Dental Health:

Wisdom Teeth

 

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If you go to your dentist for regular check-ups, you will likely know if your wisdom teeth have come in or if they are impacted. If your dentist thinks you need to have your wisdom teeth removed, you will probably need to make an appointment with an oral surgeon (a doctor who is trained to do surgery that involves gums and teeth) for an evaluation. Some people never have any problems with their wisdom teeth, and some people never even form wisdom teeth.

 

What are wisdom teeth?

Wisdom teeth are the last molars to develop. They are located on each side of the jaw in the very back. By the time you are between 16-19 years old, you should be able to see them. If you can’t, they may be impacted, meaning they haven’t broken through the gums yet, or they may be completely absent. Wisdom teeth are the last permanent teeth to come in so there is often not enough room for them to grow into your mouth completely. These trapped or impacted wisdom teeth will most likely need to be removed by an oral surgeon.

 

How can I tell if I have wisdom teeth?

You may not even realize that you have wisdom teeth or that they may even be impacted.
During a regular check-up, your dentist will take an x-ray to find out where your wisdom teeth are located and if they are impacted.

 

Be sure to tell your dentist if you have any of the following symptoms:

• Trouble opening your jaw
• Pain when you bite or chew
• Swollen gums at the back of your mouth or near the side of your jaw
• Irritation or pain when you open your mouth

Why are wisdom teeth removed?

Wisdom teeth are usually removed if they become impacted or if they are crowding other teeth. This means your wisdom teeth either don’t break through your gums or they only partially break through. Impacted or trapped wisdom teeth can cause problems such as:

• Pain on one or both sides of your mouth—with or without eating
• Infection—food and bacteria can get stuck in the partial opening or flap around the trapped wisdom tooth and can cause swelling of the gums
• Movement of teeth and change in bite
• Benign (harmless) cysts or tumors of the jaw

What should I expect if I find out that my wisdom teeth are a problem?

Your dentist and/or oral surgeon will give you specific instructions to follow. Below is a summary of what you might expect to happen if you need to have your wisdom teeth removed.

• Your dentist will likely have you make an appointment with an oral surgeon to have your wisdom teeth removed.
• Your oral surgeon will talk to you about the procedure and what anesthesia or sedatives (medication that make you relaxed and put you to sleep) will be used.
• An x-ray will be taken so that the oral surgeon can remove your tooth/teeth the best way. A panoramic x-ray (an x-ray of your whole mouth) will be taken of all of your wisdom teeth as well as the teeth around them. Some people get all of their wisdom teeth removed to prevent any future problems.
• Some oral surgeons prescribe antibiotics before or after surgery. For example; if you have an infection, or a weak immune system.
• It is best to wear a short sleeve top or one with sleeves you can roll up easily as you will likely have an IV (intravenous- small tube in your arm that will give your body medicine and fluids when you are asleep).
• You will not be able to eat or drink for 6 hours before your procedure.

How are wisdom teeth removed?

Simple extraction- If your wisdom tooth or teeth are not impacted but you need to still need to have them removed, you may be able to have them taken out with a local anesthetic. Using a very small needle, your dentist will inject numbing medicine into the gum area around the tooth/ teeth that need to be removed. The wisdom tooth/teeth are then removed using a special dental instrument.

 

Surgical extraction- This procedure is used if your wisdom tooth/teeth are impacted (completely covered by the gum and bone of your jaw) or partially impacted (partly covered) Before the procedure your dentist or oral surgeon will inject a local anesthetic (numbing medicine) into the gum area around the tooth/teeth that will be removed, Next you may be given IV medicine or general anesthesia in a hospital operating room (medicine that will put you to sleep so you won’t be awake during the procedure). Your oral surgeon may need to make a small cut into your gum to remove your tooth/teeth.

 

What is recovery like?

You will likely be mild to moderately uncomfortable after you have your wisdom teeth removed, but the pain or discomfort should only last for a couple of days. It is important to follow the specific instructions that your dentist or oral surgeon give you. The information below is an example of what your recovery might be like.

• After the incision is made and the wisdom tooth or teeth are taken out, you will be given a piece of gauze to bite down on. You will need to bite down on the gauze for 20-30 minutes so that a blood clot can form. You will be given gauze pads to take home so you can change the pads as they become wet with blood. It is common for the area to bleed on and off for the next 24 hours.
• If your oral surgeon had to cut your gum to get your tooth/teeth out, you may have “stitches”. Depending on the kind of stitches you have you may or may not have to have them removed. Some stitches need to be removed by your oral surgeon when the gum has healed and some dissolve on their own.

Do:

1. Prop your head up with pillows instead of lying flat.
2. Use an icepack on your face to help with pain or any swelling.
3. Continue to brush and floss your teeth carefully, but stay clear of the extraction areas.
4. Take the medicine prescribed by your oral surgeon for pain.
5. Talk to your oral surgeon about replacing your pain prescription with over-the- counter pain relievers, such as acetaminophen (Tylenol®), or ibuprofen (Motrin®) as your pain improves.
6. Eat “soft” foods such as yogurt, gelatin, pudding, and macaroni & cheese.
7. Rinse your mouth every couple of hours with about 1 cup of warm water and ½ teaspoon of salt and spit out (don’t swallow). This will help prevent infections.
8. Follow the directions your dentist and/or oral surgeon give you so that you can lower the chance of any pain or future problems. Full healing takes about 1-2 weeks.
9. Call your oral surgeon if you have a fever or if the pain doesn’t lessen in a few days.

Don’t:

1. Don’t smoke for at least 24 hours after an extraction. A good time to stop forever!
2. Don’t use a straw to drink.
3. Don’t drink very hot liquids.
4. Don’t eat foods with little seeds (sesame seeds, poppy seeds) or small grains (rice) that may get stuck in the tooth sockets.

Are there any risks involved when having my wisdom teeth removed?

Having wisdom teeth removed rarely causes big problems, but with any surgery, there are possible risks involved.

 

Pain and Dry Socket- About 5% of extractions result in “dry socket” (when a blood clot does not form in the hole where the tooth was removed and the bone underneath becomes exposed to air and/or food). A dry socket can be very painful and may need to be treated with a special dressing so that the area can heal.

 

Bleeding that is heavy or that lasts longer than 24 hours- some bleeding is normal during the first 24 hours but it should not be heavy and it should stop within a day.

 

Numbness- It is normal for your mouth, chin and possibly your lips to feel numb until the anesthesia or local anesthetic (numbing medicine) wears off. If your lower lip and chin continue to feel numb, there may have been some irritation to a nerve in your jaw. This is more common when your lower wisdom teeth are removed. It may take 3-6 months for a nerve to heal and in rare cases it can be permanent.

 

Damage to teeth next to or near your wisdom teeth- It doesn’t happen very often, but occasionally a nearby tooth/teeth can get damaged.

 

Damage to existing dental work (crowns, etc.) close to your wisdom teeth.

 

If you have any of these symptoms after you have your wisdom teeth removed, it is very important for you to tell your oral surgeon!

 

 

How much does it cost to have wisdom teeth removed?

If you have dental insurance, the cost of having your wisdom teeth removed will either be partially or completely covered. General health insurance sometimes will cover dental procedures as well. Depending on what type of general health insurance you have, it may cover all or part of the procedure. Be sure you talk to your dental and or Health Insurance Company BEFORE your oral surgery to find out about the kind of coverage you have and how much you will have to pay out of pocket!

 

It is more common for problems with wisdom teeth to develop during the teen and early adult years, but you may never have any problems with your wisdom teeth. The most important thing to remember is to take care of your teeth (brush and floss regularly) and see your dentist for regular checkups.

 

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Written by the CYWH Staff at Children's Hospital Boston

 

Updated: 5/26/2009