Most adults have 32 teeth by age eighteen. The first molar teeth erupt by age six, the second molars a few years later, while the third molars are the last teeth to erupt around age 17 - 20. These four third molars are also known as wisdom teeth.
If the wisdom teeth are aligned properly and can be reached for cleaning purposes, they generally don’t have to be removed. However, most people have only enough space for 28 teeth in their mouths. Because the wisdom teeth are the last to erupt, they often don’t have enough space to align themselves properly. Wisdom teeth with insufficient space often align themselves in unusual positions in an attempt to find some space to erupt within the mouth. Wisdom teeth with insufficient space may emerge only partly or remain completely embedded within the jaw; these wisdom teeth are called impacted. These unusual positions may jeopardize the health of adjacent teeth and necessitate removal in order to prevent future problems.
A wisdom tooth is extracted to correct an actual problem or to prevent problems that may occur in the future. When wisdom teeth come in, a number of problems can occur:
The relative ease at which your oral surgeon can extract your wisdom teeth depends on the position of the impacted teeth. Your surgeon will be able to give you an idea of what to expect during your pre-extraction examination. A wisdom tooth that is fully erupted through the gum can be extracted as easily as any other tooth. However, a wisdom tooth that is underneath the gums and embedded in the jawbone will require an incision into the gums and then removal of the portion of bone that lies over the tooth. Oftentimes for a tooth in this situation, the tooth will be extracted in small sections rather than removed in one piece to minimize the amount of bone that needs to be removed to get the tooth out.
What Is The Best Way To Have My Wisdom Teeth Removed?
In general, wisdom teeth can be removed under intravenous / conscious sedation (in the rooms) or general anesthesia (in a hospital); easy cases can sometimes be done under local anaesthesia. Mr. Erasmus will determine which anaesthetic technique is best suited for your particular case.
What Does Recovery Involve?
People differ a lot, so does the effects of wisdom tooth extraction. How quickly you heal depends on the degree of difficulty of the extraction (a simple extraction of a fully erupted tooth versus a tooth deeply impacted into the jawbone). In general, here's what to expect (and some tips to speed up recovery):
Three of the more important complications include:
Dry socket is a relatively uncommon condition (about 2-4% of cases) that occurs when a blood clot either fails to form or becomes dislodged. Without a blood clot, healing is delayed. A dry socket typically occurs 3 days after the extraction and is accompanied by severe pain. Mr. Erasmus will treat the dry socket by placing a medicated dressing in the socket. Dressing will need to be removed and replaced until the pain has subsided.
Long-term numbness of the lip and chin is a very uncommon complication following the removal of wisdom teeth. The roots of some wisdom teeth are often close to the nerve that supplies feeling to your lower lip and chin; in some cases this nerve can be bruised or damaged during the extraction process and result in long-term numbness. In the majority of cases the numbness is transient, but can last many weeks to months, or even longer. However, it is also known that in a small number of cases the numbness could be permanent.
Mr. Erasmus will always assess your individual risk of nerve damage and if indicated, obtain a 3D scan of your jaw to image the nerve and assess this potential risk.
Infection following the removal of wisdom teeth occurs in around 5% of cases, but is dependent on a number of factors, such as the patient’s oral hygiene after surgery, smoking and healing capacity. You will be prescribed a course of antibiotics and an antiseptic mouthwash in an attempt to minimize the risk of infection, but it can still occur despite our best efforts to prevent it.
We will arrange a check-up appointment some 7-10 days post-surgery as this is the period we are most likely to see infection.
An opening in the floor of the sinus cavity may occur when an upper wisdom tooth is extracted.
If your wisdom teeth are not causing problems, it may be difficult to decide whether to have them removed to prevent problems later in life.
Consider the following:
You may consider making a consultation appointment with Mr. Erasmus, who will examine your mouth and take an X-ray to assess the status of your wisdom teeth and determine whether removal is indicated. If indicated, he will advise you on the appropriate anaesthetic technique and possible risks involved in your particular case.
*Esposito M (2004). Impacted wisdom teeth. Clinical Evidence (12): pp 1930–1933.
Bui CH, et al. (2003). Types, frequencies, and risk factors for complications after third molar extraction. Journal of Oral and Maxillofacial Surgery, 61(12): pp 1379–1389.