By the age of 18, the average adult has 32 teeth; 16 teeth on the top and 16 teeth on the bottom. The teeth in the front of the mouth (incisors, canine, and bicuspid teeth) are ideal for grasping and tearing off food into smaller bite size pieces. The back teeth (molar teeth) are used to grind food up into a consistency suitable for swallowing. The last four teeth to erupt are your third molars, also known as “wisdom teeth.” While most other teeth have fully erupted by age 12, this is the time when the wisdom teeth are starting to calcify and form. The average mouth usually has enough room to hold only 28 teeth. When the third molars do not have enough room to erupt, they can form in various different angulations, also known as being impacted.
There are many different forms of impaction, whether vertical or horizontal. 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. Many times, wisdom teeth are accessory teeth and have inadequate root morphology to function as regular molars. Even when they align properly and fully erupt, they are very difficult to maintain proper hygiene and at a high risk of problems in the future.
Impacted teeth can be partially erupted, causing a deep opening around the teeth that allows bacteria to grow and become infected. The flap of tissue that covers the partially submerged wisdom tooth (called the operculum) creates a deep pocket that cannot be properly cleansed even with proper brushing and flossing. As debris and bacteria accumulate, one can experience cycles of pain and pressure due to inflammation and infection. This condition is called pericoronitis. Once the offending tooth is removed, the deep pocket will disappear along with the symptoms.
Even when fully erupted, the teeth are difficult to properly maintain due to limited access. Therefore, they are much more prone to cavities. Once a cavity develops in a wisdom tooth, extraction is usually recommended because the access is very poor and restoration with fillings and crowns can be difficult.
As the wisdom tooth forms, a group of cells that created the tooth buds, called the follicle, remains around the crown of the tooth. When impacted and untreated over long periods of time, the cells within the follicle can cause formation of a tumor or cyst. A cyst is a fluid filled sac lined with follicular cells. They are usually not cancerous and cannot spread to other parts of the body; however, when untreated, they can grow to very large sizes to cause local destruction of the jawbone and adjacent teeth. When your surgeon removes your wisdom teeth, he also removes the follicular sac to prevent formation of such cysts.
Growth of teeth roots and cysts can displace and resorb bone as it forms. When wisdom teeth are removed, a variable amount of bone will need to be removed as a standard technique of the surgery, depending on the degree of impaction. When wisdom teeth are removed at a young age (i.e. mid-teenage years), 90 – 100% of the bone will grow back. However, when they are removed at a later age, only a fraction of the bone will regenerate. This results in a persistent pocket or bony defect behind the second molars that can become problematic. It emphasizes the need to have wisdom teeth treated early to prevent this and many other potential complications.
Some dentists and orthodontists believe that pressure and force from erupting wisdom teeth can cause movement and relapse of orthodontically aligned teeth. This movement happens very slowly over months and years. Removal of the offending wisdom teeth and use of your orthodontic retainers could prevent this potential problem.
Possible damage to the nerves that supply sensation to your lip, chin and tongue are inherent potential complications that can occur with removal of lower molars, especially wisdom teeth. When these teeth are removed early, the root formation is incomplete and not in close proximity to the nerve trunk. Therefore, the possibility for lip and chin numbness is essentially zero. As the roots grow, they can form hooks and loops that can touch or even wrap around the nerve trunk. Subsequently, damage to these nerves during removal is much higher at later ages (i.e. late 20s and older). Rarely, the numbness and tingling can be permanent. Early removal is highly recommended to avoid such future problems and to decrease the surgical risk involved with the procedure.
In most cases, the removal of wisdom teeth is performed under general anesthesia.
Your wisdom teeth are not useful teeth. They do not aid in chewing or function. However, they are located in the very back of your jaw, where it is difficult for your toothbrush or floss to reach. This difficulty in hygiene makes the teeth much more susceptible to cavities and infection. When wisdom teeth are removed at a later age, the surgery becomes more difficult and the recovery time is prolonged. We do not believe that if wisdom teeth come in straight and don’t bother you, they do not need to be removed. We believe they should be removed as early as possible.
Everyone heals differently. Generally, when the wisdom teeth are removed during the teenage years, recovery is usually less than a week. However, when the roots are fully formed with a solid foundation to the jawbone, the recovery is much longer. A broad estimate for recovery time is less than a week if under 20 years old; 1-2 weeks for patients in their early to mid-twenties; and more than 2 weeks for patients older than their late twenties or thirties.
We recommend two types of medicines following the surgery. The first medicine is prescription strength ibuprofen, which will provide baseline pain relief without the side effects of the stronger narcotics. The second medicine is a strong narcotic, either Vicodin or Percocet. These medicines have many undesirable side effects, and therefore should only be used for breakthrough episodes of discomfort.
It depends on the difficulty of the procedure. When removing wisdom teeth in younger patients, we generally recommend removing all four at the same time while the patient is asleep. However, at more advanced ages, when there is potential for increased difficulty, we sometimes recommend treating one side of the mouth at a time. For example, the upper and lower wisdom teeth on the right side would be removed first, followed by the removal of the upper and lower wisdom teeth on the left side after the right side has fully healed.