Wisdom Teeth

Why Wisdom Teeth May Need To Be Removed

A full grown adult will usually have 32 permanent teeth. The last teeth to break through the gum (erupt ) are the second and third molars. Second molars usually erupt at around age twelve. Third molars (wisdom teeth) are often formed in bone by early teen years but not erupted until late teen years to early twenties. By that time many of us have reached full or near full jaw bone size. As a result, there is often not enough room at the back of the jaw to accommodate the full eruption of these wisdom teeth. In some instances they are unable to break through the bone and gum tissue overlying them. More often, a part of the upper surface of these teeth may erupt, but not reach its full functional position. Teeth which are unable to fully erupt are called impacted.

Molar teeth serve the purpose of grinding our food. To do so, an upper molar needs to grind against an opposing lower molar. If either or both of these teeth do not reach their intended positions then that grinding function is not performed. Nonfunctional molars offer no benefits to us, since they are neither cosmetic nor involved in speech. Such teeth are more likely to cause problems. Some of the most common problems are:

• Irritation of the overlying gum, often leading to infection.
• Disturbances to the second molar teeth which they are up against.
• Formation of cysts surrounding the impacted tooth.
• Decay between the impacted tooth and the second molar because of inadequate hygiene.
• Bone loss between the impacted tooth and its second molar neighbor.
• Irritation and ulceration of the cheek caused by misdirection of the impacted tooth.

 Evaluation and Treatment Planning

As with most situations, it is desirable to identify and prevent problems rather than treat them after damages occur. Of course this is not always possible and some patients require treatment on an urgent basis. In those instances, our office makes every effort to accommodate patients promptly. But when it is possible, evaluation of third molars is best conducted during the mid teen ages. Times will vary, since people develop at different rates, but for most people age sixteen should be early enough to avoid irreversible damages and allow for flexible planning.

The process should start with an oral examination and panoramic X-Ray. In our office, this is a simple visit, conducted in an area away from the treatment environment. Patients and parents have ample opportunity to meet the doctor, ask questions and return home to consider the options. During this time the doctor will evaluate the overall status of the patient with specific emphasis on potential for additional jaw growth and development. The panoramic X-Ray is digital in nature. This means that it requires minimal radiation and can be viewed in detail on a computer screen, which is easy for non-professionals to see and understand. In most instances this X-ray is very accurate in helping the doctor to assess the position of the developing wisdom teeth and to predict their eruption potential. In other words how likely it is that they will be fully functional.

Based on the evaluation, the doctor will usually make some recommendation. In many instances this may not involve the need for urgent surgery. It is most important to first determine if there is a potential for the teeth to be of future value. If there is, then waiting and watching with follow up visits and new X-Rays is the answer. In those cases where it can be determined that the teeth will never be fully functional, removal will usually be recommended. The timing of such treatment will vary widely based on many factors such as:

• Symptoms; swelling or pain
• Likelihood of infection
• Development of the wisdom teeth
• Patient’s personal calendar

When surgery is not urgent, every effort is made to arrange treatment for the most convenient time for patients and their families. It is for this reason that we suggest early evaluation so that emergencies can be avoided. But since emergencies do happen, we make every effort to resolve them as quickly as we can. Our office staff is well prepared to help you with your scheduling, whether elective or urgent.

Choice Of Anesthesia

When treatment is elective and patients have no significant medical problems, all modes of anesthesia are available. The objective is to provide a totally pain free experience. For some people, this can be managed by providing complete numbness with local anesthesia. For many however, some other method is desired to control anxiety. The use of either gas analgesia or intravenous sedation works very well to supplement the complete absence of pain from the local anesthetic. A full discussion of these options and an explanation of how they work is an important part of the evaluation visit.

Preparing For Treatment

Patients anticipating sedation may not have any solid food for eight hours prior to anesthesia and may not have liquids for six hours, unless needed in very small quantity to swallow medicine.

Patients who are taking medications or have medical issues should discuss this with the doctor before the visit.

In cases where any form of sedation or analgesia is to be used, it is required that a responsible adult be present to safely accompany the patient home. In those instances the patient will not be permitted to drive.

In elective cases, on the day of treatment, it is advisable to have parents or a responsible adult accompany young patients having wisdom tooth surgery.

In the case of minors (under the age of 18) it is necessary for a parent or guardian to be present to discuss and sign the consent form.

At The Time Of Treatment

All patients will have time to review things with the doctor and ask any last minute questions before consenting to treatment.

Those patients receiving local anesthesia only, will be made numb in a gentle fashion and a period of time will be set aside to let the numbness take effect. During this time they may relax, read a book, listen to music or chat with the staff. After a short while the doctor will check the numbness. If additional anesthesia is needed, it will be given then. After the doctor is certain that the numbness is complete, the teeth will be removed.

Those patients choosing nitrous oxide/oxygen analgesia will be evaluated and monitored by the doctor during their use of the gas. Nitrous oxide and oxygen produces a very pleasant feeling that accompanies the total numbness provided by the local anesthetic. In these cases the gas is started well before the anesthetic is given, which makes that part much more pleasant. Analgesia patients will be carefully monitored to ensure that they are fully recovered from the effects of the gas before being discharged.

Those patients receiving sedation will be monitored first, using painless electronic equipment to check the pulse, blood pressure, oxygen saturation and electrocardiograph. Intravenous sedation will produce a relaxed comfortable and pain free experience, which will usually not be remembered. Local anesthesia is given after the patient is adequately sedated. The duration of anesthesia after the treatment is finished is very short and does not usually require a long stay in the recovery area. Patients are not moved to a recovery area until they are fully able to walk on their own. Responsible adults accompanying patients who are in recovery are encouraged to stay with them at this point if possible. Patients will be discharged when it is felt by the staff that they satisfy the criteria to safely return home.

At The Time of Discharge

Patients and accompanying parents or companions will be given verbal as well as written instructions by our staff. Written instructions may be found in the instruction section of this website.

Appropriate prescription medication and instructions for use will be reviewed.

A follow up appointment will be scheduled.

Please contact our office at 973-376-1144 if you have questions or wish to schedule a consultation visit.