Wisdom Teeth and Impacted Teeth
The removal of a wisdom tooth or impacted tooth is a minor surgical operation
- What are wisdom teeth?
Wisdom teeth, also called "third molars," are the last teeth to develop and grow into the mouth. They are located in the very back of the mouth, near the entrance to the throat. Wisdom teeth usually finish their development between the ages of 15-21 years, a time that is traditionally seen as when one gains maturity and "wisdom."
- What are impacted teeth?
Teeth become impacted when there is not enough space for them to grow into the mouth, and their normal growth and eruption are prevented by overlying gums, bone, or another tooth. Many times, teeth that have been impacted appear to erupt later in life; this is usually from the adjacent gums receding, or pulling back, because of gum disease.
- How serious is an impacted wisdom tooth?
It is not normal for a tooth to remain below the surface; if wisdom teeth are impacted, difficulties may develop. The most common problem associated with impacted teeth is pain: it may be dull and aching, or sharp and excruciating pain. Also, infections tend to develop that are very painful and may be serious, requiring antibiotics and even hospitalization.
Just because a wisdom tooth doesn't hurt doesn't mean it's without problems: we know today that as many as one third of all people who have wisdom teeth have what are called "silent infections." These painless, longstanding infections are linked to heart disease, stroke, and low birth weight pregnancies later in life.
Impacted teeth have also been known to damage roots of nearby teeth, occurring in about 5% of all impactions. In addition, other problems associated with impacted teeth include: periodontal disease (which is felt to increase overall, and be progressive and resistant to treatment when wisdom teeth begin to show), decay, cysts or tumors, and crowding of other teeth in the mouth.
- What is the procedure like?
The removal of a wisdom tooth is a minor surgical operation. Depending on how impacted they are, the removal of wisdom teeth often requires an incision of the gums, possible cutting of tooth, and some removal of bone.
The entire surgery may last for a series of minutes, depending on the difficulty of the procedure, with the whole appointment lasting an hour or so. Anesthetic is used, as well as sterile instruments. Dissolvable stitches are often employed to aid in the healing process.
- What are the anesthesia options?
Anesthesia options include local anesthesia, nitrous oxide (laughing gas), intravenous sedation, or general anesthesia. These options can make the procedure most tolerable and relaxing.
- What is the recovery like?
Some swelling and soreness are typical after having wisdom teeth removed. There may be slight discoloration of the skin. Ample time should be allowed for the body and mouth to heal after the procedure. Detailed instructions and medications will be given to you by Dr. Bonine to enhance your comfort during recovery, and minimize swelling.
- What complications may arise?
No complications are expected. Nevertheless, any operation carries some risk. If the impacted teeth are in the lower jaw, they may rest near a nerve that serves the lip or tongue. While all precautions will be taken, there is a chance that the nerve will become irritated. This may result in some numbness or altered feeling of the lower lip or tongue. This effect is usually temporary in most cases.
Upper impacted teeth may be near the sinus, a hollow part of the upper jaw. Occasionally, an opening to the sinus could result, requiring special care and/or closure.
The wisdom tooth consultation will allow you to discuss these risks and other questions with Dr. Bonine.
- Do they really have to come out if they haven't been a problem yet?
Not all wisdom teeth need to be removed. However, it is important that one has a thorough consultation with an oral surgeon to help you with this decision. No one can tell when an impacted wisdom tooth may cause trouble, yet it is much easier to have an impacted wisdom tooth removed when young.
A tooth (or teeth) may be more difficult to remove if an infection has developed or other complications have occurred. In most cases, an x-ray taken of the jaws—even at a young age—will likely predict which teeth will become impacted.
The American Association of Oral and Maxillofacial Surgeons (AAOMS) estimates that 85% of all wisdom teeth will need to be removed, and concludes that the best outcomes occur when teeth are removed by age 17. Researchers have found that the risk of complications from surgery only increases with age.
Dr. Bonine, whose office is located in Brighton, Michigan, was a part of the six-member AAOMS 2007 national task force on wisdom teeth.