Family Dentistry

Wisdom Teeth

Third molars are the teeth that are commonly called Wisdom teeth and are usually very misunderstood by most patients. These teeth typically erupt into the mouth at about 18 years of age for females and 21 years of age for males, but can have a significant range in both genders and can erupt anywhere from 16 to 25 years old in any patient. They are the last permanent (adult teeth) to erupt; since they are posterior (back) teeth their primary function is to increase the chewing surface in the mouth. They have a tendency to push the teeth in front of them towards the front of the patient’s mouth. This causes the spaces between any teeth anterior (more forward than the wisdom teeth) to be closed and create more room for the wisdom teeth. This action can be very advantageous for patients who teeth do not make contact with each other, causing all the teeth in the arches to abut with each other and strengthen the arches. This can also cause problems in patients who have missing permanent teeth that were not replaced in a timely fashion. When missing permanent teeth are not replaced in a timely manner the teeth on either side of the space will tip and drift into the space and the opposing teeth will erupt excessively (super erupt) into the space to try to fill it. The influence of wisdom teeth will expedite this process making it more crucial for adults to replace any missing permanent teeth as soon as possible.

There are many reasons for removing wisdom teeth these include but are not limited to a lack of space in the patient’s mouth to fully and properly accommodate the wisdom teeth, their incorrect position in the patient’s mouth, which can cause a multitude of problems, their incomplete eruption in the patient’s mouth, the lack of eruption of the wisdom teeth into the patient’s mouth, the eruption of only some of the wisdom teeth in the patient’s mouth, the extensive brake down of the wisdom teeth in the patient’s mouth and periodontal disease effecting both the wisdom teeth and the more importantly the teeth in front of them (the second molars). If the wisdom teeth are fully or partially erupted in the patient’s mouth and can be visualized by the dentist their removal or extraction is no more difficult a clinical procedure than any other permanent molar. This can be done in the dental office with local anesthesia without the need for any advanced surgical techniques. The bleeding is controlled by biting on gauze pads and post treatment discomfort is controlled with either over the counter analgesics, prescription analgesics or both. Recovery time is two to three days and healing is complete in several weeks.

When wisdom teeth are not erupted into the patient’s mouth there are considered to be impacted. There are several different classifications of impactions and each has its own procedures, healing times and post treatment discomfort. If the wisdom teeth are erupted out of the jawbone but not through the gingiva, or gum tissue, they are considered soft tissue impactions. This requires the gingiva or gum tissue to be incised and retracted so the dentist can access the wisdom teeth and remove them. This is done with very similar techniques as removing any permanent molar tooth while placing an appropriate number of sutures, or stitches, closes the gingiva. This means that the recovery time, healing time and post treatment discomfort are very similar to extraction of any permanent molar and are handled in much the same way.

When the wisdom teeth are partially erupted out of the jawbone but not the gingiva they are considered partial bony impactions. As with soft tissue impactions the gingiva has to be incised and retracted so the dentist can access the teeth, but with the teeth still mostly in the jawbone the dentist has to remove some of the bone surrounding the teeth so they can be removed. This removal of bone will cause more post treatment swelling and discomfort while increasing recovery and healing time, therefore the dentist will manage this case according to the extent of bone removal that was necessary to complete the extractions, often adding a potent anti-inflammatory medication to the patient’s post treatment medication regiment.

When the wisdom teeth are not erupted out of the jawbone they are considered full bony impactions. As with the other impactions the gingiva needs to be incised and then bone needs to be removed for the dentist to accesses the teeth. At this point the dentist will determine how much more bone will need to be removed to extract the teeth. This is the most complex, difficult and extensive type of surgery; therefore it will have the most post treatment swelling and discomfort and have the longest recovery and healing times. Once again the dentist will manage this case according to the extent of bone removal that was necessary to complete the extractions adding more potent analgesics and anti-inflammatory medications to the patient’s post treatment regime.