Wisdom teeth usually appear between the ages of 16 and 25. They are usually the last teeth to develop and are located in the back of your mouth, behind your second molars. Their development is usually completed between the middle teenage years and early twenties, a time traditionally associated with the onset of maturity and the attainment of “wisdom.”
It is common for wisdom teeth to affect other teeth as they develop. The wisdom teeth may be classified as being fully impacted (completely covered by bone); partially impacted (only part of the wisdom tooth is covered by bone; soft tissue impacted (being covered by the gum tissue only); or erupted. Sometimes the wisdom tooth fails to erupt completely through the gum bed. The gum then extends over the biting surface, forming a soft tissue flap around the tooth which makes the area difficult to clean. Debris and bacteria can easily accumulate, which may cause a mild to severe infection. In this situation, the recommended treatment is the extraction of the wisdom tooth.
Regardless of how impacted, they are or even if they are “coming in sideways” they are often extracted to prevent issues with the remaining teeth, loss of bone, dental caries, crowding and pathology. The vast majority of wisdom teeth are recommended to be extracted.
Long-term, multi-center, prospective studies have shown that because of inflammatory reactions, wisdom teeth have been linked to worsening of diabetes, cardiac issues, failed prosthetic joints, premature labor, and low birth weight in babies. Dentists have known for many years that what happens in the mouth can affect other important areas of the body. The remainder of the medical community is now agreeing with these findings and the recommendations of having all wisdom teeth extracted is now being recommended.
Why should I have my wisdom teeth removed?
If you do not have enough room in your mouth for your third molars to fully erupt, a number of problems can happen. Impacted wisdom teeth should be removed before their root structure is fully developed. In some patients it is as early as 12 or 13, and in others it may not be until the early twenties. Problems tend to occur with increasing frequency after the age of 30. Some of the possible problems related to not removing your wisdom teeth include:
Infection
The most frequent clinical problem we see is pericoronitis, (a localized gum infection). Without enough room for total eruption, the gum tissue around the wisdom tooth can become irritated and infected, resulting in recurrent pain, swelling, and problems with chewing and/or swallowing.
Cyst Formation
Non-infectious diseases may also arise in association with an impacted wisdom tooth. Cysts are fluid-filled “balloons” inside the jaw bone that develop as a result of impacted teeth and slowly expand destroying adjacent jaw bone and occasionally teeth. They can be very difficult to treat if your wisdom teeth are not removed in your teenage years. Although rare, tumors can be associated with the delayed removal of wisdom teeth.
Possible Crowding
Impacted wisdom teeth may contribute to crowding of your teeth. This is most noticeable with the front teeth, primarily the lower front teeth and is most commonly seen after a patient has had braces. There are a number of factors that cause teeth to crowd after braces or in early adulthood. Retained, impacted wisdom teeth may be a contributing factor. Unless you have an active problem when you see the oral surgeon, the reason for removal is primarily to prevent long-term damage to your teeth, gums and jaw bone.
Damage to Adjacent Teeth
If there is inadequate room to clean around the wisdom tooth, the tooth directly in front, the second molar, can be adversely affected resulting in gum disease, bone loss around the tooth, and/or decay.
What if I don’t have my wisdom teeth removed as a teenager or young adult?
As wisdom teeth develop, the roots become longer and the jaw bone more dense. When it is necessary to remove impacted wisdom teeth in your thirties, forties or beyond, the post-operative course can be prolonged and there is a higher complication rate. Treating these complications is often more difficult and less predictable than with a younger patient. Healing may be slower and the chance of infection can be increased. If your impacted wisdom teeth are not removed in your teenage years or early in your twenties and they are completely impacted in bone more complications can occur. For older adults it may be advisable to wait until a localized problem (such as exposure of the tooth, bone loss, cyst formation or localized gum disease) develops. In general, you will heal faster, more predictably and have fewer complications if you are treated in your teens or early twenties. Most patients will end up having their wisdom teeth removed at some point in their lives. 80 year old patients are not excited about having their wisdom teeth extracted due to the symptoms and possible complications listed above.
What happens on the day wisdom teeth are removed?
Most people prefer to be unaware of the experience when they have their wisdom teeth removed and usually decide to be sedated. You will be provided with appropriate anesthesia options at your consultation. All outpatient surgery is performed under appropriate anesthesia to maximize your comfort. Our office staff has the training, licensing, and experience to provide the various types of anesthesia. Dr. Arne’ and his staff operate above the standards required by the State of North Carolina. All surgical staff are certified by the American Heart Association in Advanced Cardiac Life Support (ACLS). All staff members are certified in Basic Life Support. Anesthesia services are provided in an environment of optimum safety, utilizing modern monitoring equipment and a well-trained experienced staff. The Surgical Care Team, the office facilities, and Dr. Arne’ is inspected on behalf of the Board of Dental Examiners on a regular basis.
On the day of your procedure, you will take medications to help minimize post-operative pain and swelling. We ask that a parent or responsible adult accompanies you to the office and plans to stay with you the rest of the day. The procedure will take about 30 to 60 minutes and you will probably be in the office for 90 minutes. Recent advances in medicine and technology allow patients to undergo wisdom tooth removal in a manner, which promotes rapid healing and minimal post-operative discomfort. State-of-the-art sterilization and infection control techniques are used at all times.
On the morning or afternoon of your surgery, it is essential that you have nothing to eat or drink (excluding prescription medications with a sip of water) for at least 6 hours (preferably longer). Clear liquids are ok up to 2 hours prior so long as it is in moderation. Clear liquids include water, coffee without cream, soda water, Sprite® or Sprite® like products, etc… the goal is for the body to rapidly absorb these liquids. Solids like milk and creamer take longer to digest. This does not mean you should try to fit in one “last meal” exactly six hours before your surgery. Having anything in your stomach can increase the risk for serious anesthetic complications, including nausea and vomiting. Failure to follow these directions will result in cancellation of your surgery.
When you are seated in the pre-surgical or holding area we will make every effort to make you as comfortable as possible. If you are going to be sedated, we usually will place an IV in your right hand. This is a quick and nearly painless procedure that ensures optimal delivery of your medication. Local anesthesia is given to you after you are “asleep” for pain control, comfort, and allow adequate time to travel home and rest. You will be sleepy for a significant portion of the day.
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.
Prior to the local anesthesia wearing off, you should try a non-narcotic anti-inflammatory medication such as ibuprofen (Advil®) first, to see if that adequately treats your pain. If not, begin your other prescription pain medication. The best way to take these medications is to alternate them. For example, take the ibuprofen, wait 3 hours and take the prescription medication, wait 3 hours and it will be time to take the ibuprofen again, repeat…..The local anesthesia may last until late in the evening and should not be confused with an injury to your nerve. If the anesthesia has not worn off by the next day, please call the office. We recommend starting your post-operative diet with clear liquids such as Jello® and broths, gradually increasing in substance as your body permits.
If you are given antibiotics and you take birth control pills, please be aware that the birth control pills might become ineffective and therefore you should take appropriate precautions.
What does wisdom tooth 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, Dr. Arne’ 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. Dr. Arne’s insurance specialist 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 our office at
910-762-4011 to speak to one of our patient care coordinators.
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