molars. In addition, due to mixing of gene pools, some adults never develop wisdom teeth at all and some end up with more teeth than jaw. Perhaps in the distant future, we won’t have to worry about them at all. Today, most people experience at least one impacted wisdom tooth.

Why Remove Wisdom Teeth?Wisdom teeth that are not painful seem harmless enough. But if they are not removed early, they often cause problems such as:

INFECTION (PERIOCORONTIS): The mouth is full of bacteria that normally do not get past the protective layer of gums. But when an impacted tooth breaks through the gum surface, bacteria can get in causing an infection in the gums around the crown of the tooth. This infection can cause severe pain, swelling, jaw stiffness, and even general illness.

DESTRUCTION OF THE NEXT TOOTH: An impacted tooth may still try to grow where it has no room, eroding the tooth next to it. This is called RESORBTION. Eventually, this could lead to the loss of both teeth.

PAIN: Infection in a decayed wisdom tooth or in the gum around an impacted tooth can cause pain. If a decayed wisdom tooth is not situated in a healthy position, or if it is not restorable, we may recommend its removal. An impacted tooth can also cause pain if it presses against a nerve or the next tooth.

CROWDING: An impacted tooth can crowd nearby molars out of alignment. If you are undergoing orthodontic care, we may recommend that your impacted wisdom teeth be removed.

CYSTS: When a tooth is impacted, the sac of tissue around the crown remains in the bone. Occasionally, the sac fills with fluid forming a cyst that can readily destroy or enlarge the bone and endanger surrounding structures. Wisdom tooth extraction can be done under local anesthetic or sedation ”sleep dentistry”. Most commonly a panoramic radiograph (one that circles the head and shows the entire portion of the jaws) is required to visualize the wisdom teeth in relation to other structures and root anatomy.

Photo of Panoramic Xray. Note horizontally impacted left wisdom tooth on the right side of the image.

Upper wisdom teeth roots tend to be more conical in shape or taper together making their extraction usually straightforward. Lower wisdom teeth range in root anatomy and can range from a simple extraction to a complicated extraction to a full bony extraction where bone is covering the entire crown surface.

Discomfort:

The amount and duration of discomfort one should expect is very unpredictable. Some discomfort will usually be present for 7 – 9 days and may not start until the second or third day due to increased swelling. Take the medication prescribed as needed for discomfort. Stop taking if nausea occurs. Take medications with food and/or 8 ounces of water to reduce stomach upset. If narcotics are prescribed, do not drive while taking.

Swelling:

Significant swelling and bruising may follow your surgical procedure. To help reduce swelling, we recommend that you place an ice pack over the area, 15 minutes on and 15 minutes off, for the next 2 to 4 days for the swelling subsides. You should also elevate your head with pillows or use a recliner. It could take 3 – 4 days for the swelling to peak. We recommend that you avoid all strenuous exercise and heavy lifting for the first 5 to 6 days. If you have undergone a sinus lift graft, avoid blowing your nose and sneezing for two weeks. You may need to take an over the counter non-drowsy decongestant such as Sudafed or Afrin to dry up the nasal cavity.

Bleeding:

A slight oozing of blood will appear in your saliva for several hours after surgery. This will almost always stop without attention. If excessive or continuous bleeding occurs:

1. discontinue all rinses

2. sit in an upright position

3.apply a moistened tea bag with gentle pressure to the immediate area for twenty minutes (repeat as necessary)

Fever:

Slight fever is common after a surgical procedure. It may last for a day or so. Fever may be caused by inadequate fluid intake as well. If excessive or at all questionable do not hesitate to phone our office.

Smoking:

Smoking will definitely slow healing and should be avoided or reduced. Smoking is harmful to the success of this operation. We recommend stopping for 2 weeks before surgery and not smoking until completely healed. We can assist you in many ways to help fight the craving. Since smoking depletes Vitamin C.

Diet:

We recommend soft foods such as eggs, ground meat, cottage cheese, pasta, fish, soups, milkshakes, mashed potatoes, instant breakfast, bananas, Jell-O, and ice cream.