What Are Wisdom Teeth?

Wisdom teeth, or third molars, are the last teeth to develop and appear in the mouth. They
are called "wisdom teeth" because they usually appear during a person's late teens or early
twenties, which has been called the "age of wisdom." The normal position of wisdom teeth
is behind he upper and lower second, or 12-year, molars. Many times the jaws of modern
humans are not normally large enough to accommodate the four wisdom teeth. This is why
wisdom teeth cause more problems than any other teeth in the mouth. In fact, for nine out of
ten people at least one wisdom tooth remains underneath the gum due to lack of space in
the mouth.

Impacted Wisdom Teeth

When a wisdom tooth is blocked from erupting or coming into the mouth normally, it is
termed "impacted." A tooth may be only partially impacted, meaning it grows in crooked
and breaks through the gum only partially, or it may fail to break through at all and thus
remains totally impacted. Serious problems can develop from partially impacted teeth,
such as pain, infection, and crowding of, or damage to, adjacent teeth. For totally
impacted teeth, more serious problems can occur if the sac that surrounds the impacted
tooth fills with fluid and enlarges to form a cyst.

How Wisdom Teeth Are Treated

The treatment of impacted wisdom teeth involves their removal using special surgical
techniques appropriate for each individual case. A dentist who has specialized training
in the removal of wisdom teeth is called an oral and maxillofacial surgeon, or OMS. If the
wisdom teeth have fully erupted in normal position, they may be observed by your dentist
during your regular visits to ensure that you are properly cleaning them and no problems
are developing, such as decay. Minor abnormalities in the position of an erupted wisdom
tooth may be taken care of by your dentist, or removal might still be best.

The removal of wisdom teeth can be performed on an out-patient basis, either in the dental
office, or in certain cases, in a hospital setting. If the tooth is impacted, an incision is made
in the gum tissue and the tissue is turned back so the tooth can be seen. If bone is covering
the tooth, it may need to be removed in order to expose and extract the tooth. The tooth may
be removed whole, or in some cases it may be cut into sections, and each section is then
individually removed. After surgery you will spend some time "in recovery" before going
home. In most cases normal activities can be resumed within a few days depending on the
degree of impaction and the number of teeth removed.

What To Expect During Surgery

Anesthesia
Modern anesthesia technology now makes it possible to perform even complex surgery in
the dental office with little or no discomfort. During surgery, one or more of the following is
used to control pain and anxiety: local anesthesia that numbs the surgical area; nitrous
oxide-oxygen (sometimes called "laughing gas") to relax you; intravenous sedation for
relaxation; and general anesthesia that puts you to sleep. Your surgeon will fully explain
the type of anesthesia that is most appropriate for your needs.

The Surgical Procedure
The method used to remove your wisdom teeth will depend on various factors, for example,
the position of the teeth; the length of curvature of the tooth roots; the thickness of the bone
surrounding the teeth; and so on. If the teeth have fully erupted, it is possible to simply
remove each tooth intact from its socket in the bone, using forceps or other instruments
designed for this purpose. If gum tissue is covering the tooth, an incision will be required to
turn back the gum and expose the tooth. Likewise, if bone covers the tooth, the surgeon
will remove sufficient bone to expose the tooth and allow its removal.

If an incision through the gum tissue is needed to gain access to an impacted tooth, the
surgeon may place some sutures (stitches) at the end of the procedure to hold the tissue
together and aid healing. These stitches may dissolve on their own after surgery, or you
may have to return to the office for their removal.

Immediately Following Surgery
If your surgery was performed in the dental office or hospital outpatient facility, you will
probably rest for some time before you are driven home by your companion. During this
"recovery" time the surgeon or an assistant will monitor your condition and make sure you
are ready to leave.

After Your Surgery

What to Expect
Your surgeon and/or the office staff will give you specific instructions to follow after
surgery is completed. You can expect some bleeding for a while, and you will probably be
asked to bite gently on gauze for a few hours after surgery to allow a blood clot to form in
the extraction site(s). Even a little blood can seem like a lot to you, so don't be alarmed by
gentle oozing of blood for a few hours after surgery. However, if bleeding is excessive
after you return home, contact your surgeon immediately for instructions.

Ice packs applied to the face following surgery will help to reduce swelling, but expect
some swelling to occur during the normal healing process. This swelling may
increase for the first 48 to 72 hours and then begin to subside. There may be some
discoloration of the skin during healing, first black-blue in color, then turning yellow and
disappearing in a few days. There may also be pain for several days following surgery.
Your surgeon will prescribe the appropriate pain medication for your needs.

Diet
As your mouth heals following surgery, your jaw may be sore and may not open as wide
as usual. After a few days, moist heat applied to the face may be helpful, and gentle oozing
and closing of the mouth can help exercise the jaws and restore normal movement. In the
extraction sites, the formation of a blood clot following surgery is important for the healing
process, so be careful not to disturb this clot when eating. For the first two days following
surgery, eat soft foods and drink fluids, but avoid using a straw. The suction could disturb
clotting. Do not rinse your mouth vigorously until clotting is complete, although gentle rinsing
with salt water may be recommended by your surgeon to aid healing. Avoid eating hard or
sticky foods that might damage our jawbone, particularly if bone was removed during
surgery. And remember that smoking can disturb blood clots and the healing process.
Clean your mouth gently with a toothbrush after the first day following surgery, but avoid
disturbing blood clots with the toothbrush.

During Healing
Yes to:
- soft foods
- fluids without straw
- gentle cleaning of mouth

No to:
- tobacco use
- sucking fluids with straw
- vigorous rinsing or cleaning that will disturb blood clots
- hard/sticky foods
- vigorous exercise during the first 3-5 day