Wisdom Teeth Extraction
The most common dental extractions involve wisdom teeth.
Wisdom teeth, or third molars, are the last teeth to erupt
and the most frequent cause of jaw problems, particularly
in teenagers and young adults. The average adult has 32 teeth
by eighteen to twenty years of age; sixteen teeth on top and
sixteen teeth on the bottom. However, most people only have
enough room for twenty-eight teeth. Consequently, people's
third molar teeth usually remain impacted. Specifically, impacted
teeth are those that have not erupted or cannot erupt normally.
Even if wisdom teeth do erupt, they usually require removal
as an adult due to decay and/or periodontal disease. Consequently,
Dr. Jung recommends removal of wisdom teeth at an early age,
preferably before root formation is complete. Same is in keeping
with the position paper recently published by the American
Association of Oral & Maxillofacial Surgeons (AAOMS).
Pericoronitis is the term for the pre-surgical infection that
typically develops in the third molar area. Partial tooth
eruption can leave an opening around the tooth in which bacteria
can multiply and cause infection. The result- swelling, jaw
stiffness, pain, and general malaise. If wisdom teeth are
not removed, infections can frequently recur, adjacent teeth
can become decayed, and periodontal (gum & bone) disease
can develop. On occasion, cysts and tumors, possibly resulting
in loss of multiple teeth and/or jaw resection surgery, do
develop. In short, there is rarely an indication to not remove
wisdom teeth. Even in cases where other teeth have been removed
to facilitate orthodontic treatment there is rarely a good
reason to keep one's wisdom teeth. Ultimately, removal of
wisdom teeth is the cure for the various problems people encounter
with them.
For your comfort, intravenous (IV) sedation or general anesthesia
can be provided to accomplish your surgery. This means that
you will not be aware of the extraction procedure, even the
shots, and that your surgery can be accomplished with a minimum
of discomfort and anxiety. Once your wisdom teeth have been
removed, detailed post-operative instructions will be reviewed
with you and the individual taking you home. A copy of same
is on the back of your pre-operative instruction sheet.
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Dental Extractions
We have developed techniques to remove teeth painlessly and
with efforts to always save supporting bone and gum tissues.
This is important so there are good structures to later support
the placement of implants, bridges or dentures for the best
possible functional and cosmetic results.
What Is an Impacted Tooth?
An impacted tooth is one which has not come into the mouth
by the time it would be expected to have. In other words it
is stuck. The most common reason for a tooth to become impacted
is lack of space. Other reasons may include cysts and tumors
associated with the tooth, fusion of the tooth to the surrounding
bone or nearby teeth, or in some instances for unknown reasons
a tooth just fails to complete its movement into the mouth.
Which Teeth Become Impacted and
Why?
The tooth most likely to become impacted is the wisdom tooth,
or third molar. These teeth are the third set of permanent
(adult) molars. They are called wisdom teeth because they
are supposed to enter the mouth by the "age of wisdom,"
roughly eighteen years of age. Hence why they are also know
as the "eighteen year molars," in contrast to the
first or six year molars and the second or twelve year molars.
Wisdom teeth are not only the most likely teeth to be impacted,
but also the most likely to be deformed, missing or present
in extra numbers. Most people have four wisdom teeth: upper
right and left and lower right and left. Some people are missing
one or more wisdom teeth and others have extra sets (as many
as triple in my experience).
Since many people do not have enough room for all of their
teeth to come in, the one most likely to be stuck or impacted
is the last one to form, the wisdom tooth. The other teeth
had used up the available space as they came into the mouth.
When a person has crowded teeth, the wisdom tooth may have
even less space available after the rest of the teeth are
straightened. Not all people have impacted wisdom teeth; some
people do have enough room for their wisdom teeth.
The wisdom tooth is not the only tooth that may become impacted.
Other teeth that are often impacted include the canine or
eye teeth and the premolars or bicuspids (small molar like
teeth behind the eyeteeth). Any tooth may become impacted
if it does not enter the mouth on time. Some people have extra
teeth and if these do not have room, these too may become
impacted.
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What if Anything Needs to Be Done?
Does anything need to be done for an impacted tooth? The answer
depends on a few things. First, if there is enough room and
the tooth is an important one for function or cosmetics, then
if possible, an attempt is made to bring the tooth into position
with a combination of surgery and orthodontics (braces). This
is commonly done for impacted canine or eyeteeth. If the tooth
does not have enough room, is an extra tooth or is deformed,
often it needs to be removed.
What Happens if Nothing Is Done?
Sometimes the answer is nothing, for a while anyway. Nothing
may happen for years. If the tooth persists on trying to come
into the mouth it may push against the nearby teeth and damage
them. If the gum opens up enough over an impacted tooth to
allow bacteria from the mouth to enter the space around the
impacted tooth, it may become infected. Depending on the type
of bacteria, several problems may develop.
An impacted tooth may cause difficulties with proper tooth
cleaning and allow plaque (which is full of bacteria) to accumulate.
This may lead with time to periodontal (gum) disease and spread
to the nearby teeth. Other types of bacteria may cause tooth
decay. The wisdom tooth or a nearby tooth may become decayed.
Less commonly, the sack of tissue that surrounds the wisdom
tooth may start to enlarge and fill up with fluid, forming
what is called a cyst. A cyst may continue to grow and damage
the jawbone, nearby teeth or other structures. This sack may
also form tumors or growths. Although most of these are benign
(and may still grow like the cysts) some may rarely be malignant
(cancer).
Delaying treatment may also place the nearby teeth at risk.
Many patients come in to have a wisdom tooth removed because
of pain, but many times the tooth in front of it is so badly
damaged that it is the one that hurts. Sometimes a wisdom
tooth may not cause problems until the person is much older,
as old as the nineties in my experience. That is definitely
not a good age to be having wisdom teeth removed.
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When Is the Best Time to Do Something?
Most of the problems with impacted teeth tend to develop with
time. However, the best time to treat these teeth is before
the problems develop. If a tooth has enough room and is to
be brought into the mouth, there is a limited window of time
to do this. As time passes, the tooth becomes harder and harder
to move until it loses the ability to move. If a tooth does
not have enough room, the best time to remove it is before
it causes problems (infection, gum disease, decay, damage
to other teeth, etc.) but before it finishes its development.
To a certain degree, an impacted tooth closer to the surface
can be easier to remove. But, the structures that anchor a
tooth in the jaw are the surrounding bone and the roots, not
the gum that covers it. The more mature and harder the bone
and the more developed and longer the root, the harder the
tooth becomes to remove. A common mistake is to wait for the
tooth to come in more, hoping that it becomes easier to remove.
The easiest time to remove a wisdom tooth is when the roots
are about half to three quarters formed.
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