What are Wisdom Teeth?
Third molars are commonly referred to as wisdom teeth. They are usually the last teeth to develop and are located in the back of your mouth, behind your second molars. Their development is usually completed between the middle teenage years and early twenties, a time traditionally associated with the onset of maturity and the attainment of wisdom.
What Is An Impacted Tooth?
Although most people develop and grow 32 permanent adult teeth, many times their jaws are too small to accommodate the four wisdom teeth. When inadequate space prevents the teeth from erupting they are called impacted. This indicates their inability to erupt into the proper position for chewing and cleaning.
Types Of Impactions
We will need to see you for a consultation to determine if you will benefit from wisdom tooth removal. A special x-ray of your mouth and jaws (panorex) will be taken to determine if your wisdom teeth are impacted, if there is room for them to erupt, and how difficult it will be to have them removed.
- Soft Tissue Impaction: There is not enough room to allow the gum tissue to retract for adequate cleaning of the tooth.
- Partial Bony Impaction: There is enough space to allow the wisdom tooth to partially erupt. However, the tooth cannot function properly in the chewing process, and creates cleaning problems, among others.
- Complete Bony Impaction: There is NO space for the tooth to erupt. It remains embedded in the jaw bone or if even partially visible requires complex surgical techniques for removal.The impacted wisdom tooth may also be in an unusual position and difficult to remove. This situation can also arise when the shape or size of the jaw bone and other facial structures make removal of this tooth significantly more complex.
Oral Examination
With an oral examination and x-rays of the mouth, Dr. Ponce and Tender Dental & Family Dentists can evaluate the position of the wisdom teeth and predict if there are present or future potential problems. Studies have shown that early evaluation and treatment result in a superior outcome for the patient. Patients are generally first evaluated in the mid-teenage years by their dentist, orthodontist, or by an oral and maxillofacial surgeon.
All outpatient surgery is performed under appropriate anesthesia to maximize patient comfort. Our doctors are trained, licensed, and highly experienced in providing various types of anesthesia for patients.
Why Should I Have My Wisdom Teeth Removed?
If you do not have enough room in your mouth for your third molars to fully erupt, a number of problems can happen. Impacted wisdom teeth should be removed before their root structure is fully developed. In some patients it is as early as 12 or 13, and in others it may not be until the early twenties. Problems tend to occur with increasing frequency after the age of 30. Some of the possible problems related to not removing your wisdom teeth include:
Infection:
The most frequent clinical problem we see is pericoronitis, (a localized gum infection). Without enough room for total eruption, the gum tissue around the wisdom tooth can become irritated and infected, resulting in recurrent pain, swelling, and problems with chewing and/or swallowing.
Cyst Formation:
Non-infectious diseases may also arise in association with an impacted wisdom tooth. Cysts are fluid-filled “balloons” inside the jaw bone that develop as a result of impacted teeth and slowly expand destroying adjacent jaw bone and occasionally teeth. They can be very difficult to treat if your wisdom teeth are not removed in your teenage years. Although rare, tumors can be associated with the delayed removal of wisdom teeth.
Possible Crowding:
Impacted wisdom teeth may contribute to crowding of your teeth. This is most noticeable with the front teeth, primarily the lower front teeth and is most commonly seen after a patient has had braces. There are a number of factors that cause teeth to crowd after braces or in early adulthood. Retained, impacted wisdom teeth may be a contributing factor. Unless you have an active problem when you see the dentist, the reason for removal is primarily to prevent long-term damage to your teeth, gums and jaw bone.
Damage to Adjacent Teeth:
If there is inadequate room to clean around the wisdom tooth, the tooth directly in front, the second molar, can be adversely affected resulting in gum disease, bone loss around the tooth, and/or decay.
The Dental Implant Surgical Procedure
The procedure to place a dental implant takes 30 to 60 minutes for one implant and only 2 to 3 hours for multiple implants. The number of appointments and time required, vary from patient to patient. The surgeon will bring great precision and attention to the details of your case.
Prior to surgery, you may receive antibiotics and for greater comfort, intravenous sedation or laughing gas. These options are discussed with you at your consultation appointment. A local anesthetic will be administered to numb the area where the dental implant will be placed.
When you are comfortable, the surgeon makes a small incision in the gum tissue to reveal the bone, creates space using special instruments, and gently inserts the titanium implant. The top of this implant is often visible through the gum. Sometimes it is better in the early stages of healing to have the implant covered by the gum tissue.
Healing after Dental Implant Surgery
Now the healing begins. The length of time varies from person to person, depending upon the quality and quantity of bone. In some cases, implants may be restored immediately after they are placed. The surgeon will advise you on follow-up care and timing. After the initial phase of healing, the surgeon places an abutment (support post) or a healing cap onto the dental implant during a brief follow-up visit. This allows gum tissue to mature and provides access to the implant.
Occasionally, impressions are made at the time the implant is placed. This enables the crown to be ready when the implants have healed. How long your mouth needs to heal is determined by a variety of factors. Follow-up care (one to four appointments) is usually needed to ensure that your mouth is healing well and to determine when you are ready for the restorative phase of your treatment.
It may be beneficial to perform a soft tissue graft to obtain stronger, more easily cleaned and natural appearing gum tissue in the area around the implant. This process involves moving a small amount of gum tissue from one part of your mouth to the area around the implant. Most often, it is a brief and relatively comfortable procedure.
Whether it’s one tooth or all of your teeth that are being replaced, your dentist will complete the restoration by fitting the replacement tooth (crown) to the dental implant.
When are dental implants placed?
Implants are often placed several months after extraction. At times, an implant may be placed immediately after extraction of a tooth. This may involve a little more risk, but it simplifies the process—you won’t have to wait for another appointment to place the implant. When infection or other problems with the bone are present, immediate implant placement is not the best treatment.
If your tooth has been missing for some time, the adjacent support bone is likely to grow thinner and shrink. This occurs because the root of the natural tooth has to be present to stimulate the bone. As much as one third of your jaw’s thickness can be lost in the year following tooth extraction. If you are missing enough bone, you may benefit from having additional bone grafted into the area. This ensures the implant will be adequately supported when it is placed in the jaw.
How many implants do I need?
Most frequently, one implant per missing tooth is placed. Because many of the larger teeth in the back of your jaws have two or three roots, the most common approach is to replace missing back teeth with larger implants.
What If I Don’t Have My Wisdom Teeth Removed As A Teenager Or Young Adult?
As wisdom teeth develop, the roots become longer and the jaw bone more dense.When it is necessary to remove impacted wisdom teeth in your thirties, forties or beyond, the post-operative course can be prolonged and there is a higher complication rate. Treating these complications is often more difficult and less predictable than with a younger patient. Healing may be slower and the chance of infection can be increased. If your impacted wisdom teeth are not removed in your teenage years or early in your twenties and they are completely impacted in bone, it may be advisable to wait until a localized problem (such as cyst formation or localized gum disease and bone loss) develops. In general, you will heal faster, more predictably and have fewer complications if treated in your teens or early twenties.
What Happens On The Day Wisdom Teeth Are Removed?
Most people prefer to be unaware of the experience when they have their wisdom teeth removed and usually decide to be sedated. You will be provided with appropriate anesthesia options at your consultation. All outpatient surgery is performed under appropriate anesthesia to maximize your comfort. Our office staff has the training, licensing, and experience to provide the various types of anesthesia. These services are provided in an environment of optimum safety, utilizing modern monitoring equipment and a well trained experienced staff. The Surgical Care Team, the office facilities, and the doctors are inspected on behalf of the Board of Dental Examiners on a regular basis.
On the day of your procedure, you will take medications to help minimize post-operative pain and swelling. We ask that a parent or responsible adult accompanies you to the office and plans to stay with you the rest of the day. The procedure will take about 30 to 60 minutes and you will probably be in the office for 90 minutes. Recent advances in medicine and technology allow patients to undergo wisdom tooth removal in a manner, which promotes rapid healing and minimal post-operative discomfort. State of the art sterilization and infection control techniques are used at all times.
On the morning or afternoon of your surgery, it is essential that you have nothing to eat or drink (excluding prescription medications with a sip of water) for at least 6 hours (preferably longer). This does not mean you should try to fit in one “last meal” exactly six hours before your surgery. Having anything in your stomach can increase the risk for serious anesthetic complications, including nausea and vomiting. Your procedure will be rescheduled if you have not heeded these guidelines. We may provide you with a prescription for pain medication at your consultation appointment, which for your convenience, can be filled in advance. When you are seated in the surgical room, we will make every effort to make you as comfortable as possible. If you are going to be sedated, we usually will place an IV in your left arm. This is a quick and nearly painless procedure that ensures optimal delivery of your medication. Local anesthesia is given to you afterwards to ensure comfort, and allow adequate time to travel home and rest. You will be sleepy for a significant portion of the day.
If your surgery requires stitches, these are usually the type that dissolve in 3 to 5 days and do not require removal. You may also notice a sensation of your gums feeling swollen and pulling away from your teeth. This is all part of the normal recovery, and will subside in several days.
Once the local anesthesia wears off, you may require prescription pain medication. Please try non-narcotic anti-inflammatory medications such as ibuprofen (Advil®) first, to see if that adequately treats your pain. If not, begin your other prescription pain medication. The local anesthesia may last until the following day, and should not be confused with an injury to your nerve. We recommend starting your post-operative diet with clear liquids such as jello and broths, gradually increasing in substance as your body permits.
We do not recommend using dairy products such as yogurt, ice cream or milkshakes on the day of surgery, as nausea and vomiting may develop in conjunction with the anesthetic and pain medication. If you are given antibiotics and you take birth control pills, please be aware that the birth control pills might become ineffective and take appropriate precautions.
What Does Wisdom Tooth Removal Cost And Is It Covered By Insurance?
The fee for your treatment is determined by a number of factors. These may include the difficulty involved in removing your teeth and which type of anesthesia is best for you. During your consultation appointment, the surgeon will need to review your x-rays, complete an examination and determine the best option for anesthesia, before an accurate estimate can be provided. Every insurance company has a different policy regarding the extent of coverage for a given surgical procedure.
What If I Have Questions Before Surgery?
At the time of your consultation, your specific situation will be discussed in greater detail. We encourage you to ask any questions you may have. If new questions arise after your consultation, please call our office at East Bonanza Office Phone Number702-307-2273 (CARE) to speak to one of our patient care coordinators.
