What Are Wisdom Teeth?
Wisdom teeth also known as the third molars are situated at the back of the mouth. They are normally the last teeth to erupt and appear in the mid-teens to early twenties, a period usually identified with the beginning of maturity and the acquirement of wisdom. Most people usually have four wisdom teeth.
What Is An Impacted Tooth?
Even though most adults have 32 permanent teeth, often times the jaw is too small for all the teeth to fit. This creates a problem for the wisdom teeth to erupt properly and they can become impacted as they cannot erupt into the right position for their optimal functioning.
Types of Impactions
It is important you schedule an appointment with us so that we can determine whether wisdom teeth removal is appropriate for you. We will take an x-ray of your mouth and jaws (panorex) to find out whether your wisdom teeth are impacted, whether they have sufficient space for them to erupt, and the complexities involved in trying to remove them.
Common Types of Impactions.
- Soft Tissue Impaction: This happens when there is insufficient space to enable the gum tissue to pull back for thorough cleaning of the teeth.
- Partial Bony Impaction: This takes place when there is adequate room to enable the wisdom teeth to erupt up to a certain extent. However, the tooth is not able to function optimally. As a result, this makes chewing and cleaning difficult.
Complete Bony Impaction: In this case, there is no room for the tooth to erupt and it fails to come out of the jawbone. If it appears partially out of the jawbone, it may be in an unusual position that needs delicate surgical procedures to be completely removed.
Why Your Wisdom Teeth Should be Removed
When you lack sufficient space for your wisdom teeth to erupt properly, some problems can arise. It is best to remove your impacted wisdom teeth before their root structures are completely integrated into the jawbone. In some patients, the removal of third molars may take place as early as 12 or 13 years of age, and in others it may not occur until they are in their late teenage years. It has been observed that impacted wisdom teeth cause severe problems when patients are over 30 years of age.
Here are some problems that can result from not taking out your poorly functioning wisdom teeth.
The most common dental problem with impacted wisdom teeth is pericoronitis, in which the gum tissue surrounding the wisdom teeth becomes swollen and infected. If the wisdom teeth erupt partially, a localized gum infection will take place and result in frequent pain, irritation, and difficulties in properly eating food.
Cysts refer to fluid-filled sacs that appear around the crown of improperly erupted wisdom teeth. Even though the occurrence of cysts is not very common, they can damage the jawbone, teeth, and nerves when they develop.
An impacted wisdom tooth may force adjacent teeth out of their correct position. As a result, this may lead to possible crowding of the front teeth. This condition is usually seen after someone has had braces or during early adulthood.
Damage to Adjacent Teeth:
If the impacted wisdom teeth exert pressure on the nearby teeth, it can lead to “erosion cavity” in which the wisdom teeth hit the other good teeth. This usually results in damage to both teeth.
What If You Don’t Want Your Wisdom Teeth to be Removed as a Teenager or Young Adult?
You can still remove your wisdom teeth in your 30s, 40, or 50s. However, as you get older, the process of their removal becomes more complex, healing is not easy, and the risk of developing complications is increased. When wisdom teeth are growing, their roots increase in size and the jawbone becomes denser; therefore, removing them when they have not been fully developed in younger patients is more desirable. In case your poorly formed third molars are not taken out in your teens or early twenties, you can wait until a localized dental problem occurs (for example, cyst formation, gum infection, or degradation of the jawbone). Generally, removing your wisdom teeth early in life is advisable than waiting for age to take its toll on you.
On the Day Wisdom Teeth Are Removed
It is important not to eat or drink anything for 6 hours (preferably, for even longer hours) before the start of the procedure. However, you can take prescription drugs using a small amount of water.
You will need a responsible adult who can drive you to and from our office and stay with you throughout the day.
Before your impacted wisdom teeth are taken out, you will be given an appropriate anesthesia to ensure your maximize comfort. At Westside OMS, we have an experienced and certified staff who will administer the right anesthesia to reduce unnecessary pain.
The removal of wisdom teeth is carried out in an environment of maximum safety, making use of the latest technology. The entire process will take about thirty to sixty minutes to be completed.
.After the surgery, you will receive stitches that will dissolve by themselves in three to five days without being removed.
When trying to resume your normal diet after your surgery, it is important you begin with clear liquids such as broths and Jell-O, before moving on to other foods.
What Happens Afterwards – What Will I Feel Like?
Every person’s response to wisdom teeth removal differs, and the feeling of pain can vary from minor discomfort to extreme pain. You may experience swelling in your mouth and cheeks after undergoing the surgery. On the first day you will want to use ice packs to calm the swelling. Normally, the swelling will become more serious by the third day but should gradually start to ease. By the fourth day you will want to use heat instead of ice. You will be given a complete list of post-surgery instructions.
What Are The Potential Complications?
Just like in any other operation, wisdom teeth removal can result in complications. Some of these complications include the following:
Injury to Sensory Nerve
One of the main concerns during the extraction of wisdom teeth is the nerve found in the lower jawbone that provides sensation to the regions around the mouth. This nerve is normally situated very near the roots of the third molars found in the lower jaw. When your wisdom teeth are removed while their roots are still shorter during your early teenage years, it will be easier for the procedure to be done without affecting this nerve. At times, when the wisdom teeth are extracted, particularly when an individual is older, the sensitive nerve can be damaged. After the strength of the anesthesia has weakened, you may start experiencing a numbness sensation due to possible harm caused to the nerve. In certain rare circumstances, the damage to this nerve can lead to a permanent change of feeling, which is the same as that of a local anesthesia. It is essential that you be informed of this possibility prior to agreeing to have your wisdom teeth removed.
Your wisdom teeth located in your upper jaw are found near your sinuses. Therefore, if they are taken out, it can lead to an opening created between the mouth and sinus. As earlier mentioned, if your wisdom teeth are extracted early in life when their roots have not fully developed, the likelihood of this complication occurring is minimal. Nonetheless, if it takes place, it normally closes on its own.
Dry sockets (also called alveolar osteitis) are still the most common complication developing after the extraction of wisdom teeth. A socket refers to the opening in the bone where the wisdom tooth has been extracted. When a tooth has been taken out, blood clotting normally occurs in the hollow socket to shield the underlying jawbone. However, if the blood clot fails to develop, it causes the bone to be exposed to anything that enters the mouth. This usually results in irritation that can last for several days.
Dry sockets are most common in people who smoke, use contraceptive pills, or do not take proper care of their teeth.
Sometimes, post-operative infections arise after wisdom teeth removal. You will need to come to our office for checkup if you have any infection. Usually, giving you an antibiotic for seven days will heal any infection you may have. However, if this does not work, the area will be drained and sanitized.
Here are some other complications that can occur during the post-operative period.
- Irritation around the edges of your lips
- Facial bruising
- Bleeding from the tooth removal area
All the frequently asked questions about the common post-operative complications are tackled in the provided instruction sheet
What is the Cost of Wisdom Teeth Extraction and is it Insurance Covered?
The cost of removing your wisdom teeth depends on a number of factors, including the level of complexity in extracting your teeth and the type of anesthesia appropriate for your specific case. At the time of your dental visit, we will assess your x-rays, carry out an examination, and decide on the most suitable anesthesia for you before making an accurate approximation of the total costs involved in the procedure. Each insurance company has its own guidelines concerning the extent of coverage. At Westside OMS, we will do our best to assist you in obtaining the maximum insurance coverage for your surgical procedure.
The Day of Treatment
Be sure to have an adult with you at the time of removal. Make plans to have a parent or responsible adult stay with you for the rest of the day, following wisdom tooth removal.
If your surgery requires stitches, these are usually the type that dissolve in 3 to 5 days and do not require removal. You may also notice a sensation of your gums feeling swollen and pulling away from your teeth. This is all part of the normal recovery, and will subside in several days.
Once the local anesthesia wears off, you may require prescription pain medication. Please try non-narcotic anti-inflammatory medications such as ibuprofen (Advil®) first, to see if that adequately treats your pain. If not, begin your other prescription pain medication. The local anesthesia may last until the following day, and should not be confused with an injury to your nerve. We recommend starting your post-operative diet with clear liquids such as Jell-O and broths, gradually increasing in substance as your body permits.
We do not recommend using dairy products such as yogurt, ice cream or milkshakes on the day of surgery, as nausea and vomiting may develop in conjunction with the anesthetic and pain medication. If you are given antibiotics and you take birth control pills, please be aware that the birth control pills might become ineffective and take appropriate precautions.
What Happens Afterwards – What Will I Feel Like?
Wisdom Teeth Presentation
To provide you with a better understanding of wisdom teeth, we have provided the following multimedia presentation. Many common questions pertaining to wisdom teeth are discussed.
On the first day after surgery you may experience some minor bleeding and pain. You should cover your pillowcase with something so that you don’t get any blood on it. Each individual’s reaction to surgery varies, and the sensation of pain can range from mild discomfort to severe pain. 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 use the first day, the less swelling you are likely to have on the second day. Please remember to put ice on the first day even if it is somewhat uncomfortable to have the cold next to your skin. On the third day, you will notice that your jaw muscles are stiff, and it is difficult to open your mouth normally. You can apply moist heat to your face on the second and third day allowing your muscles to relax more and open wider. Most of the time you will want to limit your activities for a few days. We ask that you follow your post-operative instructions closely. Doing so will make you as comfortable as possible during the first few days following your procedure. Please allow time for your body to begin healing before resuming an active social, academic, or athletic schedule. Most patients feel like they are over the hump and on their way to recovery in 3 to 5 days.
Are There Any Problems?
As with any medical procedure, there can be complications or an unanticipated result. Some complications that patients undergoing Wisdom Tooth Extraction may experience include damage to the sensory nerve that supplies sensation to the lips and tongue, sinus communication, infections, and dry sockets.
After the procedure, our assistants will review your post-operative instructions with your escort. We ask that you follow these instructions closely, as they will make you most comfortable following your procedure. If you were sedated, you will be comfortable and drowsy when you leave the office. Most patients prefer to go home and rest with no other physical or scholastic activities planned for a few days. With any medical procedure, there can be unexpected results. These can include delayed healing, infection and post-operative numbness or tingling in your lip, chin, or tongue. The oral surgeon will review relevant post-operative events with you and answer any questions during your office visit.
Damage to Sensory Nerve:
A primary concern is a nerve within the lower jawbone that supplies feeling to the lower lip, chin, and tongue. This nerve is frequently very close to the roots of the lower wisdom teeth. Having these teeth out between the ages of 12 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, and especially in older patients, the nerve can become injured. When local anesthesia wears off, you may experience a tingling or numbing sensation in the lower lip, chin, or tongue. Should this occur, it is usually temporary and will resolve gradually over a period of weeks or months. On rare occasions it can result in a permanent alteration of sensation similar to having local anesthesia. We feel that you should be aware of this possibility before consenting to surgery.
The upper wisdom teeth are situated close to your sinuses, and their removal can result in an opening 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. However, if it does occur, it will usually close spontaneously, but we may give you special instructions to follow, such as avoid blowing your nose for two or three days following the surgery. You can wipe your nose, but don’t blow your nose. If you have to sneeze, you should sneeze with an open mouth into a tissue. Pressure should not be created in the sinus area, which may dislodge the healing blood clot. If you sense this condition occurring after the surgery, please contact the office. An additional procedure may RARELY be necessary to close the opening.
Dry sockets continue to be the most common problem people experience following dental surgery. They arise due to premature loss of a blood clot in the empty tooth socket. This seems to occur with greater frequency in people who smoke or are taking birth control pills. While both jaws can be affected, they usually occur in the lower jaw on the third to fifth day. They cause a deep, dull, continuous aching on the affected side(s). Patients may first notice the pain starting in the ear radiating down towards the chin.
The symptoms frequently begin in the middle of the night, and your pain medication regimen may not help. Treatment can involve changing your prescription. Occasionally it is helpful to place a medicated dressing in the empty tooth socket. This will help decrease the pain and protect the socket from food particles. The effectiveness in alleviating the pain lasts for 24-48 hours and may require dressing changes every day or two, for five to seven days. Dressings usually are removed when you have been pain free for 2 to 3 days.
The dressing doesn’t aid in healing. The only reason to place a dressing is for pain control. If medication is controlling the pain, the socket will heal without a dressing. Following removal of the dressing, an irrigation device may be provided to help you to keep food particles from lodging in the extraction site.
Occasionally, post-operative infections occur. This usually requires an office visit and clinical examination. Many times, just placing you on an antibiotic for one week will take care of the infection. If it persists, the area will have to be drained and cleaned. Other temporary problems you may experience in the post-operative period include stiffness of the jaws, chafing around the corners of your lips, facial bruising, and blood oozing from the extraction sites. The post-operative 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 Wisdom Teeth Removal Cost And Is It Covered By Insurance?
The fee for your treatment is determined by a number of factors. These may include the difficulty involved in removing your teeth and which type of anesthesia is best for you. During your consultation appointment, the surgeon will need to review your x-rays, complete an examination and determine the best option for anesthesia before an accurate estimate can be provided. Every insurance company has a different policy regarding the extent of coverage for a given surgical procedure. The oral surgeon’s office staff will help you obtain maximum insurance coverage for your treatment.
What If I Have Questions Before Surgery?
At the time of your consultation, your specific situation will be discussed in greater detail. We encourage you to ask any questions you may have. If new questions arise after your consultation, please call the doctor’s office to speak to one of the patient care coordinators.
The Day of Treatment
Please do not eat or drink anything prior to your surgery. Having anything in your stomach can increase the risk for serious anesthetic complications.
With an oral examination and x-rays of the mouth, Dr. Dhadli can evaluate the position of the wisdom teeth and predict if there are present or future potential problems. Studies have shown that early evaluation and treatment result in a superior outcome for the patient. Patients are generally first evaluated in the mid-teenage years by their dentist, orthodontist, or by an oral and maxillofacial surgeon.
All outpatient surgery is performed under appropriate anesthesia to maximize patient comfort. Dr. Dhadli is trained, licensed, and highly experienced in providing various types of anesthesia for patients.
Wisdom Teeth Removal
In most cases, the removal of wisdom teeth is performed under local anesthesia, laughing gas (nitrous oxide/oxygen analgesia), or general anesthesia. These options, as well as the surgical risks (i.e., sensory nerve damage, sinus complications), will be discussed with you before the procedure is performed. Once the teeth are removed, the gum is sutured. To help control bleeding bite down on the gauze placed in your mouth. You will rest under our supervision in the office until you are ready to be taken home. Upon discharge your postoperative kit will include postoperative instructions, a prescription for pain medication, antibiotics, and a follow-up appointment in one week for suture removal. If you have any questions, please do not hesitate to call us at Hillsboro Office Phone Number 503-547-8879.
Wisdom Tooth Removal Overview
For a brief narrated overview of the wisdom tooth removal process, please click the image below. It will launch our educational MiniModule in a separate window that may answer some of your questions about wisdom teeth.
Our services are provided in an environment of optimum safety. We utilize modern monitoring equipment and our staff are experienced in anesthesia techniques.