WISDOM TEETH: Should you Have Them Removed… Or Not?

    The age-old question of whether or not to remove 3rd molars (a.k.a “wisdom teeth”) is one we are asked quite frequently. Whether to keep them or have them removed can be a complicated decision, based on each patient’s individual anatomy and circumstances.  You’re more likely to have issues with these molars than with any other teeth, simply because of their location in the mouth. Some people don’t develop them at all. The most recent statistic is that about 35% of people are actually missing one or more of their 3rd molars.

     

    Wisdom Teeth Used To Serve A Purpose

    In ancient times, mankind possessed a larger jaw which had room for all 32 teeth, including the four wisdom teeth. As a result, wisdom teeth fit easily in the mouth, making it easier for people to actually use them.  Then, they caused far fewer problems than they do today in our smaller jaws.

     

    Why/How They Became Unnecessary

    When mankind discovered fire and began to cook their food, the change led to softer foods that could be eaten with just the 28 teeth that came in during childhood, rendering the extra four teeth as unnecessary over time.

    At the same time, a number of physical changes impacted wisdom teeth. For example, man’s brain began to grow as he became more developed and advanced. This growth meant that people developed larger skulls. The space for these skulls was taken from the jaw. A genetic mutation discovered in 2004 leads to smaller jaws. Called the MYH16 mutation, this change probably reduced jaw size enough to make room for our ancestors’ growing brains, but as jaws shrank, wisdom teeth ran out of room.  Now, the wisdom teeth that do show up create problems from not having enough space. They are the same problems we have today: Overcrowding, pain, crooked teeth, and infection.

     

    About Wisdom Teeth

    Wisdom teeth typically erupt between the ages of 17 and 25. In many people, wisdom teeth do not break through the gum all the way and grow fully out – only part of them does. This is more common in the lower jaw than in the upper. The reason is usually that there just isn’t enough room in the jawbone.

    Some people have problems with them long before they erupt through the gums, and some people never have any issues whatsoever.  There are several factors involved and there really is no ONE universal answer as to whether or not you should keep them or have them removed.

     

    Some considerations for REMOVING wisdom teeth may include:
    1. Whether they are causing pain in the jaw or contributing to infection in the gums.
    2. Whether there are cysts present around their roots.
    3. Whether there is enough space in the jaw for the 3rd molars to erupt into a healthy functioning position.
    4. Whether or not they are impacted (when the tooth may not have enough room to come out through the gum like it should).
    5. Whether they are damaging adjacent teeth or preventing them from developing or coming in properly.
    6. Whether there is enough room and they are accessible enough to be cleansed properly. If not, the result will be cavities and/or swollen gums.
    7. Whether there is bone loss around the roots.
    8. Whether there are lesions (abnormal looking tissues) around them.
    9. Third molars are easier to remove before the roots are completely formed, which is why oftentimes, we recommend removal at younger ages. Healing after oral surgery is often much quicker in younger people than in older adults. For this reason, many dentists put the cutoff age for elective removal of wisdom teeth at around 40.
    10. Wisdom teeth may interfere with orthodontic treatment.
    11. In most cases, because of the limited space in the very back of the jaw, they don’t really help people with chewing their food unless there are other missing teeth and they’ve moved forward.
    12. The potential for creating future problems like it causing bone loss in your jaw around the tooth, it damaging the teeth next to it or their roots, or getting infections in the bone surrounding it.

     

    Some considerations for KEEPING wisdom teeth are if:
    1. There is enough room for them to erupt into a healthy maintainable position in the jaw and it has no ill effects on neighboring teeth.
    2. There is concern for potential complications from removing them; such as probable infection or possible permanent numbness (this is often an area of consideration when the roots of the wisdom tooth are too close to the nerve that runs along the lower jawbone.)
    3. (If it IS erupted into a good position in the jaw and able to be used and kept clean,) a third molar could be used at some point in the future to support a fixed or removable bridge. This is sometimes a consideration when other molars in a quadrant are deemed either questionable or are expected to fail in the future for one reason or another.

    These are just a some of the considerations that should be addressed in deciding whether or not to undergo removal of wisdom teeth. Be sure to consult with us if you ever find yourself at this crossroad. We do not recommend wisdom tooth removal for every patient. Every person’s anatomy is different, and some people are able to keep their wisdom teeth their whole life without any complications at all. We will review all the factors involved and discuss the benefits, options and risks of both sides of this decision with you.

     

    The day of surgery.  What to expect:
    HOW IS IT DONE? Exactly HOW it is removed is determined by its position in your mouth. How far it is out of the gum? Has it come through the gum completely, is it partially imbedded in the bone? Fully impacted in bone? Near the main nerve? Growing under other roots?  In some cases, it’s a simple extraction, where the site is numbed, and the tooth loosened and then removed with dental forceps. In other cases, say, if your tooth is still partially or fully below the gum line, it may need to be cut into pieces as it’s removed to keep the hole as small as possible.
    PAIN/ANXIETY DURING THE SURGERY: You will be numbed for this to keep from being in pain during the procedure. For anxiety, depending on your preference and medical history, you could also be given medicine to make you feel sleepy so you won’t be anxious or remember much, or you may have IV Sedation, where you’re put to sleep and wake up after everything is done.
    PAIN MANAGEMENT AFTERWARD: As far as pain management after the numbing anesthetic wears away, you may be able to manage the discomfort with over-the-counter drugs such as Ibuprofen or Tylenol, or you may be given a prescription painkiller, especially if they took out or had to add any bone.
    ACTIVITY/WORK/LIMITATIONS AFTERWARD: Most people are able to get back to their normal activities within the next day or two, depending on how many teeth were removed and how complicated the circumstances of the surgery were. We do recommend that you take it easy the day OF, get plenty of rest, hydrate your body well and eat a light meal as soon as possible. As far as heavy exercise we recommend you wait a few days (typically about 3 days). If your job involves heavy physical labor, it’s best to schedule your surgery on a day when you can have a few days off afterward, so you do not have to exert yourself so much (a Thursday or Friday).
    SUTURES & POST OP INSTRUCTIONS: It is often hard to tell if a patient will need sutures or not until after the surgery is finished. Sometimes, the site is sutured and sometimes it is not, depending on various factors. Once the tooth/teeth are removed, the area is cleansed and packed with sterile gauze to help stop the bleeding. Ice packs are then applied and you will continue with ice 5 minutes on/5 minutes off, for the day OF surgery. Try not to spit too much or too vigorously, or to form a suction type motion in your mouth (like using a straw, or smoking, etc), as this action could loosen the blood clot that forms to keep that socket from bleeding. This blood clot is important. If it is dislodged too soon, it leaves the bone and nerves exposed, leading to a painful condition called a Dry Socket. Common culprits include suction from straws or smoking, food getting lodged in the site, bad hygiene, forceful spitting, coughing, and sneezing.

    Dry sockets can happen with simple extractions as well as with more complex surgical ones. It is very important to follow the instructions given to you to avoid this from occurring.

    You’ll want to drink plenty of water, but stay away from alcohol, hot beverages/hot soups (lukewarm is OK), or carbonated drinks for 24-36 hours, and stick with softer foods that won’t bother the area for a few days. Opening your mouth fully may be difficult for a few days. This is from the anesthetic and the traumatized soft tissues. You may also have lingering numbness in the area for anywhere from a few hours to up to a few days afterward.

    When you leave the office, you will receive a full list of instructions tailored to your specific circumstances, as well as Dr. McFadden’s cell phone number, so you can call him directly with any questions or concerns after hours or over the weekend.

    It is normal to have some bleeding the first day and to feel sore and possibly even have some swelling for up to a few days.  Using ice packs and keeping your head elevated will help with swelling. For some people, there can be some residual bruising as well and although it may look scary to some people, this is considered normal.

     

    How Much Does Wisdom Tooth Removal Cost And Is It Covered By My Insurance?

    COST: It is nearly impossible to give an accurate estimate of the cost until we’ve seen you for an exam and a panoramic x-ray. The cost varies depending on how many wisdom teeth being removed and whether they are fully erupted, partially erupted, or they’re partially or fully or impacted. (This is determined with the panoramic x-ray).  Another factor of cost is the method of anesthesia you decide on. You will receive a written estimate at your consultation. There are never any “after the fact” or surprise fees in our office, even in the occasional event that something more difficult or extra is ultimately done, IF unforeseen circumstances arise. Once you’re given an estimate, you’ll know exactly what you’re looking at, cost-wise. No surprises.
    INSURANCE: As far as your insurance goes: The coverage is determined by your individual insurance policy. Most extractions are covered by dental insurance; however, with some policies, impacted wisdom teeth are passed on to your medical insurance provider. Bring both your medical and your dental insurance information with you to your consultation and our staff will contact your insurance company and estimate your benefits. We are glad to assist you by completing and filing your insurance claims for you.

     

    Your Care And Comfort

    If you have wisdom teeth that are causing you problems, Dr. McFadden can help you. With over 30 years of surgical experience, he and our expert team and staff are dedicated to your care and comfort. Please be assured that anesthesia is available at whatever level is appropriate for each patient. We offer Oral Sedation, Nitrous Oxide, and IV Sedation so whatever your needs are, we’ve got it covered. If anything is unpleasant for you, it will not be done until you are comfortable.

    We encourage you to express any concerns that you may have prior to treatment.