Frequently Asked Questions About Wisdom Teeth
(Are you trying to find out what to expect on surgery day?)
1. "What are wisdom teeth?"Wisdom teeth are usually the last to erupt, but not all wisdom teeth have enough room to erupt, and many will not. Those teeth that cannot erupt remain impacted (imbedded) in the jaw, and become increasingly difficult and risky to remove as we grow older.
2. "How do I know when my wisdom teeth are coming in?"
Some people have discomfort from teeth that are trying to erupt, but most people do not. Wisdom teeth trying to erupt where there is inadequate space for them to do this can cause infection, swelling of the face, decay in the good teeth in front of them (second molars), and can cause the crowding and shifting of other teeth, especially the ones in the front. Orthodontists are very keen to recommend removal of the wisdom teeth to protect a nice orthodontic result.
3. "Are my wisdom teeth impacted, and what does that mean?"
An impacted tooth is any tooth that has not erupted and is still either just under the gingiva (gum) or imbedded in the bone. It's completely possible for wisdom teeth to become impacted; if you're feeling pain in your mouth or are told by your dentist or orthodontist that you may or do have impacted teeth, it's nothing to be brushed off. Impacted teeth can result in serious infections, and the safest and least painful solution is removal of the impacted tooth or teeth by a qualified oral surgeon.
4. "Why do I need my wisdom teeth out? They aren't bothering me, and I didn't even know they were there until the dentist saw them sleeping in my jaws!"
Sound familiar? Almost everyone has wisdom teeth, and very few of us have room for them to erupt in a healthy fashion. There are many variations in their number: some have none; most have four; some, like me, have/had two. In my practice years, I have seen several patients with eight. It’s important to remember that you may not have to have your wisdom teeth removed if they are healthy and have erupted in good alignment with not gum tissue problems like soreness (few people fall into this category, unfortunately). But if you have had the discomfort caused by pressure, or even pain with swelling in your face, you are noticing signs that you probably don't have enough room for your wisdom teeth.
Also, orthodontists are quick to request that wisdom teeth be removed to prevent unwanted movement in your finished orthodontic (braces) result. Your dentist and oral surgeon can best determine the need for removal for you, and like many issues, it's best to be proactive and not wait until the wisdom teeth have caused a problem, especially for your other teeth.
5. "Why are they there if we don't need them and they cause problems?"
Ask that of the appendix! Basically, prehistoric men and women had larger, longer jaws, and had more room than we have.
6. "My wisdom teeth are already in (erupted), so do I need to have them out?"
The answer is no! If the gum tissue around them is healthy, the teeth are free of decay, and their position is good, you should hold on to them.
7. "The orthodontist sent us here, and says the wisdom teeth need to come out now!?"
Rarely is removal of wisdom teeth an emergency unless there is pain or infection. An oral surgeon will have a separate opinion about timing based on development of the teeth as well as your physical development. Timing of the surgery is important to limit unnecessary difficulty with removal and potential complications; waiting too long on them can lead to other problems for removal. Roots that are mature can cause increased risk of removal around your sinus (in the upper wisdom teeth), and the very important nerve that gives feeling to your lower lip and chin (running underneath the lower wisdom teeth). The consultation with your oral surgeon and recent (within the past two years) x-ray of your teeth are critical to evaluate every aspect of development in relationship to timing. I have taken impacted wisdom teeth from patients as young as nine, and as old as 95; in the case of the nine-year-old it was to prevent future problems with eruption of other more important teeth, while the 95-year-old would only be treated if they were having problems with infection or pain.
In fairness to the orthodontist, they seek removal of your wisdom teeth because they are trying to protect your nice finished bite! Some dentists, including orthodontists, do not believe that pressure from erupting wisdom teeth can cause new crowding of your front teeth (usually, but not limited to, the lower incisors). I am a firm believer that slow, steady forces—not unlike the slow forces the orthodontists use to improve your bite—can cause unwanted movement of other teeth. I've seen it too many times. If you have finished braces, and have retainers to hold things where the orthodontist wants, you are in a good holding pattern. You should try to get wisdom teeth removed before you give up your retainers, and before their roots complete development. Without lifelong retainers (which are rarely recommended) and despite removal of wisdom teeth, new crowding can still develop as we age. There are many other factors that play into this.
8. "My wisdom teeth are causing me pain. What's going on?"
Wisdom teeth pain can be caused either by decay (teeth that haven't erupted fully into your mouth) or a lack of room in your mouth that causes irritation in the gum tissue and possible infection. If there isn't enough room for your teeth to erupt, pain developing from attempted eruption can occur time and time again, and usually gets worse each time. Infections from partially erupted wisdom teeth can be quite serious, and need to be treated immediately.
9. "Can't any dentist remove my wisdom teeth?"
Yes, if a dentist feels comfortable with offering you surgery, any dentist can remove your wisdom teeth. However, oral and maxillofacial surgeons are the most highly trained in removal of wisdom teeth, and are most highly trained also in the use of office general anesthesia. Any specialist in a certain type of surgery does more of that surgery than other dentists. Oral surgeons also perform the more difficult surgeries that other dentists are uncomfortable doing.
10. "What are the potential problems if my wisdom teeth are not removed?"
Even fully erupted wisdom teeth can cause problems if there is not enough room in the gum tissue around them to prevent problems. Inadequate room causes problems with cheek irritation, cheek biting, decay, and general problems with hygiene. Unless a larger (panoramic film) has been taken, it is rarely possible to clearly see the areas completely surrounding wisdom teeth that are impacted, or still under the gums and in the bone. Even though you may not initially have symptoms, cysts and other problems can develop around impacted or imbedded teeth, and these can only be seen clearly on a panoramic type film. Some cysts are considered benign tumors, and these can be more destructive to the jaw.
11. "When should my wisdom teeth be removed?"
Most wisdom teeth are removed around the age of sixteen. Removal of wisdom teeth can be more difficult at a younger age when the teeth are further from the surface. However, not everyone develops wisdom teeth at the same pace, and some x-rays of a sixteen-year-old patient might show what appears to be wisdom teeth developed much less, needing more time before considering surgery. On the same note, some fourteen-year-old patients show signs of an earlier need to remove their wisdom teeth. Every patient is unique, and that is why a consultation and panoramic film is very important. Your oral surgeon is THE expert concerning timing for wisdom teeth removal.
Patients who seek regular dental visits will be more likely to be alerted to potential problems with their teeth by their dentist. Those who wait until they have developed pain or infection have waited too long. Waiting too long puts the teeth in front of the wisdom teeth at risk of decay, which depending on the position of the teeth can be very difficult for an oral surgeon to fix. Keep in mind that recovery from any surgery is quicker and easier when we are young. Removal of impacted wisdom teeth, especially when there is more than one removed at a time, is routinely accomplished with you either asleep or deeply sedated. Oral surgeons are the experts when it comes to evaluation and removal of wisdom teeth.