What Are Wisdom Teeth?
Wisdom teeth are the four permanent (adult) teeth at the very back of your mouth on the top and bottom. They are the last permanent teeth to appear. Wisdom teeth get their name because they usually come in between the ages of 17–21, around the age when a person gains maturity and wisdom. Most other permanent teeth come in a few years earlier, by age 13.
Sometimes wisdom teeth do not have enough room to come in, or they are in the wrong position. They may come in sideways or at a slant, pushing against the teeth next to them (Figure). These wisdom teeth are called “impacted” and may have to be removed so that they don’t cause future problems.
How Do You Know If Your Wisdom Teeth Need to Be Removed?
Regular dental visits allow your dentist to track the growth and condition of all of your teeth. After doing an oral exam and taking X-rays, your dentist can look at your wisdom teeth and talk to you about whether they should be removed. Wisdom teeth extraction, or removal, may require surgery.
Why Are Wisdom Teeth Removed?
Your dentist will examine your wisdom teeth and may recommend having them removed so they don’t cause future problems.
Possible Problems with Wisdom Teeth
- Teeth and gums can become infected. When a wisdom tooth partially comes through the gums, it can create an opening where bacteria may enter. This can cause pain, swelling and jaw stiffness.
- They can damage or crowd other teeth. This is caused by a wisdom tooth that doesn’t have enough room in the jaw to grow in or one that is coming in sideways or at an angle.
- A fluid-filled sac (cyst) or tumor can form on or near an impacted tooth, destroying surrounding bone or tooth roots.
- Periodontal (perry-oh-DON-tal) disease, also known as gum disease, can develop because wisdom teeth are hard to brush and clean between.
- Pericoronitis (perry-kor-on-EYE-tus) can develop. It is an infection of the soft tissues that cover an unerupted or a partially erupted tooth.
How Are Wisdom Teeth Removed?
A general dentist can perform wisdom tooth extractions. But, if your dentist sees a need for any special care, you may be referred to an oral and maxillofacial (max-UH-lo-FAY-shul) surgeon. This is a dentist who specializes in surgery of the hard and soft tissues of the mouth, including the removal of impacted wisdom teeth. If your dentist refers you to a specialist, the two will work together to provide you with the best care.
What Can You Expect?
- Your dentist will explain what to expect and help you plan for the appointment. He or she may recommend dressing comfortably in loose clothing and arranging for someone to be with you after your dental visit.
- Extractions are usually performed under local anesthesia. This means you stay “awake” but your mouth is numbed with a pain medication. You can discuss with your dentist the types of anesthesia and pain or antianxiety medication to determine what is right for you.
- Talk to your dentist about any questions you have about the procedure. He or she will also tell you how you can get advice after office hours if you have any problems after surgery.
- Tell your dentist about past illnesses and current medications you are taking — this should include both prescription and over-the-counter drugs.
- Be prepared to rest and avoid vigorous activity. Recovery time will vary from person to person, so be sure to follow your dentist’s instructions on when you can return to normal activities.
- Avoid solid foods that require a lot of chewing. Stick to soft foods and liquids. Do not drink with a straw. The “sucking” action could make the wound site take longer to heal.
- You may have some swelling and discomfort. This is normal, but your dentist will talk to you about what you can do to help manage these problems.
- Be sure to know how to reach your dentist during non-office hours in case you have any questions or concerns about the healing process.
- There will usually be a follow-up appointment to ensure the site is healing.
In some cases, there may be complications after treatment. It is possible to get “dry sockets.” Dry sockets can develop when the blood clot that forms over your socket is displaced, leaving bone and nerves exposed. Smoking can increase the risk for complications and delay healing. Follow your dentist’s instructions carefully to reduce the risk for complications.
Not everyone’s teeth develop on the same schedule. See your dentist regularly so he or she can monitor the growth of your wisdom teeth.
What about pain relief?
Some people think that pain after wisdom teeth removal can only be tackled with prescription medicines. But that’s not true. Studies show that a combination of ibuprofen and acetaminophen—both common pain relievers you can buy off the shelf under many brand names—work just as well as prescription medicines without the side effects like the potential for addiction. Talk to your dentist about options for pain relief.
If you use tobacco in any form, it is important to quit. Smoking and vaping can cause problems with your healing process. Ask your dentist or physician for information about ways to quit.
Panorex radiograph courtesy of Brian A. McMurtry, DDS, FAGD.
Impaction photo courtesy of Dr. Jeffrey Dorfman, NYCdentist.com.