What to do About Wisdom Teeth: A Wise Guide to Your Third Molars

Roughly 10 million wisdom teeth are extracted each year in the US. Are all those extractions really necessary? Making the decision to keep your wisdom teeth or let them go has become a little trickier recently. There are conflicting ideologies with one side saying it’s better to keep them unless you have a problem, and the other saying it’s better to take them out before you ever have a problem. Let’s take a look at what we know.  

What Problems Can Wisdom Teeth Cause?

When your dentist evaluates your wisdom teeth, what exactly are they looking for? They are not only looking at the current condition, but for conditions that are likely to arise. Let’s take a closer look at some of the factors that play into the decision to keep or lose your wisdom teeth.  

Is there enough space for the wisdom tooth to erupt fully into the mouth?

When there is not enough room, complications can occur. The tooth may be angled or even horizontal. Why is this a problem? As the tooth erupts, it applies a force. If it is angled toward the root of the tooth in front of it, the force of the erupting tooth can damage the root of the second molar. Symptoms can be very slow to show up and sometimes the second molar must be lost.  

Is there enough room for good oral hygiene?

shutterstock_572357584 (1) Sometimes, wisdom teeth erupt fully into the mouth, but there is so little space or the teeth erupt at such an angle that it is difficult or impossible to do an adequate job brushing. Not being able to clean the wisdom teeth can lead to gum disease and tooth decay. If you can’t get a toothbrush on it, your dentist will not be able to get a drill to it. This is a situation where it may be best to remove the tooth before it becomes a problem.  

Presence of Cyst

While seemingly harmless, cysts can become large enough to undermine the structure of the jaw. In some cases, the lining of the cysts can become cancerous. While it is a rare occurrence, if a tooth is left in bone, regular monitoring will be required.  

Presence of Gum Disease

Your dentist will want to make sure the tissue around the wisdom teeth are healthy and free of gum disease. If the wisdom teeth erupt in such a way that they form a trap for food and bacteria, gum disease can develop, giving rise to infections.  

Partially Erupted Wisdom Tooth

A wisdom tooth that doesn’t grow in all the way can cause problems, too. This mostly happens on the lower wisdom teeth without enough room to erupt fully. They erupt partway into the mouth and become stuck. Sometimes the problem is a flap of skin that remains over the tooth. In this case, bacteria can be driven under the skin and cause an infection. Sometimes, people don’t even know a tooth has begun to erupt and it becomes decayed. When this happens, it can cause decay of the second molar, as well.  

Pain and other symptoms

Of course, if you have been having any pain in your jaw or sinuses, that will factor into your dentist’s recommendation, also.

If You Have Risk Factors, Do You Have to Get Your Wisdom Teeth out?

Your dentist is there to advise you about the risks you face and to make recommendations based on the best information available. Unfortunately, it is, thus far, impossible to make exact predictions about how wisdom teeth are going to develop. Most wisdom teeth erupt between the ages of 17 and 21. To avoid complications, most evaluations are done before the wisdom erupt. The jaw is still growing during this period, so spacing is an estimate. When evaluating your mouth for wisdom tooth removal, your dentist is looking at a risk versus benefit scenario. How likely will you be to develop one or more issues with your wisdom teeth? How good is your oral hygiene? How might this impact you later in life? They may talk to you about past surgeries and your anxiety levels while coming up with a recommendation for you.  

Who Should Extract Your Wisdom Teeth?

shutterstock_588369593 Oral and Maxillofacial surgeons are highly trained specialists who can sedate at different levels and who have the training to manage the most severe complications. That being said, some general dentists have sedation permits and routinely and successfully take out wisdom teeth. Talk to your dentist about what’s best for you.  

When is the Best Time to Have Wisdom Teeth Removed?

There are two schools of thought here. One says the best time to remove wisdom teeth is before you ever have a problem and before the roots develop. The reasoning is that if there is an evident lack of space, there is no reason to wait for the wisdom tooth to try and erupt into a jaw with limited space and begin to cause problems. Teeth are easier to remove before the roots develop. Do it early and avoid most complications.   The other school of thought is to wait and see if a problem develops and remove it then. There is no way to know if the teeth will erupt, at all. If the tooth stays impacted in bone, there are few reasons to remove it. If it erupts fully into the mouth, it can be monitored frequently for problems. Your dentist will make a recommendation based on the best information available and on their expertise with situations like yours. Each situation is different.   The other part of this question is that because you will need some recovery time, wisdom teeth removal is commonly done over long breaks from school for teens, like summer break or Christmas break, and before the weekend for people who have to work. You need to have time to rest and recover.  

What are The Risks of Wisdom Tooth Removal?

Like any surgery, wisdom tooth removal comes with some risks. The ones that are common aren’t serious and the ones that are serious are not common. Let’s take a look.  
  • Pain usually worst at 72 hours after surgery then improves
    • Extraction site
    • Jaw
  • Dry Socket
    • Loss of the healing clot in the socket.
    • Occurs in about 20% of extractions
    • Uncomfortable but not serious
  • Bleeding
  • Numbness in tongue, lip, or cheek that is usually temporary but may be permanent
    • Due to nerve injury
  • Infection
  • Damage to adjacent teeth or dental work
  • Root fragments may be left behind
  • Reactions to drugs
    • Anesthesia risks including death
  • Fracture of mandible
  • Sinus perforation

What Should I Expect from my Wisdom Tooth Removal?

shutterstock_511485358 If you choose to have your wisdom teeth out under IV sedation, you will have a different experience than if you choose to do it with numbing only. Talk to your dentist about the best course of action for you. IV sedation offers a safe, well-monitored administration of a drug like versed which will relax you while still allowing you to remain conscious. If you choose to have your procedure done under conscious sedation, you will be asked to stop eating and drinking for 8 hours before your appointment time.  

Before the appointment

You will have a consultation with the surgeon or with your dentist where all the risks and complications of your situation are explained to you. You will need to have a panoramic x-ray taken to see your wisdom teeth and where they lie in relation to other vital structures. You will make decisions about sedation and if you decide to have sedation, you will be asked to have a driver come to the appointment with you. You should have someone who is available to tend to you after the appointment, as well. This is a good time to ask questions about  
  • Any prescription medicines you take
  • When to stop eating and drinking
  • How long the surgery is scheduled
  • How complicated your particular case is
  • Postoperative care
  • Recovery

During the Procedure

Again, your experience will vary based on the anesthesia. Most wisdom teeth are removed using either conscious sedation or local anesthesia.

Conscious Sedation

If you are having conscious sedation, you will have an IV started in your arm or hand and drugs will be administered into the IV. You will become sleepy and will have very little memory of the procedure.  

Local Anesthesia

If you opt to have your procedure with local anesthesia, you will be numbed up, but you will be fully aware of the procedures. Usually, your dentist or surgeon will recommend this type of anesthesia for simple extractions.  

The Procedure

The actual removal of your tooth will begin with numbing. Then depending on how your teeth are positioned and whether they are erupted, an incision will be made. If the tooth is impacted, bone will be removed to expose the tooth. If the tooth has no root, it can be extracted fairly easily. If it has developed roots, it may need to be sectioned and taken out in pieces. After extraction, the socket will be cleaned and sometimes packed with a resorbable foam. Sutures will be placed where necessary and a gauze pressure pack placed to aid with stopping any bleeding.  

After the Procedure

If you’ve had the procedure under local anesthesia, you will be free to go. If you have the procedure under sedation, you will be monitored for a short recovery period. Your IV will be removed and someone will go over instructions to care for your mouth. You will also be given written instructions and extra gauze.  

How Do I minimize my risk of Complications?

Make sure you follow your instructions carefully. Here are a list of common instructions to follow. You will be given instructions specific to your case.   First 24 hours
  • Keep firm biting pressure on sockets for at least 30 minutes or until bleeding stops
    • Most bleeding can be stopped with firm pressure
    • Some pink in the sink is normal
    • Some blood tinged saliva on pillowcase is normal
  • Be still and keep your head elevated
  • Don’t engage in any bending or heavy lifting
  • Soft diet lots of fluids
    • Nothing too hot to drink to minimize bleeding
    • Nothing alcoholic or carbonated
  • Don’t smoke or drink through a straw to minimize risk of dry socket
    • No smoking for at least 72 hours
  • Use ice pack
  • No rinsing
  • Light brushing away from extraction sites
  Day 2
  • Resume  activity as tolerated
    • No heavy lifting or vigorous exercise
  • Alternate heat packs with ice

How Do I Know if I Should Call my Dentist or Surgeon?

Your dental team is there to address your concerns. If you have any questions, ask them. If, after your procedure, you experience any of the following, call your dentist or surgeon:  
  • Heavy bleeding that you cannot stop with pressure
  • Difficulty breathing or swallowing
  • Fever (slight elevation of body temp is not unusual after surgery)
  • Malaise
  • Swelling that gets worse after third day, especially with fever
  • Numbness that lasts into second day
  • Blood or pus from nose
  • Water in nose when drinking
  • Burning in nose
  • Pus from extraction sites

What to expect While Healing

You will have discomfort. Usually the pain and swelling are the worst about 72 hours after surgery then get better. Your bone will take about 4-6 weeks to heal and full remodeling of the bone could take up to a year. You may spit out little splinters of bone for a long time while it remodels. Your face may look thinner over time. shutterstock_93135241  

Don’t Be Afraid to Ask Questions

Your dental team is trained to answer your questions and discuss your concerns. Communication is the key to good decisions about your health!