The wisdom of wisdom teeth removal
Wisdom teeth removal is a traditional practice verging on a rite of passage for many Americans. The procedure is so common, in fact, that in any given year over 10 million wisdom teeth, or third molars, are extracted from patients in the United States alone.
That’s a lot of teeth.
Conventional wisdom, however, on the efficacy and necessity of removing these troublesome molars has faced some questions in recent times.
What are ‘wisdom teeth’ and why do we have wisdom teeth?
Wisdom teeth, also known as third molars, are the third and final set of molars located at the very back of a person’s mouth. Most people have two sets of wisdom teeth - two teeth in the upper jaw and two in the lower - for a total of four wisdom teeth. Unfortunately, for the vast majority of modern human beings, these extra molars are nothing but vestigial teeth from a far distant past. For most of us, they are nothing but trouble.
Once upon a time, our strong-jawed hunter-gatherer ancestors relied on these change molars to grind up tough roots, hard nuts, and sinewy meats. Once we learned how to farm staple grains such as wheat, barley, and rice, and discovered that cooking food was a great idea, our need for such strong jaws and extra teeth disappeared. Our mouths have been shrinking ever since resulting in jawbones that simply don’t have enough space to accommodate all our teeth.
Wisdom Teeth Removal FAQ
The truth is there isn't enough room in the jaw for wisdom teeth because our jaws are not large enough to accommodate the ample space required for wisdom teeth to erupt properly. Reduction in the weight of the facial skeleton is an evolutionary trend. Since there is not enough space for them to erupt properly, wisdom teeth often appear in various angles like the description shown above. This can result in toothache or jaw pain, infections leading to trismus (limited mouth opening) and halitosis (bad mouth odor), cysts, and erosion or erosive gum lesion in the oral cavity. Also, the lack of space could potentially contribute to crowding of the remaining teeth and referred TMJ pain, headache, and earache.
Third molars, commonly referred to as wisdom teeth, often damage the adjacent teeth, called second molars. Dentists and oral surgeons routinely recommend removing wisdom teeth before they cause damage or harm to adjacent dentition and anatomical structures as well as patients' overall health.
In general, as practitioners we consider the involvement of three Ps when asked "To Remove or Not To Remove" third molars:
- Pathology (a disease process caused by the impacted third molar)
- Periodontium (meaning that the presence of a third molar is negatively affecting the gum and bone level of the adjacent second molar)
Most likely, yes.
Here is a simple exercise.
Locate a mirror and look at the back teeth at the back of your mouth; these are referred to as molars. By around the age of 12 or 13, you should see two "molars" in place. Now, think of "third molars," which are your wisdom teeth.
To see if you have ample room for your wisdom teeth, put your finger behind either second molar. If you feel a flat platform of gum tissue, there is a chance you have enough room for your third molars. If you feel the gum tissue curving upwards, then this is a sign that you don't have nearly enough room for your wisdom teeth.
This illustration is only an estimate to check for room in your mouth. There are a lot more criteria that an oral surgeon considers during the consultation. This is just a quick test to provide you with an idea of what an oral surgeon is going to do to measure the space at the back of your mouth.
Please keep in mind that appropriate clinical examination and specialized imaging are necessary to confirm a definitive diagnosis and propose a treatment plan.
- What will happen if I leave my wisdom teeth intact as they are now?
- Do I need to have all my wisdom teeth removed?
- What are the risks of surgery based on my health concerns?
- What are common complications that could arise if the procedure is not handled appropriately?
- How do my wisdom teeth rank in terms of difficulty level that you've seen?
- What are my options for anesthesia?
- Will I need to have someone drive me home following surgery?
- When can I expect to return to school or work?
- What type of diet should I be expecting after the procedure?
- When can I resume routine versus strenuous physical activity?
The ideal time to get your wisdom teeth removed is before the root is fully formed.
The wisdom teeth removal procedure becomes more complicated as patients age, roots fully develop, and jaw bone becomes denser.
Teeth grow from the crown down to the root, so if you get your wisdom teeth removed before the root develops, then the surgery is much easier, complication rates are much lower, and the recovery time is much less as well.
Keep in mind sometimes you won't be able to see the crowns or third molars due to being impacted or, in other words, being entirely covered by bone and/or gum. Therefore, if you're a teenager or young adult and are unaware of the presence of wisdom teeth in your mouth, you need to schedule a consultation with Dr. Senehi to discuss the presence or absence of third molars, and it's clinical consequences in relation to your mouth and overall health.
When should I consider wisdom teeth removal?
Generally speaking, if the wisdom teeth are impacted or otherwise causing pain and distress, they should be removed. Many doctors, dentists, and dental professionals recommend removing wisdom teeth even before impaction occurs or other issues arise. For many in the field, it is far better to remove them before they cause problems. Generally speaking, most people who opt to have their wisdom teeth preemptively removed have their third molars extracted between the ages of 18 and 25, to minimize complications during surgery and have a smooth recovery. Ultimately, whether or not to extract and remove one, two, or even all of a patient’s wisdom teeth will have to be a conversation between a patient and their dentist. At the end of the day, it’s a judgment call.
What To Expect
Wisdom teeth removal is a standard procedure millions of Americans opt to undergo every year. For many patients, wisdom teeth removal has come to signify a coming of age and a rite of passage into adulthood. Indeed, wisdom teeth, also known as third molars, are the last set of teeth that leave the mouth. Unlike baby teeth, however, wisdom teeth won’t come out naturally. Instead, they must be removed with skill and precision. Also unlike baby teeth, wisdom teeth removal is significantly more involved.
Here’s what you can expect.
Preparation for Wisdom Teeth Removal
The first step to wisdom teeth removal is preparation. This means as a dual degree, DDS. MD. Oral & Maxillofacial Surgeon, I conduct a thorough and rigorous evaluation of the patient’s existing oral and physical health including taking x-rays to assess the position, condition, and accessibility of the wisdom teeth in question.
Once the images and other diagnostic data have been assessed, I will provide the patient my advice about how to best address wisdom teeth removal. A treatment plan is developed, with input from the patient, that prioritizes a very smooth process with minimal impact to the mouth and jaw as possible.
Patients will also be asked about any allergies, in particular, allergies to different categories of medications or dental anesthetics and sedatives that could potentially cause unnecessary complications. Another important factor I take into consideration is a patient’s prescription medicine use. Managing patient's routine prescription regimen significantly influences the preparation process. Once everything has been reviewed, an appointment is set for the procedure, and the patient receives an email containing a checklist in preparation for their appointment at Facial & Oral Surgery Institute.
On the day of the surgical procedure, we ensure the following precautions have been enforced. First, we make sure patients have someone they trust who will drive them home after the procedure due to the lingering effects of anesthesia. Depending on the type of anesthetics used, specific restrictions previously explained in detail will be confirmed making sure patients are compliant with guidelines which affect the safety and efficacy of the procedure.
The Wisdom Teeth Extraction Procedure
The wisdom teeth procedure begins with anesthesia, either local anesthesia, or intravenous sedation which itself divides into three different categories, light, moderate, and deep, or in rare cases general anesthesia.
Local anesthesia only numbs the surgical site. In effect, patients will remain awake and aware of the procedure. However, they will not feel any pain. Patients also feel the mechanical pressure involved during the removal process.
Intravenous Sedation (Light. Moderate, Deep)
Sedation anesthesia, "Twilight Zone" works a little differently. Sedation anesthesia is typically administered via intravenous (I.V.) drip and lowers the patient’s consciousness to a very relaxed state of mind. Most patients will have no memory of the procedure and will feel no pain.
A small percentage of patients will receive general anesthesia. With general anesthesia, the patient is rendered entirely unconscious.
Anesthesia is necessary not only for patient comfort but to also ensure that the patient does not move or flinch during the procedure which can disrupt the delicate extraction process. Also, it helps patients to keep their mouth open for a relatively long period of time with no difficulty.
Once a patient is appropriately anesthetized or sedated, the wisdom tooth extraction procedure begins. Unlike extraction of other teeth, wisdom teeth extraction is unique in a sense where it requires a skilled surgeon, typically an oral & maxillofacial surgeon, such as myself who can perform the operation.
The surgeon will begin by making an incision into the gum and soft tissue in order to expose the bone and tooth. Incision design significantly influences the rate of damage to surrounding neurovascular structures, resulting in irreversible complications, as well as reducing the time it takes for the site to close. Some bone around and adjacent to the wisdom tooth may also be removed to facilitate the removal process.
For wisdom teeth that are severely impacted, additional bone may need to be removed in order to minimize complications during removal. Often, a wisdom tooth will be removed in sections in a process known as controlled tooth division. This is accomplished with special tools which divide the tooth into more manageable pieces for removal. When ready, either extraction forceps or a dental elevator is used to extract the tooth.
With the tooth removed, there is still plenty to do. It is critically important for my surgical team to assist me in cleaning the surgical area of any debris and remaining tooth remnants. When the extraction site has been thoroughly cleaned, stitches or sutures may be used to close the wound. A gauze pad is placed over the extraction site to stop the bleeding and to help a blood clot form that will naturally close the site and allow it to heal.