Procedures

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• Wisdom Teeth
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• Glossary

Wisdom Teeth

WHAT ARE IMPACTED TEETH?

The term "impacted" simply describes a tooth which is not fully exposed in the mouth because it is covered by soft tissue or bone. The impacted tooth is further classified as to its degree of impaction by the amount of bone and soft tissue covering it. A tooth may be classified as bony impacted, partial bony impacted, and soft tissue impacted based on the clinical dental and x-ray examination. Any tooth may become impacted due to crowding or maleruption, but statistically the third molars (wisdom teeth) are most likely to become impacted.

WHY DO WISDOM TEETH HAVE TO BE REMOVED?

Impacted teeth require removal for any one of several problems associated with over-retained wisdom teeth. The most common problem associated with impacted teeth is infection and the resultant pain and swelling. These infections tend to be recurrent until the impacted tooth is removed.

Impacted teeth also tend to cause damage to adjacent teeth by promoting decay and periodontal (gum) disease or by erosion of the adjacent tooth's root by continued maleruption. Finally an impacted tooth retains the follicle (dental sac) which originally helped form the tooth. When a tooth remains impacted this follicle cannot resorb. Over time this persistent follicle can undergo cystic transformation or more rarely even form true tumors. Timely removal of the impacted tooth can prevent these changes from ever occurring.

Wisdom Teeth Presentation

To provide you with a better understanding of wisdom teeth, we have provided the following multimedia presentation. Many common questions pertaining to wisdom teeth are discussed.

Having trouble? Please make sure you have version 9 of the Flash browser plugin in order to correctly view this presentation. This software is available as a free download.

ARE THERE ANY RISKS INVOLVED IN THE REMOVAL OF WISDOM TEETH?

As with any surgical procedure, there are some associated risks with removal of wisdom teeth. Common to all surgical procedures is the risk of bruising, pain, and post-operative swelling. Application of ice packs for the first 24 to 48 hours will help prevent these complications. Appropriate narcotic and non-narcotic medications will be prescribed to minimize discomfort. Also, the use of intravenous general anesthesia tends to minimize preoperative and postoperative anxiety which consequently helps decrease post-operative pain. Narcotic medications and anesthetic agents can impair your reflexes and judgment. It is strongly advised not to make important financial decisions, operate machinery, climb ladders, use power tools, and drive while under the influence of these medications.

Postoperative infection is also a concern and your chances of a postoperative infection can be reduced by combination of good post-operative oral hygiene and avoiding foods which have seeds, kernels or are hard and crunchy during the first few postoperative weeks. Occasionally antibiotic therapy will also be prescribed by the doctor.

Finally, there can be the possibility of damage to a sensory nerve which allows the lower lip, tongue, chin, and gums to feel hot, cold, and pain. This change is usually temporary lasting anywhere from several weeks to several months, but in some cases, more frequently with patients who are 25 or older, these changes can be permanent. While this change does not affect the facial appearance of the patient (the patient can move the tongue and lip normally) a resulting sensation loss can occur which can best be described as a Novacaine shot which is wearing off. Further explanation of these risks can be viewed on our video download.

DO ALL IMPACTED TEETH NEED TO BE REMOVED?

As with any surgical procedure, the surgeon and the patient must weigh the benefits and risks. While the majority of impacted teeth should be removed, occasionally after completing the dental and x-ray exam the surgeon may advise against the removal of an impacted tooth because the benefits of removal do not warrant the risk or cost associated with the procedure. The patient must understand there are still risks of future problems if the asymptomatic impacted tooth is not removed.

HOW ARE IMPACTED TEETH REMOVED?

Impacted teeth are removed by incising and reflecting gum tissue and removing covering bone tissue for purposes of exposing the impacted tooth. Frequently the sectioning of the tooth into smaller pieces is necessary to facilitate the removal of the impacted tooth. This procedure can be done using local anesthesia, or IV sedation or general anesthesia depending on patient preference.

DOES MY INSURANCE COVER THIS PROCEDURE?

Most dental and medical plans will cover all or much of the cost of removal of an impacted tooth. Frequently telephone calls or a written request may be necessary to verify and confirm the extent of your coverage and your specific plan eligibility requirements. Our office will make every attempt to assist you in understanding your insurance plan and help you communicate effectively with your insurance company.

HOW LONG IS THE PROCEDURE?

The duration of any surgical procedure is obviously dependent on the difficulty of the procedure itself. At the time of examination, the doctor will be better able to judge the length of time necessary to complete your surgery. It is usually recommended for patients rides to make themselves available for the full morning or afternoon session, as some patient's may require more immediate post-operative recovery time than others.

HOW LONG IS THE RECOVERY PERIOD?

The recovery period varies from patient to patient and depends on several factors: including the degree of tooth impaction, age of patient, overall medical health, and other risk factors such as maintaining good hygiene and avoiding the use of tobacco products. Compliance with the post-surgical instructions will substantially aid in shortening the recovery period. Our doctors and staff are available for any questions are concerns you might have after the completion of your surgery. Please feel free to contact us if you have any concerns or questions about your postoperative care.

Typical mild infection of an impacted tooth.

Typical decay on the back of the second molar caused by impacted wisdom tooth.

Severe decay on both second molar and wisdom teeth as well as periodontal (boneless) damage to the back of the second molar led to the extraction of both of these teeth at age 29. Earlier removal of the wisdom tooth would have prevented this damage to the second molar.

Resorption of roots of the second molar caused by malerupting wisdom tooth.

Typical appearing cyst of moderate size producing loss of bone around adjacent tooth as well as a weakening of the lower jaw. This cyst has been caused by the tissue found around an impacted tooth.

A very large cyst or tumor which formed from the tissue surrounding the impacted wisdom tooth. Biopsy proved this to be a tumor. Mandibular resection and bone grafting cured this patient.

A very large tumor formed from the tissue around an impacted wisdom tooth which has destroyed one half of the lower jaw. Mandibular resection and bone grafting cured this patient.

Some wisdom teeth chew on your cheek. This painful ulcer was caused by a malerupted upper wisdom tooth. Removal of this wisdom tooth allowed the ulcer to heal.