Wisdom Teeth Extraction at Daniel Tebbi DMD Cosmetic Dentistry
And Orthodontics, Encino California 91436
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) and/or a 3-dimensional scan will be taken to determine if your wisdom teeth are impacted, if there is room for them to erupt, and how difficult involved 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: The tooth is only partially erupted/exposed due to either lack of space of the (angled) position of the tooth.
Complete Bony Impaction: There is NO space for the tooth to erupt. It remains embedded in the jawbone 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 jawbone and other facial structures make removal of this tooth significantly more complex.
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:
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.
Non-infectious diseases may also arise in association with an impacted wisdom tooth. Cysts are fluid-filled “balloons” inside the jawbone that develop as a result of impacted teeth and slowly expand destroying adjacent jawbone 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.
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 oral surgeon, the reason for removal is primarily to prevent long-term damage to your teeth, gums and jawbone.
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.
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 jawbone 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 They 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.
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.
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. We recommend starting your post-operative diet with clear liquids such as jello and broths, gradually increasing in substance as your body permits.
What Happens Afterwards – What Will I Feel Like?
On the first day after surgery, you may experience some minor bleeding and pain. You should cover your pillowcase with something so that you don’t get any blood on it. Each individual’s reaction to surgery varies, and the sensation of pain can range from mild discomfort to severe pain. A variable amount of swelling can be expected following the surgery. This swelling usually peaks on the second day and should begin resolving on the third day. You can limit the amount of swelling you will have by using ice for the entire first day. Most of the time you will want to limit your activities for a few days. We ask that you follow your post-operative instructions closely. Doing so will make you as comfortable as possible during the first few days following your procedure. Please allow time for your body to begin healing before resuming an active social, academic, or athletic schedule. Most patients feel like they are over the hump and on their way to recovery in 3 to 5 days.
Dry sockets continue to be the most common problem people experience following dental surgery. They arise due to premature loss of a blood clot in the empty tooth socket. This seems to occur with greater frequency in people who smoke or are taking birth control pills. While both jaws can be affected, they usually occur in the lower jaw on the third to fifth day. They cause a deep, dull, continuous aching on the affected side(s). Patients may first notice the pain starting in the ear radiating down towards the chin.
The symptoms frequently begin in the middle of the night, and your pain medication regimen may not help. Treatment can involve changing your prescription. Occasionally it is helpful to place a medicated dressing in the empty tooth socket. This will help decrease the pain and protect the socket from food particles. The effectiveness in alleviating the pain lasts for 24-48 hours and may require dressing changes every day or two, for five to seven days. Dressings usually are removed when you have been pain free for 2 to 3 days.
The dressing doesn’t aid in healing. The only reason to place a dressing is for pain control. If medication is controlling the pain, the socket will heal without a dressing. Following removal of the dressing, an irrigation device may be provided to help you to keep food particles from lodging in the extraction site.
What Does The Procedure 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. 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 the doctor’s office to speak to one of the patient care coordinators.
With an oral examination and x-rays of the mouth, Dr. Tebbi 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.
(818) 789- 2034
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