What are Wisdom Teeth?
Wisdom teeth, or 3rd molars, are the last teeth to develop and appear in the mouth. They are called “wisdom teeth” because they usually appear during a person’s late teens or early twenties, which has been called the “age of wisdom”. The normal position of wisdom teeth is behind the upper and lower second, or 12 year, molars. Many times the jaws of modern humans are not normally large enough to accommodate the four wisdom teeth. This is why wisdom teeth cause more problems than any other teeth in the mouth. In fact, for nine out of ten people at least one wisdom tooth remains underneath the gum due to lack of space in the mouth.
Impacted Wisdom Teeth
When a wisdom tooth is blocked form erupting or coming into the mouth normally, it is termed “impacted”. A tooth may be only partially impacted, meaning it grows in crooked and breaks through the gum only partially, or it may fail to break through at all and thus remains totally impacted. Serious problems can develop from partially impacted teeth, such as pain, infection, and crowding of, or damage to, adjacent teeth. For totally impacted teeth, more serious problems can occur if the sac that surrounds the impacted tooth fills with fluid and enlarges to form a cyst.
This enlargement can hollow out the jaw and result in permanent damage to the adjacent teeth, jawbone and nerves. If the cyst is not treated, a tumor may develop from the walls of the cyst and a more involved surgical procedure may be required for removal.
Many problems with wisdom teeth can occur with few or no symptoms, sot here can be damage without your knowing it. It is important to know that as wisdom teeth develop, their roots become longer and the jawbone denser. Thus, as a person grows older, it becomes more difficult to remove wisdom teeth and complications can become more severe. In addition, as people age there is an increased chance of the symptoms mentioned above. For these reasons, the surgeon may recommend the removal of wisdom teeth even if they are not yet causing obvious problems, particularly for young adults.
What to expect during surgery:
Anesthesia – Modern anesthesia technology now makes it possible to perform even complex surgery in the dental office with little or no discomfort. During surgery, one or more of the following is used to control pain and anxiety: local anesthesia that numbs the surgical area; nitrous oxide-oxygen (Laughing gas) to relax you, intravenous sedation for relaxation; and general anesthesia that puts you to sleep. Dr. Flugrad will fully explain the type of anesthesia that is most appropriate for your needs.
Surgical procedure – The method used to remove your wisdom teeth will depend on various factors, for example, the position of the teeth; the length of curvature of the tooth roots; the thickness of the bone surrounding the teeth; and so on. If the teeth have fully erupted, it is possible to simply remove each tooth intact from its socket in the bone, using forceps or other instruments designed for this purpose. If gum tissue is covering the tooth, an incision will be required to turn back the gum and expose the tooth. Likewise, if the bone covers the tooth, the surgeon will remove sufficient bone to expose the tooth and allow its removal. If an incision through the gum tissue is needed to gain access to an impacted tooth, Dr. Flugrad may place some sutures (stitches) at the end of the procedure to hold the tissue together and aid healing. These sutures may dissolve on their own after surgery, or you may have to return to the office for their removal.
Known risks and complications:
The removal of wisdom teeth is a common procedure that usually produces few, if any, serious complications. However, as with any surgical procedure you should be aware of possible complications and discuss them with your surgeon prior to consenting to surgery. Following are potential complications you should understand:
Infection – Any time body tissues are invaded there is a slight chance of infections setting in afterwards. Signs of infection to watch for include fever, abnormal swelling, and pain, salty or prolonged bad taste, and pus formation.
Injury – Damage to fillings in adjacent teeth, to the teeth themselves, to bridgework, or to surrounding bone can potentially occur.
Dry socket – This term is used to describe a condition that can develop in the empty tooth socket, when normal blood clotting is disturbed following surgery. If a blood clot does not form properly in the socket for some reason, for example smoking or food impaction, the socket remains “dry” for a period of time and heals more slowly than usual. A dry socket can be quite painful because it leaves the bone within the socket exposed to air, food and fluids.
Numbness – In some cases major sensory nerves serving the mouth are in close proximity to wisdom teeth, and it is possible that one or more of these nerves could be irritated during surgery. If this happens, paresthesia or anesthesia can result, which means partial or total loss of felling in the areas served by the nerve. This numbness or tingling sensation can affect the lip, tongue, cheek, chin, gums or teeth, depending on the nerve that is involved. Usually the numbness is temporary, but in rare cases can be permanent.
Sinus complications – sometimes upper wisdom teeth are near the large maxillary sinus, and the roots may even penetrate into the sinus cavity. An opening into the sinus with drainage, or sinus pain (sinusitis), may occur following tooth removal. Usually these complications are temporary, but if they persist contact your surgeon.
Root fragments - occasionally roots are extremely long or fragile, and a piece of root may break off during surgery. Usually the fragment is removed, but if it is close to a nerve or its removal would jeopardize adjacent teeth, Dr. Flugrad may decide to leave the fragment in place. This usually presents no long-term problems, and the fragment can be monitored using x-rays.
Jaw fracture – in very rare cases, the manipulations required for removal of wisdom teeth can fracture the jawbone, particularly if the jaw is thin and the teeth are severely impacted. X-rays will reveal the location of the fracture, and your oral and maxillofacial surgeon can treat the problem. Even if the jaw has not been fractured, it may be weakened due to removal of bone during surgery. Care should be taken to avoid eating hard, crunchy food that place undue stress on the jaws until healing is completed.
TMJ (jaw joint) pain or abnormal function is rare following wisdom tooth removal, but this can occur. If it does, further treatment may be necessary.
There will be a hole (socket) where the tooth was removed. The socket will gradually fill in with the new bone and tissue. In the mean time, the area should be kept clean, especially after meals, with salt-water rinses and/or a toothbrush.
Your case is individual; no two mouths are alike. Do not accept well-intended advice from friends. Discuss your problem with the person best able to effectively help you--your surgeon.
