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Wisdom Teeth

Impacted-wisdom-tooth-illustration-storoe

WISDOM TEETH, or third molars, are the last teeth to develop and appear in the mouth. They are called “wisdom teeth” because they usually appear during a person’s late teens or early twenties, which has been called the “age of wisdom”. The normal position of wisdom teeth is behind the upper and lower second, or 12-year, molars. Many times the jaws of modern humans are not normally large enough to accommodate the four wisdom teeth. This is why wisdom teeth cause more problems than any other teeth in the mouth. In fact, for nine out of ten people, at least one wisdom tooth remains under the gum tissue due to lack of space in the mouth.

WHAT IS AN IMPACTED WISDOM TOOTH?
When a wisdom tooth is blocked from erupting or coming into the mouth normally, it is termed “impacted”. A tooth may be only partially impacted; meaning it grows in crooked and breaks through the gum only partially, or it may fail to break through at all and thus remains totally impacted. Serious problems can develop from partially impacted teeth, such as pain, infection, and crowding of, or damage to, adjacent teeth. For totally impacted teeth, more serious problems can occur if the sac that surrounds the impacted tooth fills with fluid and enlarges to form a CYST.

Impacted-wisdom-tooth-illustration-panoramic-pano-xray-storoe
Impacted-wisdom-tooth-xray-cyst-storoe

This enlargement can hollow out the jaw and result in permanent damage to the adjacent teeth, jawbone and nerves. If the cyst is not treated, a tumor may develop from the walls of the cyst and a more involved surgical procedure may be required for removal.

Many problems with wisdom teeth can occur with few or no symptoms, so there can be damage without your knowing it. It is important to know that as wisdom teeth develop, their roots become longer and the jawbone becomes denser. Thus, as a person grows older, it becomes more difficult to remove wisdom teeth and complications can become more severe. In addition, as people age there is an increased chance of the symptoms mentioned above.

For these reasons, your Oral & Maxillofacial Surgeon may recommend the removal of wisdom teeth even if they are not yet causing obvious problems, particularly for young adults.

WHAT IS THE BEST WAY TO IDENTIFY AN IMPACTED TOOTH?

The best way to identify an impacted third molar is by a panoramic x-ray and an examination by an oral and maxillofacial surgeon.

Impacted Wisdom Teeth Panoramic panograph pano xray

HOW SERIOUS IS AN IMPACTED TOOTH?

Serious problems can develop from partially blocked teeth such as infection, and possible crowding of and damage to adjacent teeth. More serious complications can develop when the sac that surrounds the impacted tooth fills with fluid and enlarges to form a cyst, causing an enlargement that hollows out the jaw and results in permanent damage to the adjacent teeth, jawbone and nerves. Left untreated, a tumor may develop from the walls of these cysts and a more complicated surgical procedure would be required for removal.

MUST THE TOOTH COME OUT IF IT HASN’T CAUSED ANY PROBLEMS YET?

No one can tell you when your impacted molar will cause trouble, but trouble will probably arise. When it does, the circumstances can be much more painful and the teeth can be more complicated to treat.

WHEN SHOULD I HAVE MY IMPACTED TEETH REMOVED?

The key to timely attention to third molars is regular x-rays of the mouth. With the help of these pictures the oral and maxillofacial surgeon can frequently predict if the wisdom teeth are going to cause trouble, either in the near future or later in life. If so, chances are the oral and maxillofacial surgeon will recommend their removal rather than wait for trouble to occur.

Removal is easier in younger patients. Roots are not yet fully developed and the bone is less dense. In older patients, removal before complications develop is key to shorter recovery and healing time and minimizing discomfort after surgery.

HOW ARE WISDOM TEETH TREATED?
Treatment of impacted wisdom teeth involves their removal using special surgical techniques appropriate for each individual case. Wisdom teeth are best treated by an oral and maxillofacial surgeon. If the wisdom teeth have fully erupted into normal position, they may be observed by your dentist during your regular visits to ensure that you are properly cleaning them and no problems are developing, such as decay. Minor abnormalities in the position of an erupted wisdom tooth may be taken care of by your dentist, or removal might still be best.

The removal of wisdom teeth can be performed on an outpatient basis, either in the dental office, or in certain cases, in a hospital setting. If the tooth is impacted, an incision is made in the gum tissue and the tissue is turned back so that the tooth can be seen. If bone is covering the tooth, it may be necessary to remove some of the bone in order to expose and extract the tooth. The tooth may be removed whole, or in some cases it may be cut into sections, and each section is then individually removed. Usually the surgical procedure will take less than an hour, although this varies according to each case. After surgery you will spend some time “in recovery” before going home. In most cases normal activities can be resumed within a few days depending on the degree of impaction and the number of teeth removed.

WHAT HAPPENS BEFORE SURGERY?

Before the surgeon can determine if your wisdom teeth should be removed, the surgeon must first conduct an oral-facial examination and discuss the results with you. The examination will include x-rays, which show the presence of the impacted teeth and reveal such important things as curved roots, nerve location, and other vital surgical information that requires the use of an x-ray.

A complete health/medical history will be taken including your blood pressure and other vital signs, medications you currently take, any allergies you may have, and any medical conditions that may alter treatment.

You will also be given pre-operative instructions to prepare you for the day of surgery.

WHAT HAPPENS AFTER SURGERY?

Generally after surgery the patient experiences some swelling and discomfort. However, with personalized postoperative instructions and medications, the oral and maxillofacial surgeon can reduce the possible discomfort following surgery.

Portions of the above information provided as a courtesy by:

American Association of Oral and Maxillofacial Surgeons
9700 W. Bryn Mawr Avenue
Rosemont, Illinois 60018-5701
847/678-6200 Fax: 847/678-6286
Website: www.aaoms.org