Wisdom Teeth
Impacted Third Molars
   
INTRODUCTION:  
   


The wisdom teeth (your third molars) are the last teeth to come in-and the last teeth to come in and the ones least needed for good oral health. They may not erupt, or emerge from your gums, until your late teens or early twenties-if they erupt at all. Most often, they are impacted, or trapped in the jawbone and gums, usually because there's not enough room for them in your mouth. Our jaws are smaller than those of early humans, who needed large jaws and more teeth for their tougher diet. We don't need that extra chewing power anymore. In fact, wisdom teeth often do more harm than good, and your dentist may recommend removing them


If they are impacted, you may not even know you have wisdom teeth-until pain suddenly strikes because of infection or pressure on an adjacent tooth. Late, partially erupting wisdom teeth may cause crowding or shifting or your teeth or bite. You may not know that your developing wisdom teeth are pushing on the roots of adjacent teeth-until those teeth start to shift. If your wisdom teeth do erupt, they may be hard to clean, so the odds of decay or infection of surrounding gum tissue are high.

Whether you have obvious symptoms or not, you can rely on your dentist's expertise to diagnose existing or potential problems caused by your wisdom teeth. If your dentist recommends their removal, it may be the wisest choice for the health of the rest of your mouth. Your wisdom teeth may be removed by your general dentist or by an oral and maxillofacial surgeon (a mouth and jaw surgery specialist). Or your dentist may recommend other treatment options. You can help make your treatment a success by understanding why your wisdom teeth may need to be removed, what the procedure involves, and what you can do to promote a successful recovery.

Most people have four wisdom teeth, one in each corner of the mouth, but each tooth can be at a different stage of eruption and position of impaction.

Since wisdom teeth develop over a period of many years, harmful changes in your mouth may be gradual. But these changes could result in sudden and severe pain. If you lean the different ways wisdom teeth can develop, you'll be better able to understand why you may need to have them removed.


By your late teens, your jawbone has nearly reached its adult size. But sometimes it isn't big enough to hold developing wisdom teeth. When this happens, your teeth become trapped in the bone and grow wherever they can. The crown (chewing surface of the tooth) may only partially break through the gum. In other cases, it may remain completely in the bone. The roots, which hold the tooth in place, may become misshapen or grow dangerously close to the sinus cavity or to the nerve located in your lower jaw which provides sensation to the teeth, gum, and lower lip on that side.

Cramped for room, impacted wisdom teeth grow in many different directions, commonly at an angle. A wisdom tooth may grow at an angle toward your other teeth (mesioangular position) or away from the other teeth (distoangular position). They also can grow into a horizontal or vertical position.

Like all teeth, wisdom teeth develop inside an opening (socket) in your jaw, protected by bone and gym tissue until they erupt. Over time, your wisdom teeth become more firmly anchored in your jaw as their roots lengthen and the jawbone becomes more dense. So, the older you are, the more difficult it is to remove your wisdom teeth.

PROBLEMS THAT MIGHT BE CAUSED BY WISDOM TEETH:

   

Gum Disease: When a wisdom tooth partially breaks through the gum's surface, bacteria can get under the flap, causing an infection in the gum.


Crowding:   An impacted or erupting wisdom tooth can push on adjacent teeth, causing them to become crooked or even damaging them structurally.


Decay:   A wisdom tooth that is hard to clean due to its position or because it is partially covered by gum tissue may collect cavity-causing bacteria.  This could also lead to decay in the tooth next to it.


Poor position: A wisdom tooth that grows toward the cheek can irritate nearby tissues.  If an erupted tooth is crooked, it may be hard to clean and can even make it hard to bite down.


Cysts: If the sac that holds the crown remains in the bone, it can fill with fluid, forming a cysts that can destroy surrounding bone.

 

EVALUATING THE WISDOM TEETH:

 
Are your wisdom teeth threatening the health of your mouth? An evaluation by your dentist can answer this question. Your dentist will take your dental and medical history, examining your teeth, and take x-rays to assess the health of your teeth. If your evaluation pinpoints a problem with your wisdom teeth, your dentist may recommend surgery to remove them and eliminate the symptoms, or to protect your mouth from future problems.

Your Dental and Medical History:
Your dentist may ask whether you have tooth or jaw pain or sensitivity to cold or hot foods, about prior dental treatment, and about gym or jaw problems. You may be asked about medical problems that could interfere with treatment. Be sure to tell your dentist about medications you're taking because they could affect treatment.
 

Your Dental Examination:  An examination helps your dentist determine the general health of your mouth as well as that of your wisdom teeth.  Your dentist may inspect your gyms and jaws for swelling, tenderness, or infection.  Your teeth may be examined for the presence of tooth decay.  Your blood pressure, pulse, and respiratory rate may be checked to assess whether you can undergo the procedure or anesthesia.

 

Dental X-Rays:  To help confirm the diagnosis, your dentist will take x-rays.  X-rays are especially useful for identifying potential problems when you don't have symptoms.  Intraoral x-rays are small and provide an internal view of the individual teeth and jawbone.  If intraoral x-rays don't provide enough information, other types of x-rays may be needed, such as panoramic x-rays.  They provide a clear image of the area around all four wisdom teeth, as well as the surrounding bone.  These x-rays can show hard to image impacted teeth clearly.

 

UNDERSTANDING THE SURGERY:

 
Your wisdom tooth surgery may be done in your dentist's or oral surgeon's office, an outpatient surgical center, or occasionally, in a hospital.  The surgical method depends on whether your wisdom teeth are erupted or impacted and how deep the roots are.   To help the surgery go smoothly, follow your dentist's or oral surgeon's instruction on how to prepare for surgery.

Preparing for Surgery:  You may need to take some days off school or work to give yourself enough time to recover.  Schedule a follow-up visit with your dentist or oral surgeon so that he or she can monitor your progress after surgery and check that you're healing properly.

Eating:  If your surgery is going to include anesthesia or intravenous (IV) medication, don't eat or drink anything after midnight the night before.  Otherwise, don't eat or drink anything for at least six hours before surgery.

Transportation:  You will probably be tired and not alert enough to drive home safely after your surgery.  Arrange to have a responsible adult come with you on the day of surgery who can drive you home.

Clothing:  Wear loose, comfortable clothes.  Choose a shirt or blouse with short sleeves, so if you receive an IV (intravenous) anesthetic, it can be administered easily.

Before Surgery:  To help you relax, you may be given a sedative (by pill or IV).  You may even sleep through your surgery.  Or you may receive nitrous oxide (laughing gas) and oxygen gas, given through a mask placed over your nose.  Once you are fully relaxed or asleep, a local anesthetic is used to numb the area around each wisdom tooth being removed.

During Surgery:  Expect the procedure to take about an hour.  If your tooth is erupted it may be removed (extracted) from its socket without an incision in your gums.  For impacted teeth, an incision will be necessary.  Sutures (stitches) may be used to close the incision.

After the Surgery:  You will rest for a while under close observation as you recover from the anesthetic.  When your dentist or oral surgeon is satisfied with your progress, you'll be able to go home.  You may get a prescription for pain medication as well as instruction for your home recovery. Plan to rest at home for the remainder of the day.  During the next few days, don't plan on driving, drinking alcohol or operating any kind of machinery; you may be drowsy from the pain medication, other drugs, or anesthetic.

RISKS AND COMPLICATIONS:

If you decide on removal, your dentist will discuss the risks and possible complications with you and ask you to sign a consent form.  Removal of wisdom teeth is a common procedure, but as with any surgery, there are risks, such as side effects from the anesthetic, bleeding, infection and possible other complications such as numbness.
   

Numbness:  Impacted teeth may be close to or in actual contact with the nerves that supply sensation to the teeth, gums, tongue, chin, cheeks, and lips.  Occasionally these nerves are injured when the tooth is removed, causing numbness and tingling.  If this happens, the nerve usually repairs and regenerates itself within a short time.  In some cases this process can take up to several months or the numbness can even be permanent.

Dry Socket:  Healing can be delayed if the blood clot covering the socket dissolves or is washed away.  This exposes the bone and may lead to constant, deep, throbbing pain, which can easily be treated with a dressing.

 

Infection:  Infection is a less common complication.  It can usually be treated by draining the infection or with antibiotics.

Sinus Problems:  Because the upper wisdom teeth are near a sinus cavity, the removal of these teeth can open the sinus cavity on rare occasions.  The sinus usually heals, but if a problem persists, further treatment may be needed.

Weakening of the Jaw:  In rare cases, removal of an impacted tooth can weaken the jaw, making it more susceptible to fracture.

RECOVERING AFTER SURGERY:
 

After surgery, the openings left when your wisdom teeth were removed now need to heal and eventually close.  You can promote faster healing and avoid complications by following your dentist's or oral surgeon's care instructions. You may experience some temporary discomfort in your mouth as it heals, but you can take steps to be more comfortable.

The Healing Process: 
The healing process begins immediately after surgery.  The body sends blood to nourish the tooth socket.  To control excessive bleeding, you may be instructed to bite down on a piece of gauze, applying constant, direct pressure to the area.  This helps a blood clot to form in the socket.  In a day or two after surgery, soft tissue begins to fill in the opening.  New bone tissue also begins to grow in the socket, becoming dense over the next two to three months.

 
Pain and Swelling:  As the anesthetic or pain medications that you received at the facility wears off, you may experience some discomfort.  Your gums and jaw may feel tender and sore.  To make yourself more comfortable, take the pain medication that has been prescribed.  It's normal for your cheek to swell, but you can keep swelling to a minimum by placing ice packs on your cheeks during the first 24 hours after surgery.


Healing Tips (Do's):

¨ Do apply pressure to stop the bleeding by placing the gauze directly over the extraction site.

¨ Do apply ice packs to your face to reduce swelling the day of surgery.

¨ Do eat soft foods, such as soups, and blenderized meals, after the bleeding stops.

¨ Do drink lots of fluids after the bleeding stops

¨ Do take antibiotics or pain-reducing medications, if prescribed.

¨ Do keep your mouth clean.

Healing Tips (Don'ts):

¨ Don't chew hard or crunchy foods, such as carrots or popcorn, for two weeks.  These foods could become lodged in the extraction site or fracture the weakened jawbone.

¨ Don't brush the teeth in the area of surgery until the day after surgery.  Brush carefully.

¨ Don't rinse your mouth or spit forcefully the day of surgery; it could loosen the blood clot.

¨ Don't smoke after surgery.  Inhaling creates suction, and it could loosen the blood clot.

¨ Don't overexert yourself.

¨ Don't use alcohol the day of surgery or while taking pain medications.

Call Your Doctor If You Have:

¨ Excessive bleeding.

¨ Excessive and persistent swelling.

¨ Fever .

¨ Reaction to medications .

 
YOUR FOLLOW UP CARE
   
If you have any questions or concerns while you're recovering from your surgery, call your dentist or oral surgeon.   You may also need to see your dentist or oral surgeon after surgery to have stitches removed.  Your dentist or oral surgeon may also schedule a follow-up examination to make sure that the socket is healing properly and that your mouth is returning to a normal, healthy state.

The information provided above is for educational purposes only.  Individual results may vary.  A personal consultation with your plastic surgeon is the best way to gain information about your particular complaint, and about potential treatment options to address the same

 

 
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South Miami, Fl 33143
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Mount Sinai Medical Center
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Miami Beach, Fl 33140
T (305) 665-8730
F (305) 665-8736

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info@mosasurgery.com

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