Impacted Wisdom Tooth Extractions

Wisdom Teeth

Wisdom teeth, also known as third molars, are the last teeth to erupt in your mouth. This generally occurs between the ages of 17 and 25, a time of life that has been called the "Age of Wisdom."

Anthropologists note that the rough diet of early humans resulted in the excessive wear of their teeth. Normal drifting of the teeth to compensate for this wear ensured that space was available for most wisdom teeth to erupt by adolescence. The modern diet, which is much softer, and the popularity of orthodontic tooth straightening procedures produce a fuller dental arch, which quite commonly doesn't leave room for the wisdom teeth to erupt, thereby setting the stage for problems when the final four molars enter the mouth.

What is an Impacted Tooth?

A tooth becomes impacted when there is a lack of space in the dental arch and its growth and eruption are prevented by overlying gum, bone or another tooth.
Complications such as infection (fig. a) , damage to adjacent teeth (fig. b) and the formation of cysts (fig. c) may arise from impacted teeth.

How Serious is an Impacted Tooth?

Impacted teeth can be painful and lead to infection.They may also crowd or damage adjacent teeth or roots.

More serious problems may occur if the sac surrounding the impacted tooth becomes filled with fluid and enlarges to form a cyst. As the cyst grows it may hollow out the jaw and permanently damage adjacent teeth, the surrounding bone and nerves. Rarely, if a cyst is not treated, a tumor may develop from its walls and a more serious surgical procedure may be required to remove it.

Despite the considerable concern regarding impacted third molars, a recent study sponsored by the American Association of Oral and Maxillofacial Surgeons and the Oral and Maxillofacial Surgery Foundation finds that third molars which have broken through the tissue and erupted into the mouth in a normal, upright position may be as prone to disease as those third molars that remain impacted.

Should the Tooth Come Out if it Hasn't Caused Any Problems Yet?

Not always. However, when making this decision you should know that not all problems related to third molars are painful or visible. Damage can sometimes occur without you being aware of it.

As wisdom teeth grow, their roots become longer, the teeth become more difficult to remove and complications become more likely. In addition, impacted wisdom teeth are even more likely to cause problems as patients become older.


When Should I Have My Wisdom Teeth Removed?

In general, earlier removal of wisdom teeth (below age 25) results in a less complicated healing process with less risk and complications.The AAOMS/OMSF study strongly recommends that wisdom teeth be removed by the time the patient is a young adult in order to prevent future problems and to ensure optimal healing.The researchers found that older patients may be at greater risk for disease, including periodontitis, in the tissues surrounding the third molars and adjacent teeth. Periodontal infections, such as those observed in this study, may affect your general health.
Wisdom Teeth Growth by Age

Wisdom teeth are easier to remove when the patient is younger, since their roots are not completely formed, the surrounding bone is softer, and there is less chance of damaging nearby nerves or other structures. Removal of wisdom teeth at a later age becomes more complicated as the roots have fully developed (may involve the nerve), and the jawbone is more dense.

What happens next?

If you would like a consultation and possible surgery for your wisdom teeth, please use the "practice locations" link to contact Dr. Kahenasa for an appointment. Before surgery, Dr. Kahenasa will discuss with you the risks (numbness, sinus related risks, etc) and benefits of the surgery. She will also give you a good idea of what to expect, so this is a good time to ask questions or express your concerns. It is especially important to let Dr. Kahenasa know about any illness you have and bring a list of all prescription or "recreational" medicines you are taking.

The ease of wisdom tooth removal depends on several conditions, including the position of the tooth, age of the patient, and root development. Impacted wisdom teeth may require a more involved surgical procedure, although even erupted wisdom teeth can be complicated depending on the root anatomy. Since patients are typically nervous about oral surgery, Dr. Kahenasa provides sedation/anesthesia options to assure her patient's optimal comfort and safety.

Most wisdom tooth extractions are performed in the office under local anesthesia with nitrous oxide, intravenous sedation or general anesthesia. Dr. Kahenasa will discuss the various options for your particular case after reviewing your medical history, medications, current health and surgical needs. Certain patients may also need pre-surgical medical evaluations to assure their health is optimal for surgery.  It is possible to have surgery the same day as your consultation, however, if you would like IV sedation or general anesthesia, please contact us for important instructions.

What Happens after Surgery?

Following surgery (usually day 3-4) you may experience the "puffy but chipper chipmunk" look. This look will usually include swelling in the cheeks but should be with minimal discomfort, when the prescribed medications are taken as directed.  Cold compresses will help decrease the swelling, and medication prescribed by Dr. Kahenasa will help to manage your swelling and discomfort. You will also be instructed on how to modify your diet following surgery. Dr. Kahenasa also provides you with her direct contact information for any post-operative questions or concerns and will assure you can contact her (or another doctor when she is out of town) 24 hours a day in case of emergency.