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Pittsburgh, PA 15202

Wisdom Teeth

Wisdom teeth or third molars, are the last teeth to develop. They are referred to as “wisdom teeth” because they usually appear during the late teens, or early twenties, i.e. “the age of wisdom”. In a majority of cases, the jaws of modern humans are smaller than their ancestors.

As a result, there is insufficient room for the third molars to erupt into proper alignment. These third molars are blocked and remain embedded in the jaw bone. This is why wisdom teeth cause more problems than any other teeth in the mouth. In fact, for nine out of ten people at least one wisdom tooth remains underneath the gum due to lack of space in the mouth.

A tooth may just initially break through the gum tissue, a partial bone impaction, or it may fail to erupt at all and thus remain totally impacted. Wisdom teeth that are not causing pain may seem harmless enough. But if not removed early [16-21 years of age], they often will cause the following problems:

A. Infection – the mouth is full of bacteria that normally does not get past the protective layer of the gums. When an impacted tooth breaks through the gum’s surface, bacteria can enter, causing decay of the impacted tooth or the gum tissue surrounding the tooth [pericoronitis]. This infection can cause severe pain, swelling, stiffness of the jaws, and possibly a systemic illness with involvement of the lymph nodes of the neck accompanied by high fever.

B. Pain – Infection in a decayed wisdom tooth or the gum tissues surrounding an impacted tooth can cause pain. If the decayed wisdom tooth is not situated in a healthy position, or if it is not restorable, your dentist may recommend its removal. Headaches and sinus problems may improve following the removal of impacted teeth.

C. Crowding – An impacted wisdom tooth can crowd adjacent teeth out of proper alignment
If you are undergoing orthodontic treatment, your orthodontist will most likely recommend that your impacted wisdom teeth be removed during or shortly after your therapy is completed.

D. Cysts – When a tooth remains impacted, the formative sac remains in bone. Occasionally, the sac fills with fluid, forming an expanding cyst that can erode bone and endanger surrounding structures.
Conclusion – The removal of wisdom teeth is performed in our office or, in rare instances, in a hospital setting if the patient’s medical condition warrants it.

If the tooth is impacted, an incision is made in the gum tissue and the tissue is trimmed back so the tooth can be seen. If bone is covering the tooth, it is removed in order to expose and extract the tooth. The tooth is removed in whole, or in some cases, it is sectioned and the segments are removed individually. Usually the procedure will take up to an hour, although the time can vary depending upon the complexity of the case.

In most cases normal activities can be resumed within a few days depending upon the degree of impaction and the patient’s response to healing, medical history etc. Avoid exertive activities such as most athletics which could reactivate bleeding during this time. The recovery process will go more smoothly if the post operative instructions are followed strictly, such as; 1) no smoking for at least 4 or 5 days and 2) no use of straws when drinking to prevent the pressure of suction as these can result in creating a dry socket (an open pocket that becomes an invitation for infection and sensitivity to air); 3) a soft food diet should be adhered to for at least 2-3 days (puddings, jello, ice cream (not too cold ) mashed potatoes, soups at room temperature as the healing sites will be sensitive to extreme hot or cold, or any other “soft” foods are recommended); 4) avoid carbonated beverages and acidic foods such as oranges, tomatoes etc; and 5) apply ice packs for the first 24 hours (20 minutes on – 20 minutes off) followed by moist heat for the next day or two to prevent the discomfort of swelling; and 6) keep the excision sites clean with gentle swishing of warm salt water and gentle brushing.