Wisdom Teeth

Third molars are commonly referred to as wisdom teeth. They are usually the last teeth to develop and are located in the back of your mouth, behind your second molars. Their development is usually completed between the middle teenage years and early twenties, a time traditionally associated with the onset of maturity.

When wisdom teeth are aligned properly and gum tissue is healthy, wisdom teeth may not have to be removed. However, when they are prevented from proper eruption, the early removal of wisdom teeth is strongly recommended by American Association of Oral and Maxillofacial Surgeons.

A diagram half mouth X-ray with teeth impaction and half digital graphic highlighting impacted teeth

Wisdom teeth may grow sideways, partially emerge from the gum and even remain trapped beneath the gum and bone.  

  • Soft Tissue Impaction: Wisdom tooth is partially covered by the tissue and an opening around the impacted tooth allows food debris and bacteria to trap which will eventually result in infection
  • Partial Bony Impaction: There is enough space to allow the wisdom tooth to partially erupt. However, the tooth cannot function properly in the chewing process, and creates cleaning problems, among others.
  • Complete Bony Impaction: There is NO space for the tooth to erupt. It remains embedded in the jaw bone or if even partially visible requires complex surgical techniques for removal. The impacted wisdom tooth may also be in an unusual position and difficult to remove. This situation can also arise when the shape or size of the jaw bone and other facial structures make removal of this tooth significantly more complex.
A representation of a wisdom tooth impacted by soft tissueSoft Tissue
An example of a wisdom tooth with a partial bony impactionPartial Bony
An illustration of a wisdom tooth completely impacted by boneComplete Bony

Why Should I Have My Wisdom Teeth Removed?

Poorly positioned impacted teeth can cause many problems. The opening around the impacted teeth allows food debris and bacteria to trap and will eventually cause an infection. The result can be swelling, stiffness, pain and illness. The most serious problem can occur when tumors or cysts form around the impacted wisdom teeth resulting in the destruction of jawbone and healthy teeth. Patients may show symptoms as early as 12 or 13, and in others it may not be until the early 20’s. Problems tend to occur with increasing frequency after the age of 30. Some of the possible problems related to not removing your wisdom teeth include: 

A representation of a pericoronitis infection on a wisdom tooth

Infection:

The most frequent clinical problem we see is pericoronitis, (a localized gum infection). Without enough room for total eruption, the gum tissue around the wisdom tooth can become irritated and infected, resulting in recurrent pain, swelling, and problems with chewing and/or swallowing.

An example of a cyst formation on a wisdom tooth

Cyst Formation:

Cysts are fluid-filled “balloons” inside the jaw bone that develop as a result of impacted teeth and slowly expand destroying adjacent jaw bone and occasionally teeth. They can be very difficult to treat if your wisdom teeth are not removed in your teenage years. Although rare, tumors can be associated with the delayed removal of wisdom teeth.

An illustration of teeth crowding causes by a wisdom tooth

Possible Crowding:

Impacted wisdom teeth may contribute to crowding of your teeth. This is most noticeable with the front teeth, primarily the lower front teeth and is most commonly seen after a patient has had braces. There are a number of factors that cause teeth to crowd after braces or in early adulthood. Retained, impacted wisdom teeth may be a contributing factor. 

A visual of a wisdom tooth damaging an adjacent tooth

Damage to Adjacent Teeth:

If there is inadequate room to clean around the wisdom tooth, the tooth directly in front, the second molar, can be adversely affected resulting in gum disease, bone loss around the tooth, and/or decay.

What If I Don’t Have My Wisdom Teeth Removed As A Young Adult?

As wisdom teeth develop, the roots become longer and the jaw bone more dense.When it is necessary to remove impacted wisdom teeth in your thirties, forties or beyond, the post-operative course can be prolonged and there is a higher complication rate. Treating these complications is often more difficult and less predictable than with a younger patient. Healing may be slower and the chance of infection can be increased. If your impacted wisdom teeth are not removed in your teenage years or early in your twenties and they are completely impacted in bone, it may be advisable to wait until a localized problem (such as cyst formation or localized gum disease and bone loss) develops. In general, you will heal faster, more predictably and have fewer complications if treated in your teens or early twenties.

What Happens On The Day of Surgery?

Most people prefer to be unaware of the experience when they have their wisdom teeth removed and usually decide to be sedated. You will be provided with appropriate anesthesia options at your consultation. All outpatient surgery is performed under appropriate anesthesia to maximize your comfort. Our office staff has the training, licensing, and experience to provide the various types of anesthesia. These services are provided in an environment of optimum safety, utilizing modern monitoring equipment and a well experienced staff. The Surgical Care Team, the office facilities, and the doctors are inspected on behalf of the Board of Dental Examiners on a regular basis. 

  • You may be given with antibiotics or corticosteroids to help minimize post-operative pain and swelling one day prior to the surgery. 
  • It is essential that you have nothing to eat or drink (excluding prescription medications with a sip of water) for at least 6 hours (preferably longer) if you are. Having anything in your stomach can increase the risk for serious anesthetic complications, including nausea and vomiting. Your procedure will be rescheduled if you have not heeded these guidelines. We may provide you with a prescription for pain medication at your consultation appointment, which for your convenience, can be filled in advance. When you are seated in the surgical room, we will make every effort to make you as comfortable as possible. If you are going to be sedated, we usually will place an IV in your left arm. This is a quick and nearly painless procedure that ensures optimal delivery of your medication. Local anesthesia is given to you afterwards to ensure comfort, and allow adequate time to travel home and rest. You will be sleepy for a significant portion of the day.
  • We ask that a parent or responsible adult accompanies you to the office and plans to stay with you the rest of the day. The procedure will take about 30 to 60 minutes and you will probably be in the office for 90 minutes. Recent advances in medicine and technology allow patients to undergo wisdom tooth removal in a manner, which promotes rapid healing and minimal post-operative discomfort. State of the art sterilization and infection control techniques are used at all times.

If your surgery requires stitches, these are usually the type that dissolve in 3 to 5 days and do not require removal. You may also notice a sensation of your gums feeling swollen and pulling away from your teeth. This is all part of the normal recovery, and will subside in several days.

Once the local anesthesia wears off, you may require prescription pain medication. Please try non-narcotic anti-inflammatory medications such as ibuprofen (Advil®) first, to see if that adequately treats your pain. If not, begin your other prescription pain medication. The local anesthesia may last until the following day, and should not be confused with an injury to your nerve. We recommend starting your post-operative diet with clear liquids such as jello and broths, gradually increasing in substance as your body permits.

Click Here for Detailed Post Operative Instructions After Wisdom Teeth Removal

    Wisdom Teeth Presentation

    To provide you with a better understanding of wisdom teeth, we have provided the following multimedia presentation. Many common questions pertaining to wisdom teeth are discussed.

    Wisdom Teeth Presentation