Needing to have your “Wisdom Teeth” removed has become somewhat of a rite of passage for many in the United States. Wisdom tooth removal is one of the most common oral surgical procedure that occurs in the dental office, and is one that most everyone will need to endure. A “wisdom tooth” is a particular molar, the third molar, which lies farthest back and is the last to develop and emerge into the mouth as we grow. Although many people ultimately have their wisdom teeth removed, there are many factors that need to be considered before the decision is made to do so.
Why do wisdom teeth need to come out?
The typical person has thirty-two adult teeth which all begin to form underneath the gums. These teeth will then go on to erupt into the mouth in a predictable and sequential order over time. Wisdom teeth are the last to form and thus the last to erupt. Given the average person’s facial geometry, the wisdom teeth often do not have adequate space to fully erupt, if at all. When a tooth fails to erupt into the mouth this is called “impaction”, and this is the most common reason that wisdom teeth need to be removed. Impacted teeth have the potential to cause many dental complications such as damage to neighboring teeth, gum problems, bone defects, cysts, infection, or pain. Fortunately, if the teeth are addressed in a timely manner these complications can often be avoided.
Even if the wisdom teeth do erupt into the mouth, there are still some instances where they need to be removed. It is important that we evaluate the health of the surrounding gum tissue as well as the patient’s ability to adequately clean these teeth with daily brushing.
When is the best time to have them removed?
Judging the best time to have your wisdom teeth removed kind of follows the “Goldie Locks Principle” in that there is a window of time when they are “just right.” As the wisdom tooth develops, the crown or “top” of the tooth grows first, followed by the roots. The wisdom tooth can technically be removed at any time during development, but we often find that the ideal time is when the roots have partially grown. Finding this ideal time can be tricky because everybody is different, however this generally occurs between the ages of 16 and 21 with girls being slightly ahead of boys.
Generally speaking, it is better to have your wisdom teeth taken out at a young age, as opposed to waiting until later in life. Studies have shown that symptoms such as pain or swelling associated with impacted wisdom teeth increase with age. Other studies have demonstrated that if you have your wisdom teeth taken out after the age of 26, you are more likely to have bone problems associated with the second molars . With this information in mind, it is often best to take a proactive approach as opposed to waiting the wisdom teeth to become a problem.
How do I know if my wisdom teeth need to be removed?
The first step in determining if your wisdom teeth need to be removed is by undergoing a full examination by your dentist. There are several different types of imaging modalities that we can utilize to determine the exact location and stage of development of your wisdom teeth. The most common image taken is called a panoramic radiograph. A panoramic radiograph is a two-dimensional image that can show all of your teeth as well as the relative position of other surrounding structures. Often times this type of image is adequate to assess your wisdom teeth, however there are instances in which more information is needed.
When additional information is needed about the position of the teeth, a three-dimensional image is taken. These images are called a CBCT, or Cone Beam Computed Tomography. This type of image allows the dentist to see exactly where the teeth are located relative to sensitive structures such as nerves or your sinus cavity.
With the information obtained in the examination and these images, a determination can be made as to when is the best time to have your procedure.
How is the procedure done?
When the decision is made to have your wisdom teeth removed there is often a bit of anxiety surrounding the procedure. There are a number of different options that can help make the procedure more comfortable for the patient.
The most common option many people choose is called “IV Sedation.” This mode of sedation involves the delivery of sedative medications through an IV that is placed in the arm or hand. Because the medications are delivered directly into the patient’s blood stream, the effects of the sedation are often very predictable. During this type of sedation, the patient is still technically “awake”, however they often do not remember the experience due to the effects of the medications. After the procedure is over, the patient is allowed to recover from the effects of the medications and is sent home with a responsible adult.
Another option that some patients choose is called “Oral Sedation.” In this instance, a sedative medication is given in pill form prior to the procedure and is allowed to take effect. This medication can allow for reduction in anxiety as well as memory loss during the procedure. However, since the medication is in a pill form, the effects can vary widely from patient to patient.
What can I do next?
All people are different and because of this what may work for one person may not work for the other. If you are curious about what options may be best for you, give us a call to schedule your appointment!
1. Pogrel A, Dodson T, Swift J, Bonine F, Rafetto L, Kennedy J, Malmquist J. White Paper on Third Molar Data. American Association of Oral and Maxillofacial Surgeons – Advocacy and Position statements. 2014.