Wisdom Teeth Removal: Good Idea Or Not?

Wisdom teeth removal is everyone’s rite of passage into adulthood. They start to form deep inside the jaw at age twelve and finish forming around age 21. They are the last teeth to erupt in the mouth around age 16 to 18. You can have anywhere from 0 to 4 wisdom teeth, and in a rare case more than four wisdom teeth. Some have the proper space for them in their mouth to erupt properly while most lack the space to erupt and their wisdom teeth get stuck in the bone or under the tooth adjacent to them. The information provided below is made available to provide basic information. Consult with your Local dentist. If you live in Scripps Ranch or Mira Mesa, San Diego, call us.

Why do we have wisdom teeth even though most do not have the space for them?

Before the invention of fluoride toothpaste many would lose their first teeth, sometime called 6-year molars, early in life. The wisdom tooth would erupt in the back of the mouth and push the tooth in front of it forward to take the place of the lost tooth. 

Should wisdom teeth be removed?

There is a distinctive style of thinking around wisdom teeth extraction. Most think, why remove them when they are not a problem? Others think of removing them as a preventive treatment before they become a problem. Wisdom teeth  are quite easy to remove around age 16 because they have not fully formed.

In most situations I recommend wisdom teeth to be removed up until age 30 even if they are not problematic. I recommend wisdom teeth, for those over age 30, to be removed once they become a problem. 

Reasons to remove wisdom teeth as preventive:

1. If they are impacted, they can damage the tooth in front of them. I see this frequently in the office. Since they are jammed in the back of your second molars, bacteria can accumulate in those areas. And decay in the backs of second molars on the root surface cannot be repaired and thus, lead to their loss.
2. Once the tooth is fully formed past age 21, they can wrap their roots around the nerve. They can be risky, and patients can end up with permanent numbness to the face.
3. They are hard to clean if erupted and end up with decay which can be impossible to fill leading to patients needing extractions later in life.
4. They harbor bacteria that can spread throughout the mouth minutes after brushing constantly, thus having an increased risk of decay in the mouth.
5. They can push on the tooth next to them and cause shifting of teeth. 
6. Many will develop pericoronitis on partially erupted teeth, which can be extremely painful. 

Reasons to leave wisdom teeth and NOT remove them:

1. They have fully erupted, and you can chew with them and clean them properly.
2. You have waited too long, and the roots are wrapped around the nerve, which if removed may cause permanent numbness.
3. They are embedded in bone and are not affecting any vital structure such as the tooth in front of it.
4. During the process of getting braces, teeth were extracted creating space for the wisdom teeth. This is a customary practice. Most often a bicuspid is removed and wisdom teeth, which are stronger, are kept in their place.
5. Leaving a wisdom tooth alone may have fewer complications in an elderly individual than having them removed. Some may develop big holes in the back of the jaw that may become food traps and uncomfortable.

Can wisdom teeth grow back?

Patients often ask me if wisdom teeth grow back. Usually this notion  starts from a rumor that a friend or co-worker spreads based on their own experience. People can have zero to four wisdom teeth and very rarely more. Tooth buds become visible on the x-ray as early as age 12. The number of wisdom teeth you start out with is what you are going to end up with. They are fully formed by age 21 and an X-ray will show them all.

Often when people share with others that their wisdom teeth grew back, it’s because they had several, but not all, of their wisdom teeth extracted years before and they forget that not all of their wisdom teeth were removed. Later on, they feel something poking its head above the gums and they think it’s their wisdom teeth that grew back. Also, sometimes for the sake of safety (or even accidentally) the entire wisdom tooth is not removed which many years later may erupt into the mouth.

Can wisdom teeth cause front teeth to shift?

Wisdom teeth can cause shifting in teeth. Where there is not enough space, wisdom teeth can get jammed behind the last tooth in the mouth. That pressure can cause the shift. The research I have read suggests that although it can cause crowding in back teeth, they do not cause shifting in front teeth. 

Complications associated with wisdom teeth extractions.

Most complications are rare but can happen. Before you have your wisdom teeth removed, you should discuss the risks with your doctor:

1. Using instruments during extractions may chip or damage adjacent or opposing teeth.
2. There can be fractures to bone opposing the extraction site and even may lead to the fracture of the jaw.
3. The nerve that controls the sensation in teeth, gums, and lips may be damaged during the extractions leading to altered sensations, sometimes permanently.
4. It is rare to have an infection after a tooth extraction. There are several instances where the risks can increase:
   1. You are immunocompromised.
   2. You have uncontrolled Diabetes.
   3. You have poor oral hygiene.
   4. You are not following the antibiotic regimens. 
   5. Parts of the tooth, or broken bone, was left behind during extractions.
5. Tooth extraction pain: Depending on the type of pain, there can be various levels of pain. To access a wisdom tooth that is embedded in bone and not visible in the mouth, bone will need to be removed. The more involved the extraction, the more likely the pain. For most general extractions, I do not prescribe pain meds because there is less chance of pain. In more severe cases, your doctor will prescribe you pain medications.
6. Breakage of blood clot in the extraction site may develop, especially in smokers. This leads to much pain.
7. The jaw may get sore due to opening it for an extended period during the extraction process.
8. There may be interactions with anesthetics used or medications prescribed.
9.  Swelling after wisdom teeth removal: it is quite common for the face to get swollen after an extraction. The same person may get zero swelling while extracting on one side of the mouth and have heavy swelling when doing the extractions on the opposite side the following week. Swelling and inflammation is how your body deals with trauma.
10. Extended periods of bleeding, although not common, may occur. Contact your dentist if it persists. See home care instructions below.
11. You may experience black and blue marks on your face after an extraction. This is not a bruise. The cause is blood seeping in between the outside fat layer and skin. It usually goes away after several days. It is most likely to occur in geriatric patients.
12. There are other risks of extraction, and it is not limited just to the above-mentioned.

Dangers of pulling an abscessed tooth: 

If the tooth is already infected, there is a higher chance of the infection continuing or getting larger if left alone. It is always best to remove the source of the infection. In other words, we recommend removing a tooth with an infection versus waiting for the infection to get under control with antibiotics. This is the case as long as the source of the infection is the tooth. There are times that we do not extract an infected tooth. Anesthetics may not work with an infection and to extract while the patient is in a lot of pain is cruel. Another instance is the infection has spread to the adjacent tissue and has become life threatening. You may consider visiting urgent care and consulting with your dentist or oral surgeon. If you are in Scripps Ranch, Give us a call.

Home care instructions to aid in healing for wisdom teeth removal:

1. Keep gauze in your mouth after an extraction for one hour. If the bleeding persists or returns, repeat it by replacing it with fresh gauze. If the bleeding has not stopped by the end of the second hour, place a tea bag for another hour. If it persists, contact the office.
2. Do not disturb the site. Initially place firm pressure on the gauze by biting down on it. Try not to talk or move your jaw as it will continually break the cloth and prevent the stoppage of bleeding. 
3. Do not smoke for 3 days after an extraction. This is easier said than done if you are a smoker. 
4. Do not spit or use a straw.
5. Do not brush your teeth for 8 hours. After 8 hours you can brush but stay away from the area for several days.
6. Do not use mouthwash. You may use salt water after the first 24 hours, 3-4 times a day.
7. There may be some discomfort. You may take over the counter Ibuprofen or Tylenol. If meds are prescribed, take them as directed.
8. Swelling: Apply an ice pack to the outside of your face during the first 12 hours. 20 minutes on and 20 minutes off.
9. You should wait to eat after all the numbing has worn off. If you are, for example, a diabetic and need to eat something so you do not faint, drink lesser amounts of orange juice at a time. You can also drink nutritional shakes such as Ensure.
10. After wisdom teeth are removed, eat soft, cool foods for up to 3 days. Foods include yogurt, mashed potatoes, mashed fruits, cool soups, and plenty of cool fluids.

 If you have any other questions, contact the office that performed your extractions. 

How do they remove wisdom teeth?

There are many textbooks written about the wisdom teeth removal procedure and it is a hard topic to cover in one paragraph. To start with there are many ways a tooth can present itself in the mouth. A tooth can be fully erupted in the mouth, or it can be fully impacted deep inside the jaw. A fully erupted tooth can be extracted like any other tooth. Roots of teeth have ligaments attached to bone. By moving the tooth back and forth, the ligaments break and in addition widen the bone so the tooth can be removed. Imagine swinging from a pole with the base embedded in concrete. If you swing back and forth enough from the pole it will loosen. If it does not, drilling around its base can help loosen it. With a tooth that is fully impacted in bone, the top of the tooth has to be accessed by removing the bone. Once accessed, often there is not enough space for the tooth to come out of the opening. The tooth is generally broken into pieces and removed a little bit at a time. 

If you have any questions or concerns, don’t hesitate to reach out to us at Oasis Dental Arts. Your oral health is worth taking action for, so make that call and prioritize your well-being today. Schedule an appointment today by calling (858) 271-1010, whether you’re an existing or new patient. Your smile deserves the best care possible!