Wisdom Teeth

Wisdom Teeth

As most people grow older, they eventually develop a total of 32 adult teeth, which replace “baby” teeth as they are lost. Unfortunately, sometimes, people with large teeth and/or small jaws do not have enough room in their jawbones to allow all 32 teeth to come in.

The third molar teeth (so-called “wisdom teeth) are usually the last teeth to erupt (grow into the mouth)and they wind up with no place to go! Less often, other teeth can also become trapped for various reasons. These teeth are then trapped in the bone. Think of 32 people trying to jam themselves into an elevator that is only big enough for 28 people. The last 4 people (teeth) cannot find room to grow into the mouth all the way.

When there is not enough room, some or all of the “wisdom” teeth (or other teeth) can only break through the gums part way, or sometimes not at all, and they become blocked by the other teeth around them. When this happens, the teeth are said to be “impacted” (buried or partially buried). Because these teeth often have a “window” through the gums into your mouth, every time you eat, small pieces of food debris can get underneath the gum tissue and come to rest around the buried teeth. This gives the bacteria that are normal residents in your mouth lots of food and encourages them to grow. Your immune system is then kept busy trying to keep these pesky bacteria under control. If it fails, the bacteria can get the upper hand and cause an infection.

Doctors call these infections “pericoronitis” (“perry’-cora-nitis”). your teeth hurt, it hurts to swallow, the gum tissues may be swollen and reddened, and you may have a fever. Typically this condition flares up, quiets down, then flares up again at a future time. Over the months, these times of infection often increase in frequency and last longer.

Infection is not the only problem that these teeth (especially the third molars) can cause. Because these teeth are surrounded by a “sac” of soft tissue as they lay deep inside the bone, for no reason at all at any time in your life the sac can suddenly begin to fill up with fluid and get larger, slowly dissolving the bone around it and possibly pushing the tooth out of position. Tumors can grow in the walls of these soft tissue sacs, or they can simply grow so large the jaw is weakened. When the third molars are present, people who are involved in contact sports (football, rugby, hockey, basketball, etc.) are more likely to have their jaw break if they are hit in the right place! If the buried wisdom teeth are taken out the jaw becomes stronger in that area.

Some doctors argue that wisdom teeth do not need to be removed. These are often well-meaning doctors who do not have to deal with the problems created by these teeth later in life. Oral surgeons, who must deal with patients who have not had their impacted (buried) teeth removed in their earlier years of life, believe that it is better to remove these teeth earlier in life, before they cause problems, than taking a chance that surgery will be needed when you are 60 or 70 years old. Patients who have to have tooth surgery after the age of 35 have more complications, higher risks, harder surgery, and longer healing times than patients who have these teeth removed when they are in their late teens or early 20s. The problem is that nobody has ever done a study of large numbers of patients, so we simply don’t know what the exact odds are of you developing a problem later in life. Most oral surgeons believe the odds are quite high. The best time to remove buried wisdom teeth is when the roots of the teeth are about two-thirds formed. For most people, this occurs when the patient is roughly 15-18 years of age.

How do you know if your wisdom (or other) tooth or teeth need to come out?

You need to be examined by an oral and maxillofacial surgeon whose judgment you trust. An ethical surgeon will not advise you to have surgery if you are not at risk. If surgery is recommended, the surgeon will tell you what alternatives, if any, exist and what risks and complications exist if you have

the surgery performed. You can then make an informed judgment as to whether this risk of problems is greater than the risks associated with surgery. Your surgeon will need to take an xray and look in your mouth, because every case is different. Only then will he/she be able to tell you all of the facts and advise you of the costs for the surgery you need.

Although the surgery can often be done with just a local type of anesthesia, many patients choose to be “put to sleep” (sedated) for the surgery. Although this adds slightly to the risks of surgery, it is a more pleasant way to have the surgery done. You will not be aware of what is happening during surgery, and when you awaken at the end of the case, the surgery will be finished. Your doctor will explain the advantages and disadvantages of this additional step. Do not be afraid to ask our doctors questions and be sure you understand all of the factors before you make your decisions.

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