Wisdom Teeth

By the age of eighteen, the average adult has 32 teeth; 16 teeth on the top and 16 teeth on the bottom. Each tooth in the mouth has a specific name and function. The teeth in the front of the mouth (incisors, canine and bicuspid teeth) are ideal for grasping and biting food into smaller pieces. The back teeth or molar teeth are used to grind food up into a consistency suitable for swallowing.

The average mouth is made to hold only 28 teeth. It can be painful when 32 teeth try to fit in a mouth that holds only 28 teeth. These four other teeth are your Third Molars, also known as “wisdom teeth.”

Why Should I Remove My Wisdom Teeth?

Wisdom teeth are the last teeth to erupt within the mouth. When they align properly and gum tissue is healthy, wisdom teeth do not have to be removed. Unfortunately, this does not generally happen. The extraction of wisdom teeth is necessary when they are prevented from properly erupting within the mouth. They may grow sideways, partially emerge from the gum and even remain trapped beneath the gum and bone. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to erupt successfully.

These poorly positioned impacted teeth can cause many problems. When they are partially erupted, the opening around the tooth allows bacteria to grow and will eventually cause an infection. The result: swelling, stiffness, pain and illness. The pressure from the erupting wisdom tooth may move other teeth and disrupt the orthodontic or natural alignment of teeth. The most serious problem occurs when tumours or cysts form around the impacted wisdom tooth, resulting in the destruction of the jawbone and healthy teeth. Removal of the offending impacted tooth or teeth usually resolves these problems. Early removal is recommended to avoid such future problems and to decrease the surgical risk involved with the procedure.

Oral Examination

With an oral examination and x-rays of the mouth, Dr. Casciato can evaluate the position of the wisdom teeth and predict if there may be present or future problems. Studies have shown that early evaluation and treatment result in a superior outcome for the patient. Patients are generally first evaluated in the mid- teenage years by their dentist, orthodontist or by an oral and maxillofacial surgeon.

All surgery is performed under appropriate anesthesia to maximize patient comfort. Dr. Casciato has the training, license and experience to provide various types of anesthesia for patients to make procedures more comfortable.

Removal

In most cases, the removal of wisdom teeth is performed under local anesthesia, laughing gas (nitrous oxide/oxygen analgesia) or I.V. (intravenous). These options as well as the surgical risks (i.e. sensory nerve damage, sinus complications) will be discussed with you before the procedure is performed. Once the teeth are removed, the gum is sutured and gauze is placed in your mouth to bite on to control bleeding. You will rest under our supervision in the office until you are ready to be taken home. Upon discharge, your post-operative kit will include postoperative instructions, a prescription for pain medication, antibiotics and a follow-up appointment in one week.

If you have any questions, please do not hesitate to call us at Kitchener Office Phone Number 519-741-5069

Our services are provided in an environment of optimum safety that utilizes modern monitoring equipment and staff that are experienced in anesthesia techniques.

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.

Wisdom Teeth Presentation

Complete Boney Impaction:

There is NO space for the tooth to erupt. It remains totally below the jawbone or if even partially visible requires complex removal techniques.

Unusually Difficult Complete Bony Impactions:

The impacted Wisdom tooth in an unusual and difficult to remove position. The situation can also arise when the shape of the jawbone and other facial structures make removal of this tooth significantly more difficult.

If you do not have enough room in your mouth for your third molars to erupt and they become impacted, several detrimental results can occur.

Infection – Without enough room for total eruption, the gum tissue around the wisdom tooth can become irritated and infected, resulting in recurrent pain, swelling and problems with chewing and swallowing.

Damage – If there is inadequate room to clean around the wisdom tooth, the tooth directly in front, the Second Molar, can be adversely affected resulting in gum disease (bone loss) or cavities (more appropriately known as dental caries or decay).

Disease – Non-infectious diseases can also arise in association with an impacted wisdom tooth. Cysts are fluid-filled “balloons” inside the jawbone which are associated with impacted teeth and slowly expand destroying adjacent jawbone and occasionally teeth. They can be very difficult to treat if your wisdom teeth are not removed in your teenage years. Although rare, tumors can be associated with the delayed removal of wisdom teeth.

Crowding – Although controversial, many feel that impacted wisdom teeth directly contribute to crowding of your teeth which is most noticeable in the front teeth. This is most commonly seen after a patient has had braces or in early adulthood and retained, impacted wisdom teeth are likely to play a contributory role. Although wisdom tooth removal cannot be recommended to absolutely eliminate it possible role in future crowding and other bite changes.

Frequently Asked Questions

What are Wisdom Teeth?
Wisdom teeth are the third set of molars which start to erupt into the mouth between 14 to 25 years of age. The eruption of these teeth is frequently associated with pain and infection as these teeth tend to be impacted.

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.

Soft Tissue Impactions: There is adequate jawbone to allow the wisdom tooth to erupt but NOT enough room to allow the gum tissue to recede to allow adequate cleaning of the tooth.

Partial Bony Impactions: There is enough space to allow the Wisdom tooth to partially erupt. It cannot function in the chewing process and creates cleaning problems.

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.

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 48 hours will help prevent these complications. Medications will be prescribed on an individual basis and should be taken as directed. Also, the use of intravenous anesthesia tends to minimize preoperative and postoperative anxiety which consequently helps to decrease post-operative pain. Narcotic medications and anesthetic agents can impair your reflexes and judgement. It is strongly advised not to make important financial decisions, operate machinery, climb ladders, use power tools, and drive which 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 depending on patient preference.

What Is The Best Age To Have Them Removed?
If it is recognized that you do not have enough room in your mouth for your third molars to erupt, it is advisable to have them removed as soon as it is recognized. In some patients it is as early as 11 or 12 whereas in others it may not be until 17 or 18 years of age. You will heal faster, with more predictable final healing, and have fewer complications than an older patient. An x-ray of the jawbone will allow us to evaluate root formation and determine the optimum time for wisdom tooth removal.

If I Decide To Do It, When Should I Have Them Removed?
There is probably never a good time to undergo an elective procedure such as wisdom teeth removal. We recommend that the surgical appointment doesn’t conflict dramatically with school activities. The most “popular” time for wisdom teeth removal is during the summer (July and August are always very busy) and school vacations. If you live at or near home, any time you have a long weekend is also good. The bottom line is that with adequate preparation, any time will work for most people if they have planned accordingly in advance.

What Are Dry Sockets?
In our practice, dry sockets are an uncommon problem people experience following dental surgery. They arise due to premature loss of a blood clot in the empty tooth socket. This seems to occur with greater frequency in people who smoke or are taking birth control pills. While both jaws can be affected, they usually occur in the lower jaw on the third to fifth day. They cause deep, dull, continuous aching on the affect side(s). Patients may first notice the pain starting in the ear radiating down towards the chin. It frequently begins in the middle of the night, and mild pain medication usually doesn’t help. Treatment involves placing a medicated dressing in the “empty” tooth socket. This will help decrease the pain (usually within 20 minutes) and protect the socket from food particles. The effectiveness in alleviating the pain lasts for 48 to 72 hours. The medicated dressings may be placed more than once. The dressing doesn’t aid in healing. The only reason to place a dressing is the pain control. If Motrin (ibuprofen) is controlling the pain, the socket will heal without a dressing. An irrigation device may be given to you to help keep food particles from lodging in the extraction site following removal of the dressing.

Does My Insurance Cover This Procedure?
Most dental plans will cover some of the cost of removal of an impacted tooth. A written estimate will 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 patients may require more immediate post-operative recovery time than others. A parent or legal guardian (if under 17) or responsible adult must accompany the patient to the office and stay with the patient the rest of the day.

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 staff is available for any questions or 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.