Wisdom Teeth

Wisdom teeth, also known as third molars, are the last teeth to erupt in your mouth. This generally occurs between the ages of 17 and 25, a time of life that has been called the “Age of Wisdom.”

The average mouth is made to hold only 28 teeth. It can be painful when 32 teeth try to fit in a mouth that holds only 28 teeth. These four other teeth are your third molars, also known as “wisdom teeth.”

Anthropologists note that the rough diet of early humans resulted in the excessive wear of their teeth. Normal drifting of the teeth to compensate for this wear ensured that space was available for most wisdom teeth to erupt by adolescence. The modern diet, which is much softer, and the popularity of orthodontic tooth straightening procedures produce a fuller dental arch, which quite commonly doesn’t leave room for the wisdom teeth to erupt, thereby setting the stage for problems when the final four molars enter the mouth.

What is an Impacted Tooth?

A tooth that fails to emerge or fully break through the gum tissue is, by definition, “impacted.” While this is a common problem associated with third molars, or wisdom teeth, as they are the last teeth to develop and erupt into the mouth, other teeth can also become impacted. A tooth may be partially impacted, which means a portion of it has broken through the gum, or totally impacted and unable to break through the gum at all.

How Serious is an Impacted Tooth?

Impacted and partially impacted teeth can be painful and lead to infection and periodontal (gum) disease.  They may also crowd or damage adjacent teeth or roots.

More serious problems may occur if the sac surrounding the impacted tooth becomes filled with fluid and enlarges to form a cyst. As the cyst grows it may hollow out the jaw and permanently damage adjacent teeth, the surrounding bone and nerves. Rarely, if a cyst is not treated, a tumor may develop from its walls and a more serious surgical procedure may be required to remove it.

Despite the considerable concern regarding impacted third molars, a study sponsored by the American Association of Oral and Maxillofacial Surgeons and the Oral and Maxillofacial Surgery Foundation finds that third molars which have broken through the tissue and erupted into the mouth in a normal, upright position may be as prone to disease as those third molars that remain impacted and that third molars should be removed by the time the patient is a young adult in order to prevent related gum disease or other problems.

Must the Tooth Come Out if it Hasn’t Caused Any Problems Yet?

Not all problems related to third molars are painful or visible. Damage can occur without you being aware of it.

As wisdom teeth grow, their roots become longer, the teeth become more difficult to remove and complications become more likely. In addition, partially or totally impacted wisdom teeth are more likely to cause problems as patients age.

No one can predict when third molar complications will occur, but when they do, the circumstances can be much more painful and the teeth more difficult to treat. It is estimated that about 85% of third molars will eventually need to be removed.

When Should I Have My Wisdom Teeth Removed?

Wisdom teeth are easier to remove when the patient is younger, since their roots are not completely formed, the surrounding bone is softer, and there is less chance of damaging nearby nerves or other structures. Removal of wisdom teeth at a later age becomes more complicated as the roots have fully developed (may involve the nerve), and the jawbone is denser.  The ideal time for the extraction of wisdom teeth is usually between 15 to 25 years of age.

It isn’t wise to wait until your wisdom teeth start to bother you. In general, earlier removal of wisdom teeth results in a less complicated healing process.  The AAOMS/OMSF study strongly recommends that wisdom teeth be removed by the time the patient is a young adult in order to prevent future problems and to ensure optimal healing.  The researchers found that older patients may be at greater risk for disease, including periodontitis, in the tissues surrounding the third molars and adjacent teeth. Periodontal infections, such as those observed in this study, may affect your general health.

Why Should I Have My Wisdom Teeth Removed?

Wisdom teeth are the last teeth to erupt within the mouth. When they align properly and gum tissue is healthy, wisdom teeth do not have to be removed. Unfortunately, this does not generally happen. The extraction of wisdom teeth is necessary when they are prevented from properly erupting within the mouth. They may grow sideways, partially emerge from the gum, and even remain trapped beneath the gum and bone. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to successfully erupt.

These poorly positioned impacted teeth can cause many problems. When they are partially erupted, the opening around the teeth allows bacteria to grow and will eventually cause an infection. The result: swelling, pain, stiffness, bad breath, and illness. The pressure from the erupting wisdom teeth may move other teeth and disrupt the orthodontic or natural alignment of teeth. The most serious problem occurs when tumors or cysts form around the impacted wisdom teeth, resulting in the destruction of the jawbone and healthy teeth. Removal of the offending impacted teeth usually resolves these problems. Early removal is recommended to avoid such future problems and to decrease the surgical risk involved with the procedure.

Dr. Vahadi, who is a Board Certified Oral & Maxillofacial Surgeon, has extensive training in the diagnosis and management of impacted teeth, tooth extraction and dentoalveolar surgery.

If you have questions about wisdom teeth removal, please call our office and schedule an appointment.

Oral Examination of Wisdom Teeth

With an oral examination and x-rays of the mouth, Dr. Vahadi can evaluate the position of the wisdom teeth and predict if there are any present or possible future problems. Studies have shown that early evaluation and treatment result in a superior outcome for the patient. Patients are generally first evaluated in the mid-teenage years by their dentist, orthodontist or by an oral and maxillofacial surgeon.

All outpatient surgery is performed under appropriate anesthesia to maximize patient comfort. Dr. Vahadi has the training, licenses and experience to provide various types of anesthesia for patients to select the best alternative.

Removal of Wisdom Teeth

In most cases, the removal of wisdom teeth is performed under general anesthesia, intravenous sedation, laughing gas (nitrous oxide/oxygen analgesia), or local anesthesia. These options, as well as the surgical risks (i.e., sensory nerve damage, sinus complications), will be discussed with you before the procedure is performed. Once the teeth are removed, the gum may be sutured. To help control bleeding, bite down on the gauze placed in your mouth. You will rest under our supervision in the office until you are ready to be taken home. Upon discharge, your postoperative kit will include postoperative instructions, a prescription for pain medication, possibly antibiotics, and a follow-up appointment in one week.  If you have any questions, please do not hesitate to call us at Torrance Oral, Facial Surgery & Dental Implants Phone Number 310-373-6833.

Our services are provided in an environment of optimum safety that utilizes modern monitoring equipment and staff who are experienced in anesthesia techniques.

What Happens During Surgery?

Before surgery, Dr. Vahadi will discuss with you what to expect. This is a good time to ask questions or express your concerns. It is especially important to let the doctor know about any illness you have including allergies, and medications you are taking.

The relative ease with which a wisdom tooth may be removed depends on several conditions, including the position of the tooth and root development. Partially or totally impacted wisdom teeth may require a more involved surgical procedure.

Most wisdom tooth extractions are performed in the oral and maxillofacial surgery office under general anesthesia, intravenous sedation, laughing gas (nitrous oxide/oxygen analgesia), or local anesthesia. Dr. Vahadi will discuss the anesthetic option that is right for you.

What Happens after Surgery?

Following surgery, you may experience some swelling and mild discomfort, which are part of the normal healing process. Cold compresses may help decrease the swelling, and medication prescribed by Dr. Vahadi can help manage the discomfort. You may be instructed to modify your diet following surgery and later progress to more normal foods.