Treatment with Extractions

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By the age of 18, most adults will have 32 total teeth. However, nearly 90% of adults will only have the approximate jaw size to hold 28. Those extra four teeth are typically the third molars, or "wisdom teeth." Some people are born without these "extra" teeth – in fact, they are the most common teeth to be born without – but for the rest of us, the extra teeth in the jaw causes problems. When the wisdom teeth come in (years after the rest of our permanent teeth), there is often little to no space for them to erupt. This causes them to force themselves into strange positions in the mouth, or to grow into spaces they were not meant to – termed "impacted" wisdom teeth. Adjacent teeth can be damaged, and the odd position of the wisdom teeth next to the other teeth can trap food particles and encourage decay and infection.

In certain cases, the wisdom tooth that cannot come through becomes inflamed under the gums and in the jawbone, causing a sac to develop around the root of the tooth that then fills with liquid. This can cause a cyst or an abscess if it becomes infected. In extreme cases, a tumor can even form from the cyst, requiring more complicated surgery. If any of these situations goes untreated, serious damage to the underlying bone and surrounding teeth and tissues can result.

Even without these symptoms, wisdom teeth may still need to be extracted. The "common wisdom" of years past indicated that wisdom teeth should only be taken out after they erupted or caused problems. We now know, however, that in many cases, wisdom teeth can already cause major problems before erupting. A recent study by the AAOMS (American Association of Oral and Maxillofacial Surgeons) shows that normally erupted, well positioned wisdom teeth can be just as prone to infection as impacted wisdom teeth, furthering the case for the early extraction of wisdom teeth.

Waiting to remove a wisdom tooth only gives the tooth time to grow larger and become more difficult to extract. Also, older patients often suffer more complications and longer recovery times than their younger counterparts when undergoing wisdom tooth extractions.

What can I expect during the procedure?

Wisdom tooth extractions typically begin with a thorough examination so that we can best determine the method of extraction. The small, typical "bitewing" dental x-rays do not see far enough back in the jaw to give adequate information regarding wisdom teeth, so a larger, more comprehensive panorex x-ray will be needed, taken either by our office or by your general dentist, if they have the necessary equipment. Once we have examined your mouth and x-rays, we can make a diagnosis and recommendation regarding your wisdom teeth. Wisdom tooth extractions are the most common procedures for oral surgeons, meaning our experience and expertise are best suited for this particular situation.

We will give you appropriate pre-operative instructions so that your procedure proceeds as smoothly as possible. These may include special considerations or instructions for diet, lifestyle and medication, depending on the circumstances of the surgery. Before the procedure, an appropriate anesthesia (such as local anesthetic, IV sedation or general anesthesia) will be administered to maximize comfort during the procedure.

After the wisdom tooth is removed, the gum will be sutured and gauze placed on the extraction site in order to minimize bleeding. You will also be given post-operative instructions and any needed materials to help with healing and recovery, including antibiotics and pain medication, as we deem necessary. In most cases, we will recommend a special diet for several days after the surgery. Soft foods, cool liquids, and no straws, rinsing, smoking or sucking of any kind will help keep you nourished and also minimize the chance of damaging or removing the blood clot forming in the extraction site. Some bruising, swelling and bleeding are to be expected, and is very normal and common following extraction – however, if you have a concern you shouldn't hesitate to call our office. After the first 24 hours following the procedure, we typically recommend using a salt-water rinse to help accelerate healing. Simply mix a tablespoon of salt into eight ounces of warm water, and gently rinse the solution for 30 seconds, two to three times a day for about a week. Also be careful not to damage the extraction site while brushing and flossing. Further details can be found in our post-operative materials.

We will also schedule a follow-up appointment, usually around a week after the day of your wisdom tooth extraction, so that we can ensure the extraction site is healing properly, and to make sure you have no questions or problems we can address.