The following is a listing of general dental information.
Wisdom teeth, officially referred to as third molars, are usually the last teeth to develop and are located in the back part of your mouth. Development is usually completed between the ages of 15 and 20. Since the wisdom teeth are the last to develop, they may not have enough room to adequately erupt into the mouth to become fully functional and cleansable teeth. This lack of room or space can result in a number of harmful effects on your overall dental health.
When this occurs, the teeth are said to be impacted, indicating their inability to erupt into an alignment which will allow them to be able to function in the chewing process. There are several types of impactions:
Soft Tissue Impactions-There is not enough room to allow the gum tissue to retract for 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.
Complete Bony Impactions-There is NO space for the tooth to erupt. Most or all of the tooth remained covered by bone. Removal requires elevation of a flap of gum and bone removal.
Unusually Difficult Complete Bony Impactions-The impacted wisdom tooth is unusually difficult to remove due to its position or the proximity to other structures.
Once 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. In most cases you will experience an easier postoperative course with fewer complications if the teeth are removed when the roots are between ¼ and ¾ formed. Although this can be as early as 11 or 12, the ideal time for most patients is from the mid-teens to early twenties.
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If you do not have enough room in your mouth for your third molars to fully erupt, a number of dental problems can arise:
Infection-Without enough room for total eruption, the gum tissue around the wisdom tooth can become inflamed 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 dental decay (or cavities).
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 wisdom 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 also be associated with the impacted wisdom teeth that have not been removed.
Crowding-Although controversial, many dental professionals feel that impacted wisdom teeth directly contribute to crowding of your teeth. This is most noticeable in the front teeth, usually the lower front teeth, most commonly occurring after a patient has had braces. There are most likely a number of factors that cause teeth to crowd after braces or in early adulthood, but retained, impacted wisdom teeth may play a contributory role.
Unless you have an active problem at the time of your consultation, the reason for removal is primarily preventative to avoid long-term problems.
Many people, especially in years past, were told to take a “wait and see” approach to their wisdom teeth. Many who did not have adequate room developed some of the localized problems previously mentioned. The problem with this approach is that IF it is necessary to remove impacted wisdom teeth in your thirties, forties, fifties, or beyond, it is clearly more difficult for you as the patient. The post-operative course is usually prolonged and the complication rate is higher as you age. Treating these complications is more difficult than with a younger patient. In some cases, we will continue to advise you to wait and monitor your wisdom teeth if the risks associated with their removal outweigh the benefits. If problems do develop, we may recommend treating the affected area only.
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We will need to see you for a consultation before your surgery, at which time it will be determined if you will benefit from wisdom tooth removal. The consultation appointment is very important for both the doctor and the patient. At this time the doctor will evaluate your medical status and determine what if any further medical workup or tests would be needed prior to your surgery. He will also ascertain whether any additional medical consultation is necessary. A special x-ray of your mouth and jaws, as seen below, will be taken to determine how much room you have, if any, for your wisdom teeth to erupt.
All outpatient surgery is performed under appropriate anesthesia to maximize your comfort and safety. Our doctor and staff have the training, licenses, and experience to provide various types of anesthesia. Patients can select the most appropriate alternative in consultation with the doctor. These alternatives may include local anesthesia (“Novocain”), nitrous oxide sedation (“laughing gas”), intravenous sedation, or light general anesthesia. Based on your medical condition or the complexity of the surgery, your doctor may even recommend having your surgery performed in the hospital operating room (day surgery).
Many people clearly prefer to be unaware of the experience when they have their wisdom teeth removed and opt for some form of sedation. These services are provided in an environment of optimum safety, utilizing modern monitoring equipment (pulse oximetry, continuous blood pressure monitoring, EKG) and staff experienced in anesthesia techniques. The surgical care team (consisting of the doctor and surgical assistants and nurses) is tested and the office facilities are inspected on behalf of the Florida Board of Dental Examiners on a regular basis.
During the consultation you will be given ample opportunity to ask the doctor any questions you might have. Occasionally, a question may arise after the consultation, and either the doctor or another member of the surgical care team would be happy to answer any questions by phone.
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You should have nothing to eat or drink from midnight the night before your surgery unless you are having local anesthesia (“Novocain”®) only and have no plans for using any alternative anesthetic choices. If you have been instructed to take any prescription medications at the time of your consultation, you should do so with as little water as possible. No other fluids (like juice, milk, or coffee) should be used to take medications prior to surgery. If you are not sure about whether to take a medication prior to surgery, please call our office. You should wear comfortable, loose fitting clothes, preferably short-sleeved, to allow for placement of the I.V. and monitoring equipment. We ask that a parent or responsible adult accompanies you to the office, stays during your surgery, and plans to stay with you at home the rest of the day. Your procedure will take about an hour and you will probably be in the office for 11/2 hours.
After checking in with our receptionist, a member of our surgical staff will escort you to the operatory. You may wish to use the lavatory prior to beginning the procedure. We have CD players and a wide variety of CD’s available if you would like to listen music during your surgery. You are also welcome to bring your own CD’s if you wish. Prior to seating you, the surgical assistant will ask you to rinse your mouth with an antibacterial mouth rinse. If you are having local anesthesia only, the doctor will then administer the anesthetic the same way that your dentist might to perform a filling. If you have requested nitrous oxide sedation, the nitrous oxide will be administered via nose mask prior to the administration of the local anesthesia.
If you plan to have intravenous sedation or light general anesthesia, the surgical assistant will seat you in the dental chair and will apply several monitors including a pulse oximeter, a blood pressure cuff, a small stethoscope on the neck, and EKG wrist clips. A small nose mask will then be placed over your nose to administer oxygen or nitrous oxide during the procedure. After this, we will start an IV in your arm through which the sedation medication will be administered. Once you are asleep, local anesthesia (“Novocain®”) will be given, though you will be unaware of this. In fact, we have found that most patients are completely unaware of the procedure being performed. When you wake up from the anesthesia, you will be comfortable. We will have given you local anesthesia as well as intravenous ketorolac (Toradol®) so you won’t be in any pain, and you will still be somewhat sleepy.
Our surgical assistants will review your post-operative instructions. When you leave the office you will be comfortable and drowsy. Most patients prefer to go home and rest with no other physical or scholastic activities planned for a few days.
When you arrive home, the local anesthesia will start to wear off and then you may have some discomfort. Please remember to take an ibuprofen [Motrin 800 mg (or ketorolac (Toradol®)] as the local anesthesia is wearing off. If the ibuprofen (or ketorolac) is enough to control your pain, stay on the ibuprofen (or ketorolac) every six hours as needed. If you find the ibuprofen (or ketorolac) is not adequate for pain, we also prescribe a stronger pain medication. This stronger medication is usually Percocet® (also known as Roxicet® or oxycodone with acetaminophen). We would much prefer that you take only one-half tablet of Percocet® only if the ibuprofen (or ketorolac) is not working adequately, and only if you have been able to get some type of food in your stomach. In some patients, Percocet can cause severe nausea and vomiting, especially on an empty stomach. If this occurs, you should stop the medication, try drinking clear liquids (ginger ale, iced-tea, apple juice) and if this persists, call our office. It is very important that you do not take any over-the-counter medications or herbal medications at the same time as using the prescriptions without checking with our office.
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After the surgery, you will experience some bleeding and some pain. Each individual’s reaction to surgery varies, and the sensation of pain can range from mild discomfort to severe pain. You can expect approximately two to four days of discomfort before noting improvement. The soreness and swelling may take a week to ten days to completely resolve.
A variable amount of swelling can be expected following the surgery. This swelling usually peaks on the second day and should begin resolving on the third day. You can limit the amount of swelling you will have by using ice for the entire first day. The more ice you have on the first day, the less swelling you will have on the second day. Please remember to put ice on the first day even if it’s somewhat uncomfortable to have the cold next to your skin.
On the third day, you will notice that your jaw muscles are stiff, and it’s difficult to open your jaw as wide as you used to. This will generally resolve by the end of the first week after surgery.
Most of the time you will want to maintain a low profile for a few days. We ask that you follow your post-operative instructions closely. Doing so will make you more comfortable during the first few days following your procedure. Please allow the time to let your body begin healing before resuming an active social, academic, or athletic schedule. Most patients feel like they are over the hump in 3-5 days.
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As with any medical procedure, there can be complications or an unanticipated result that you should be aware of:
There is a nerve that supplies feeling to the lower lip, chin, and tongue which is frequently very close to the roots of the lower wisdom teeth. Having these teeth out between the ages of 12 and 18 usually provides shorter roots so that the nerve is not so close to the roots of these teeth. Occasionally, when the teeth are removed, especially in older patients, the roots have grown longer and become closer to the nerve itself. This nerve can become irritated in the process of removing the tooth. If this happens you may experience a tingling or numb sensation in the lower lip, chin, or tongue when the local anesthesia wears off. Should this occur, it is usually temporary and will resolve gradually over a period of weeks or months. RARELY, it can result in a permanent alteration of sensation similar to the feeling of “Novocain®”.
The upper wisdom teeth are situated close to your sinuses, and their removal can result in a communication between your mouth and the sinus. Once again, if the teeth are removed at an early age, the root formation is minimal, and this complication is very unlikely to occur. Should this occur, it will usually close spontaneously. We may give you special instructions to follow if this is apparent at the time of surgery. We prefer that you don’t blow your nose for about ten days following the surgery. You can wipe your nose, but don’t blow your nose. If you have to sneeze, you should sneeze with an open mouth into a tissue-you should not create any pressure in the sinus area, which may dislodge the healing blood clot. Flying in a pressurized aircraft and scuba diving should also be avoided for about ten days. If you sense a communication occurring after the surgery, please contact the office. RARELY, an additional procedure may be necessary to close the communication.
Dry sockets continue to be the most common 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 a deep, dull, continuous aching on the affected side(s). Patients may first notice the pain starting in the ear radiating down towards the chin. If this occurs you should call the office so that one of the doctors could see you to treat the problem. Treatment involves placing a medicated dressing in the “empty” tooth socket. This will help decrease the pain and protect the socket from food particles. Dressings are usually left in place for a week then removed. If pain returns within a day or two, the dressing may have to be changed. The dressing doesn’t aid in healing and the only reason to place a dressing is for pain control. If Motrin (or ketorolac) is controlling the pain, the socket will heal without a dressing. An irrigation device will be given to you to help keep food particles from lodging in the extraction site following removal of the dressing.
Occasionally, post-operative infections occur. These can either occur early after surgery (3-5 days) or late (as much as a month or two post operatively). The signs of infection include pain, increase in swelling after 2-3 days, fever and malaise. This usually requires an office visit and clinical examination. Many times, just placing you on an antibiotic for one week will take care of the infection. It will occasionally require drainage of pus that may have accumulated near the surgical site, or even more rarely, admission to the hospital for intravenous antibiotics and further surgical drainage.
Other temporary problems you may experience in the postoperative period include stiffness of the jaws, chafing around the corners of your lips, and facial bruising. The postoperative instruction sheet we will provide should answer many of the questions related to these more common concerns. If not, don’t hesitate to call the office.
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Because of the different types of impacted wisdom teeth, along with different anesthesia options, it is impossible to give you a realistic estimate of what our services will cost until we have reviewed your x-rays. Every insurance company has a different policy regarding the extent of coverage for a given surgical procedure. We will help you check with both your medical AND dental insurance carriers to determine your coverage and out of pocket liability. Our office staff will also be happy to assist you with your insurance claims.
If this information, combined with information you receive at your consultation appointment doesn’t answer all of your questions, please call the office to speak to one of the members of our surgical team.
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© Copyright 2003 The Institute of Facial Surgery (IOFS). All rights reserved.
Updated 3/06/2010 v3.00