September 22, 2011

Wisdom Teeth

The very last teeth to erupt in the mouth are the 3rd molars, better known as the wisdom teeth. In most instances the wisdom teeth have no problems erupting into the mouth, and they do not cause any problems as long as they are brushed and flossed regularly. Effective oral hygiene can be difficult for many patients because of how far back the teeth are in the mouth, so extra time and care is needed to prevent wisdom teeth from getting cavities and periodontal defects. Cavities on wisdom teeth can be very difficult to restore with traditional filling techniques, therefore the most practical treatment is to extract the decayed teeth. In our office, it can even be less expensive to have the tooth extracted than to have the filling completed.

Another common problem is when there is not enough room in the mouth for the erupting wisdom teeth. The term used to describe a tooth that becomes “stuck” behind the second molars is “impaction”.  There are varying degrees of impacted teeth:

  • Soft Tissue Impaction: This is where the wisdom tooth erupts through the jaw bone and almost to full completion, but gets stuck in the gum tissue. These are the most common impactions and usually cause the most trouble.  If the tooth is able to break through the gums, but not able to erupt all the way, food can be trapped leading to infection, inflammation, and a foul odor from around the tooth. To aid in the comfort of having them removed nitrous oxide and/or IV sedation is recommended for this procedure.
  • Partial Bony Impaction: This occurs when the tooth gets stuck coming half-way through the bone.  This is a little more difficult case to work with. This type of extraction involves pushing the gums back and removing the portion of bone hanging over the top of the impacted tooth.  IV sedation is recommended for this procedure.
  • Full Bony Impaction:  Full bony impactions occur when the tooth gets stuck entirely within the bone.  Most of the time these can be left alone without consequence.  However, sometimes pathology may involve these teeth and extraction is necessary to alleviate the problem.  IV sedation is recommended, and referral to an oral surgeon.

Risk & Benefits


Not really sure why the last teeth to erupt into your mouth are called wisdom teeth, but they are the third set of molars in the mouth and can erupt between 14 to 25 years of age. Teething pain is typically associated with tooth eruption, but these can be dramatic.


This means simply that the tooth doesn’t n to have enough room inside the mouth to full erupt into its proper place in the arch. Other teeth besides the 3rd molars can become impacted.  Other commonly impacted teeth are upper canines and lower premolars.


The most common reason for removing a wisdom tooth is infection.

  • Impaction – When a tooth erupts partially into the mouth it beaks open its enamel organ that surrounds the crown of the tooth.  This break allows food to seep into the sack and bacteria begin to digest it.  This can cause a localized infection called pericornitis.  Pain and swelling is usually associated with this conditions and extraction is the only definitive treatment.  Irrigation with warm salt water can alleviate the discomfort until you can see your dentist.
  • Decay – Because the tooth is very far back inside your mouth, it is very hard to brush and keep clean.  Consequently, decay can form.
  • Periodontal Disease – Like wise, if it is have to clean, then the bacteria can build-up around the tooth and cause gum disease.


As with any surgery, there are risks.
  • Bruising – Generally, the older you are the more likely you are going to have a bruise.  Blood thinners will also increase the chances of a bruise.  Bruising is caused when the blood seeps out into the surrounding tissue and causes a “Black and Blue mark.”
  • Pain – The act of having a tooth extracted is traumatic to your body.  An incision in made and bone may have to be removed to access the tooth.  At this point think of it as being something like a broken bone.  Discomfort usually last about 2 days.
  • Post-operative swelling – One of the cardinal signs of infection is swelling.  The area after an extraction can swell, turn red and feel hard.  This is normal for certain extractions.  Some times the doctor will give you a steroid to less this unfortunate side effect.
  • Infection – We usually lump infections into what is called a “Dry Socket.”  Although the socket is not dry because it is inside your mouth which is filled with saliva at all times, the term is used to say that there is no more blood clot inside the extraction site.  The term “osteitis” is a more correct term and can be treated with a number of ways. The patient usually knows they are experiencing a dry socket when the extraction starts to feel better on the 2rd day only to get worse on the 3rd or 4th day.
  • Numbness – This is usually experiences when the tooth is very impacted and to remove it a nerve was compromised.  This can come in true form of a numb lip, or numb tongue.  It usually games away within 6 months, but if it last loner it may be permanent.  Transient numbness shortly after the extraction can be due to the pressure of swelling caused by either the surgery, swelling, or infection.
  • Fracture – This I have never seen in my practice.  It is where the jaw fractures during an extraction.  An Immediate Oral Surgery referral in necessary.  Most of the time nothing is do other than observation.  However, this is entirely up to the oral surgeon to decide the proper treatment protocol.


In a word, no.

  • Big Mouth (or little teeth) – Some people have a large enough mouth to accommodate all their teeth in good alignment.  They can reach all their teeth to keep them clean and have few dental problem.  These are the genetically superior of us.
  • Drift – This is where a tooth in front of the wisdom tooth has been lost and there is now enough room for the 3rd molar to erupt.  The 3rd molar can now be used as a 2nd molar, but may appear a little crooked in the arch with out orthodontic guidance.
  • Full Boney Impactions – If a tooth is impacted so deeply home completely covers it, then is may never have its enamel organ pop and never get infected by the oral bacteria.  However, occasionally what started off as a benign full boney impaction as a young adult may turn into a problem as an older adult.  Periodontal disease may cause a pocket that reaches down as low as the full boney impaction and cause an infection and severe pain.  Also, in rare cases the enamel organ may undergo pathological changes and cause a cyst, or worse!


Remember, there is no such thing as dental “insurance.”  They are not insuring a thing!  They are only going to give you an allowance up to a certain low amount to help you with your dental needs.  And they will fight you “tooth and toe nail” over that little amount.  Good luck!  Our front desk can assist you with filing your insurance.


This is hard to answer.  Some are very easy to remove and others are not.  Let the doctor know if you want to have an IV sedation so you will not remember how long it took.  We offer IV sedation at out office everyday.


Many factors influence the length of recovery:

  •  Age – Generally the older the patient the longer the convalescence.  Young bone is much more plastic and vascularized.
  • Type of Extraction – The more bone has to be removed, the more healing is needed.  The more infection, the more healing time needed.
  • Medical Health – The healing power of the patient is slowed with certain medical conditions such as diabetes and liver problems.
  • Oral Hygiene – If you do not follow the doctor post operative instructions, then you may have a harder time healing.  Food impaction and carbonated beverages can cause problems, too.
  • Tobacco – Tobacco is an anti-healing drug delivered to your blood stream by a cigarette, cigar, or dip.
  • Alcohol – This liquid can dissolve out clots and thus cause a dry socket.