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Wisdom teeth (third molars) usually grow during the teenage years. Occasionally, a lack of space for normal eruption results in impacted teeth.
A visual examination and x-rays are required to assess your situation.
We can remove a wisdom tooth at any age. However, the extraction is often recommended when the root is not fully formed. Extraction at that time is usually easier and the risk of complications is lower.
As a preventive measure, it is strongly recommended to undergo an examination at the age of 15 or 16 in order to assess the progression of wisdom teeth and to know their probable orientation. If removal is necessary, it is much easier between the ages of 18 and 21 while the roots are not yet fully formed.
If root formation is already completed and the teeth positioned, we might recommend to keep or to remove your wisdom teeth, depending on the situation.
Even in the absence of pain, do not underestimate the importance of this monitoring because it is very likely that your wisdom teeth will cause you problems at some point in your life. If you already show signs of infection or damage to adjacent teeth, surgery will surely be recommended.
The development of our permanent dentition (28 of 32 potential teeth) is completed at the age of 14 or 15. The eruption of our 4 wisdom teeth occurs more slowly and sometimes these teeth never break through the gum tissue. Their root formation is completed on average at the age of 21. Positioned at the very back of the dental arches, these third molars (commonly referred to as wisdom teeth) require attention and particular treatments.
From a historical point of view, there are different theories explaining why wisdom teeth are causing us problems:
The location of the wisdom teeth and the current form of our jaws leave very little space available for these teeth to erupt properly.
Is it really necessary that these teeth “come out” whether naturally or by extraction? Following the evaluation by your dentist, it is possible that he or she will recommend that you keep your wisdom teeth if their position does not seem problematic. However, this recommendation is conditional to regular monitoring and a perfect dental hygiene. Depending on the potential risk to keep your wisdom teeth, regular dental check-ups are important and a surgical procedure might be needed.
Wisdom teeth, by their position, can cause ailments such as infections and cysts.
A tooth that grows toward the roots of the adjacent tooth will cause pressure, possibly an abscess and the deterioration or even the loss of the tooth nearby, while remaining buried in the jaw. These teeth that do not fully erupt are called impacted teeth. They represent an insidious potential for damage and pain since nothing is visible to the naked eye.
Over the years, an impacted tooth may push and obstruct the second molars. The displacement of this tooth is possible even after the end of the root formation and this could be promoted by the loss of another tooth, among other things. It is even possible, although less likely, that people over 40 can suddenly feel pain and suffer complications due to their wisdom teeth.
The long eruptive phase of the wisdom teeth (from the age of 14 to 22) can cause various unpleasant symptoms: sharp pains, headaches, pain in the throat, gum inflammation and swelling.
A wisdom tooth that manages to erupt through the gums can also be problematic if it fails to erupt completely. When a wisdom tooth partially emerges and only part of the crown is visible above the gum line, we say that it is partially impacted or partially erupted. This situation creates an ideal trap for food debris and promotes dental decay. Even with strict hygiene measures, infections may develop on these sites and cause discomfort and ailments which are detrimental to your health.
Wisdom teeth assessment starts with a dental examination using a panoramic x-ray (that allows to see the entire jaws). With that information, the dentist will be able to know if wisdom teeth are present and what is their current position in order to anticipate potential problems.
This assessment can be done during your follow-up exam, but often, a separate appointment is necessary to provide you with explanations about the procedure and its cost.
The dentist will examine the position of your third molars, their formation as well as your joints and your jaw. He or she will also be able to detect the presence of cysts using a panoramic radiograph. After studying your case, it is possible that the dentist would recommend the removal of your wisdom teeth.
Since wisdom teeth are rarely in proper position and completely erupted, simple extraction of these four teeth is unlikely and they will possibly require a surgery.
Depending on your situation, your dentist might decide to perform the surgery or refer you to a specialist: the maxillofacial surgeon. After obtaining his degree in dentistry, this professional pursued a specialization during four additional years in order to learn how to perform complex surgical procedures of the mouth and face. Therefore, the complexity of the intervention (which depends on the position of your teeth, the proximity of the lower nerve and the shape of the roots) or simply your dentist’s practice may influence the decision whether or not to perform the surgery.
Whatever the reason, if your dentist chooses to refer you to a maxillofacial surgeon, the cost of the intervention will have to be discussed with that specialist who will also require an assessment to make his own diagnosis and to decide on the procedures to be followed. When possible, the lending or the electronic transfer of the panoramic radiograph taken by your dentist may reduce the costs of the examination with the specialist as well as your exposure to x-rays.
A written estimate of the interventions and their costs will be given to you so that you can send it to your insurer to obtain a predetermination of benefits. This predetermination is often necessary and therefore strongly recommended because it will facilitate the reimbursement of your benefits according to your dental coverage.
Some clinics contact directly your insurer and inform you of the decisions while others leave that step to you. If this is the case, do not delay in sending the documentation to your insurer because it can take a few weeks until they inform you of the amount that you have to pay for your surgery.
Logically, the duration of the surgery will be influenced by the number and type of extractions. If you require two simple extractions and two semi-impacted ones, the time needed for surgery will not be the same as for four impacted teeth.
Ideally, this type of surgery should take place early in the week because the surgeon will be available in the following days if complications arise. In addition, your surgeon will give you the contact information of a resource person you can get in touch with at any time during this period.
Post-surgical treatments such as examination costs, appointments related with complications and post-operative follow-up are included in the cost of your surgery if they are provided by the attending surgeon.
The recovery time is normally from 3 to 7 days, depending on the case.
Whether the procedure takes place at your dental clinic or with the maxillofacial surgeon, these four steps will be the same. Only the type of anaesthesia will be different.
Assisted by his staff, the surgeon will first proceed to the anesthesia. Don’t worry, it will be effective before the start of the surgery. Even if the surgery is scheduled for four wisdom teeth, the surgeon will begin working on one site at the time, generally the first two teeth located on the same side of the mouth (top and bottom) for a question of efficiency and duration of anesthesia.
Depending on the tissue that surrounds or cover the tooth, the dentist will begin by excising (cutting) the gum to reach the bone. Using various instruments including a dental drill, the dentist will remove a little amount of bone surrounding the tooth in order to extract the tooth gently. To make the extraction easier, the tooth may be crushed to small pieces. During this surgery, the dentist will also use some instruments (elevators) to free the tooth from the ligaments connecting it to the surrounding tissue.
Being under the effect of anesthesia, you won’t feel any pain during the surgery, the sound is essentially the biggest inconvenience you’ll be facing (the sound of the equipment but also the internal sound during the removal of the tooth).
Throughout the surgery, the assistant will keep the dental alveolus (socket in which the roots of the teeth were embedded) free of blood and other material obstructing it. The surgeon will eliminate any apparent rough edges to avoid any discomfort after healing. Over time, the tooth socket will regenerate with bone, but during the procedure, the surgeon will limit the bleeding by applying pressure with a gauze.
Once the tooth is removed, the extraction site will be well disinfected to limit the risk of complications. A blood clot will form to promote a good healing. Stitches will be required to maintain the integrity of the gum during recovery. Dissolvable stitches will disappear by themselves after approximately two weeks, while other types of stitches may be removed during the postoperative follow-up examination or during a subsequent appointment.
Even if most wisdom tooth extractions do not result in some complications, some problems could occur.
Here are the most common:
Dry socket (exposure of bone when a blood clot is dislodged or did not form in the extracted tooth socket) can slow down the healing of the extraction site and cause pain. A few months after the extraction of a wisdom tooth, bone will regenerate and fill the hole left in the jaw bone. But shortly after the intervention, the body will first form a blood clot which will cover the extracted tooth socket and form a protective barrier. If the blood clot is lost, the bone will be exposed and this will cause a sharp pain radiating toward the ear. If you feel this kind of pain, contact the surgeon so that he can clean the tooth socket and make sure it is covered. To avoid dislodging the blood clot, do not drink through a straw, spit or smoke during the first 24 hours.
The roots of wisdom teeth are sometimes located very close to a nerve. Their extraction therefore has the potential to touch and damage this nerve. The surgeon will evaluate this risk using panoramic x-rays.
If the nerve is affected, partial or total paralysis of the lower lip or tongue may result. In most cases, this loss of sensitivity will be temporary, but for a few, it may be permanent.
It is normal to experience blood-tinged saliva during the first 24 hours following surgery. On the other hand, if bleeding is most abundant, stop it by biting 30 minutes on a gauze or cotton that you place on the extraction site. Repeat until the gauze shows almost no more traces of blood. Your surgeon possibly gave you sterile gauzes for this purpose. Otherwise, applying a moistened tea bag may also be suitable. If after a few attempts the bleeding does not decrease, don’t delay in contacting your surgeon.