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Since the wisdom teeth are the last to develop, they may not have enough room to adequately erupt into the mouth to become fully functional and cleansible teeth. This lack of room or space can result in a number of harmful effects on your overall dental health.
When this occurs they are said to be impacted, indicating their inability to erupt into an alignment which will allow them to function in the chewing process.
One very limited statistical study indicated that 80% of Caucasian Americans do not have room for their wisdom teeth to erupt properly. Our ancient ancestors, and lower primates of today, have room for all of their teeth. It is theorized that a softer diet over many thousands of years, has caused a change in development. We may have more "wisdom," but less room for those teeth.
There are differing DEGREES OF IMPACTION of wisdom teeth. Some come in OK, but there isn't room to keep them clean. Others are covered by gum tissue only. There are also varying degrees of bone coverage from partial to very deep.
During your consultation appointment we will examine your mouth and your panographic X-ray to determine if wisdom tooth removal would be of benefit to you.
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What is The Best Age To Have Them Removed?
If it is recognized that you do not have enough room in your mouth for your third molars to erupt, it is advisable to have them removed as soon as possible. Generally, by the age that skull and jaw growth has been completed, Dr. Hanawalt can determine whether or not there is room for proper eruption of the wisdom teeth. This age is 14-16 for most people. You will heal faster and with more predictable final healing. Most people 18 or younger will generally have shorter roots on the wisdom teeth, and there will be fewer complications.
Why Should I Have Them Removed?
If you do not have enough room in your mouth for your third molars to fully erupt, a number of problems can arise.
Infection
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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 swallowing. On rare occasions these infections can be quite serious and require hospitalization.
Damage
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If there is inadequate room to clean around the wisdom tooth, the tooth directly in front, the Second Molar, can be adversely affected and result in gum disease (bone loss) or cavities (dental decay).
Disease:
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Non-infectious diseases can also arise in association with an impacted wisdom tooth. Cysts are fluid-filled "balloons" inside the jawbone which are associated with impacted wisdom teeth. They slowly expand, destroying adjacent jawbone 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.
Crowding
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Although controversial, many feel that impacted wisdom teeth directly contribute to crowding of your teeth, which is most noticeable in the front teeth, usually the lower front teeth. This is most commonly seen after a patient has had braces. There are most likely a number of factors that cause teeth to crowd after braces or in early adulthood, and retained, impacted wisdom teeth are likely to play a contributory role.
Unless you have an active problem at the time of your consultation, the reason for removal is primarily preventative to avoid long-term problems.
What If I Don’t Have Them Removed Now
Many people, especially in years past, were told to take a "wait and see" approach to wisdom teeth. Many who did not have adequate room developed localized problems previously mentioned. The problem with this approach is that IF it is necessary to remove impacted wisdom teeth in your thirties, forties, fifties, or beyond, it is clearly more difficult for you as the patient. The post-operative course is usually prolonged and there is a higher complication rate. Treating these complications is more difficult than with a younger patient. Fortunately, with today's modern techniques, complications and problems with healing are not terribly severe even in older patients. Therefore, Dr. Hanawalt recommends the removal of most teeth (including wisdom teeth) that are impacted, regardless of a person's age (with exceptions for the elderly). Assuming good health and a normal life expectancy, the likelihood of problems arising warrants the removal of these teeth.
What Happens On The Day They're Removed?
First of all, you need to decide if you will be sedated. IV sedation, "laughing gas" (nitrous oxide), and local anesthetic (Novocaine) make most patients unable to feel the surgery, not really caring about it, and usually forgetting the whole thing! 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 and experience to provide various types of anesthesia to allow patients to select the most appropriate alternative. These services are provided in an environment of optimum safety, utilizing modern monitoring equipment and staff experienced in anesthesia techniques.
We ask that a parent or responsible adult accompanies you to the office and plans to stay with you the rest of the day. You will probably be in the office for 1 1/2 hours. 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, including the use of sterile water for irrigation during surgery.
For some patients, Dr. Hanawalt may prescribe medications to be taken THE EVENING BEFORE your appointment. Some patients will need to take antibiotics THE MORNING OF the procedure. We will prescribe appropriately for you, and take it with a small sip of water. Also take all of your CURRENT MEDICATIONS that you are on all the time, at the usual time, unless we have told you otherwise. These will be taken on an empty stomach, and it usually does not cause stomach upset prior to the surgery.
Remember also to bring somebody with you so that they can drive you home after the procedure.
When you are seated in the operatory, you will be placed on nitrous oxide, and it will make you more comfortable. After this, we will start an IV in your arm. This will be done using freezing spray that will make your skin quite cold so you'll barely feel the actual IV being placed. The sedative medication will be administered through the IV. We have found that most patients are hardly aware that the procedure has been completed when we are done and have very little memory of it. You will be comfortable and without significant pain, but a little drowsy.
Our staff will review your post-operative instructions. Most patients prefer to go home and rest with no other physical or scholastic activities planned for a day or two. DO NOT WORRY ABOUT STITCHES. Stitches (also known as sutures) are usually placed to control bleeding, aid healing and help prevent food from collecting in the surgical site-- especially for lower teeth. The sutures we use dissolve in 3 to 5 days and DO NOT HAVE TO BE REMOVED.
When you arrive HOME, the local anesthesia will start to wear off and then you may have some discomfort. Your lower lip may be numb until you go to bed, though, and this is normal if we removed a lower wisdom tooth. For most patients we advise two 200mg IBUPROFEN tablets (over the counter) every 3 to 4 hours, to start WHEN you get home. IF YOU ARE ALLERGIC TO ASPIRIN, USE TYLENOL. In the event that you need something stronger, take the stronger NARCOTIC pain medication that we will prescribe. Take it SOONER rather than later. We recommend that you try to get some clear carbonated beverages, such as ginger ale, Seven-Up™, or Sprite™, in your stomach prior to taking any of the narcotic. Whatever you do, please do not start out with the narcotic as this can lead to nausea and vomiting. If you develop some NAUSEA, try to coat your stomach with an antacid such as Digel Liquid™, Mylanta Liquid™, or Maalox™ (all over the counter). If frank vomiting, call Dr. Hanawalt at (970) 493-4434.
If you are given ANTIBIOTICS and you take BIRTH CONTROL pills, you should be aware that the birth control pill might become ineffective. Take appropriate precautions.
What Happens Afterwards—What Will I Feel Like?
On the first day after the procedure, expect a little SPOT BLEEDING and minor discomfort. You should cover your pillowcase with something so that you don't get any blood on it. Use the gauze we give you, at least 3 pieces per site, or a moist TEA BAG. (tastes better!) Use only if ABSOLUTELY necessary after the 1st couple of hours. Each of us have a different pain tolerance, but most will be out of significant discomfort by the next day. WE ENCOURAGE YOU TO GO TO NON-NARCOTIC PAIN MEDS THE FOLLOWING DAY. This will help to prevent drowsiness and nausea and help you to get back to your normal lifestyle ASAP.
A variable amount of SWELLING can be expected following the surgery. This swelling usually peaks on the second day and should begin resolving on the third day. You can limit the amount of swelling you will have by using ice for the entire first day. The more ice you have on the first day, the less swelling you will have on the second day. Please remember to put ice on the first day even if it's somewhat uncomfortable to have the cold next to your skin. Put a washcloth between your skin and the ICEBAG we will provide.
On the third day, you may notice that your jaw muscles are stiff, and it's difficult to open your jaw as wide as you used to. This will resolve with the help of moist heat. You can apply moist heat to your face on the third day, and this will allow your muscles to relax more and open wider.
You should maintain a low profile for a few days. We ask that you follow your post-operative instructions closely. Doing so will make you more comfortable during the first few days following your procedure. Please allow this time to let your body begin healing before resuming an active social, academic, or athletic schedule. Most patients feel like they are over the hump in 3-5 days.
Are There Any Problems?
As with any medical procedure, there can be complications or an unanticipated result that you should be aware of:
There is a NERVE which supplies feeling to the lower lip, chin, and tongue which is sometimes very close to the roots of the lower wisdom teeth. Having these teeth out between the ages of 14 and 18 usually provides shorter roots so that the nerve is not so close to the roots of these teeth. Occasionally, when the teeth are removed, especially in older patients, the roots have grown longer and become closer to the nerve. This nerve can become irritated in the process of removing the tooth. When local anesthesia wears off, you may experience a tingling or numb sensation in the lower lip, chin, or tongue (or possibly loss of taste). Should this occur, it is almost always temporary and will resolve gradually over a period of weeks or months. RARELY, it can result in a permanent alteration of sensation similar to the feeling of Novocaine. Dr. Hanawalt will advise you beforehand if you are at particular risk for nerve injury.
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The upper wisdom teeth are situated close to your SINUSES (maxillary), and their removal can result in a communication between your mouth and the sinus. Once again, if the teeth are removed at an early age, the root formation is minimal, and this complication is very unlikely to occur. Should this occur, Dr. Hanawalt will close it at the time of surgery. We may give you special instructions not to blow your nose for 1 week afterwards. If you sense a complication occurring after the surgery, please contact the office. RARELY, an additional procedure may be necessary to close the communication.
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"DRY SOCKET" continues to be the most common minor complication following the removal of wisdom teeth. We call it "alveolar osteitis", and it means inflammation of the bone the teeth were in. Research and experience has shown that this is more common in smokers, with taking birth control pills, with pre-existing infection, and with difficult extractions. The pain of dry sockets almost always occurs on bottom teeth removed only, however, so gravity has a lot to do with it. Pooling of saliva and food debris in lower sockets (unavoidable) probably causes improper formation and maintenance of a normal blood clot. This leads to pain a couple of days later, and will last for 7 to 10 days if untreated.
In our office we use a relatively new technique that TREATS THE PAIN OF DRY SOCKETS BEFORE IT OCCURS. This new technique works for most patients but not everyone. If you're having significant pain a few days after wisdom tooth removal, PLEASE CALL US! Don't suffer! Don't think that it's "normal." This technique REQUIRES A POST-OP VISIT, without exception. Tell us the day of your procedure if you cannot come back for a post-op visit.
An IRRIGATING SYRINGE and instructions on its use will be given to you on completion of your treatment. This will keep the sockets clean during the healing phase.
Occasionally, post-op INFECTIONS occur. This usually requires an office visit and exam. Infections can occur anywhere from a FEW DAYS to a few WEEKS after the extractions. Very often they are continuations of pre-existing infection. The signs of infection are increasing swelling and discomfort. If you think you are getting infected, DON'T WAIT, CALL US. Most of the time, a one week course of antibiotics will take care of it. Sometimes a minor drainage procedure is necessary. WAITING until an infection gets severe may require hospitalization! This is rare, but happens.
Other temporary problems you may experience in the postoperative period include stiffness of the jaws, chafing around the corners of your lips, facial bruising, and blood oozing from the extraction sites. The postoperative instruction sheet we will provide should answer many of the questions related to these more common concerns. If not, don't hesitate to call the office.
What Does It Cost—And Does Insurance Cover It?
Please See Patient Information Section
What If I Have Questions Before Surgery?
If this information, combined with information you receive at your consultation appointment, doesn't answer all of your questions, please call the office to speak to one of our staff members.
Pre-Operative Instructions
Please See Patient Information Section