December 22, 2013
Wisdom teeth or third molars usually enter the mouth between the ages of 17 and 25, a time of life that is called the age of wisdom. When a tooth is blocked by another tooth or grows in a manner that makes it impossible to enter the mouth normally it is said to be impacted. It is quite common to have one or more impacted wisdom teeth. The third molar surgery can help prevent later problems like gum abscess, pericoronitis and distal cavities on the second molars due to food impaction.
If wisdom teeth are to be extracted dentists prefer to remove it when patients are younger - late teens or yearly 20s because it is an easier procedure for both patients and dentists. The bone is more forgiving, the teeth aren't fully formed and we don't have to be worried about the roots being close to important structures like the nerves in the lower jaw and the sinuses in the upper jaw. The premature removal of wisdom teeth is called germectomy.
The problem with the third molars is that they often do not have enough space to erupt in the back of the mouth. In some patients, wisdom teeth do come in, but they are so difficult to keep clean, so it's better to have it removed so they do not develop further problems to the adjacent teeth. Sometimes these teeth are stuck or impacted underneath the gums. That gives them the potential to develop cysts and cause other problems later in life. Because of the likelihood that impacted third molars can cause problems in the future they are generally recommended for removal when a person reaches early teens or twenties.
Many orthodontists refer their patients to oral surgeons for wisdom tooth extraction to eliviate hygiene challenges and minimize the possibility of gum disease, cavities and other problems that can effect the success of the orthodontic treatment.
If your orthodontist recommends extraction you will meet with a oral or a maxillofacial surgeon beforehand. The surgeon will evaluate your particular situation and may perform certain diagnostic tests. For surgery it is very important for a mouth to be clean we ask the patients to brush and floss their teeth as usual. Wisdom teeth are usually removed under general sedation although sometimes only local anesthesia is used. Patients who will receive intravenous anesthesia should not eat or drink for six hours before surgery. Finally it is best to go to surgery wearing loose and comfortable clothing.
The oral maxillofacial surgeon select the method that is best for each patient. The length and complexity of the third molar surgery depends on a number of factors. It includes the position of the tooth, the length and curvature of the roots, the thickness of the bone surrounding the teeth and the patient's overall physical condition and health.
In general an young adult's wisom teeth have incomplete root systems making tooth removal relatively uncomplicated. As wisdom teeth continue to grow their roots legthen and may go around the sensory nerves that run through the lower jaw. When that happens surgery is more difficult and complications are more likely. If the tooth is impacted, incision is made in the gum tissue which is turned back so the tooth could be seen. If bone is covering the tooth some of it may need to be removed in order to expose the tooth. This tooth may be removed in one piece or in some cases it may be cut into sections. The removal of wisdom teeth usually takes 45-60min to complete.
Once the wisdom teeth are removed the gum tissue is sutured. Following surgery patients rest under supervision in the oral surgery office before they are ready to be taken home. Before leaving, patients are given specific postsurgical instructions and prescriptions including pain medication.