Wisdom Teeth

What happens if I don’t remove my wisdom teeth?
What is the best treatment approach?
Why is it recommended to remove all four wisdom teeth?
What is the best anesthesia option?
How much pain will I have?
Will I have any swelling?
How soon can I return to work or school?
Why remove wisdom teeth that are visible and not causing problems?
I experience occasional pain only. Can I just leave them?
Will crowded wisdom teeth eventually erupt in time?
Do asymptomatic wisdom teeth in older patients need removal?
Is it necessary to remove broken down wisdom teeth that are not painful?
Can wisdom tooth removal change jaw position, bite, or my appearance?
Will removing wisdom teeth correct teeth crowding?
Is it possible to do fillings on  decayed wisdom teeth?
Can wisdom teeth removal cause or worsen TMJ problems?
How soon can I start wearing my retainer after extractions?
What is dry socket and how can I prevent it?
What is the best age for wisdom teeth removal?

What happens if I don’t remove my wisdom teeth?
Wisdom teeth frequently become impacted or stuck behind the second molars and
become extremely difficult to maintain. Plaque along with poor access for
oral hygiene, results in inflammation that can cause infection, tooth decay, or gum
disease. Wisdom teeth may also cause jaw cysts or shifting of adjacent teeth.
The most common problems associated with wisdom teeth are:
• Pain and swelling due to inflammation (pericoronitis) or infection of gum
tissue.
• Gum disease (periodontal disease) between the second molars and wisdom
teeth. They share the same bone and gum tissue and when the tissue is damaged,
repair or regeneration is extremely difficult if not impossible. This greatly
compromises the health of the second molars which are very important for
chewing.
• Decay (caries)- Cavities may occur on the wisdom teeth or on the root surface
of the second molars. This is very difficult, if not impossible, to treat. If decay
occurs on the second molar, it often has to be extracted as well.
• Cysts in the jaw bone- Cysts cause significant destruction of bone and damage
to surrounding structures (teeth, nerve, jaw bone). Some can get quite large and
weaken the jaw bone, with potential fractures.
• Shifting of adjacent teeth- This is not entirely understood by dentists, but is
probably a contributing factor. Orthodontists often recommend removal of the
wisdom teeth to prevent it.

What is the best treatment approach?
The best and most comfortable treatment approach is removing all four wisdom teeth at the same time. Here are the reasons why:
• Pain is not an additive process, which means the amount of pain does not
correlate with the number of teeth being removed. The amount of pain is the
same whether one or four wisdom teeth are removed.
• Pain medications work effectively regardless of the number of teeth removed.
• Antibiotics, pain medication, and anesthesia medications are taken only once.
• The recovery remains the same and does not increase when more teeth are
removed.
• Absence from work or school is needed only once.
• Diet restrictions and instructions remain the same.
• Extraction of all four wisdom teeth is typically a 20 to 30 minute procedure and is
well tolerated by patients.
• Saves money, as patients only pay for anesthesia once.
• Anticipation and related anxiety are experienced one time.
• Saves time.
The surgery is almost always performed in an oral surgery office that is designed
specifically for such procedures. Such offices are equipped with all necessary
instrumentations and equipment for a safe and predictable outcome. Occasionally,
wisdom teeth that are extremely complicated or associated with large cysts may be
done in a hospital under general anesthesia.

Why is it recommended to remove all four wisdom teeth?
Wisdom teeth are highly prone to decay and gum disease and shift downward after if the opposing wisdom teeth is not removed. They will eventually have to be extracted, so better to have the upper and lower teeth removed at the same time. It saves you time and money while minimizing your exposure to anesthesia medications, pain medications, and antibiotics.

What is the best anesthesia option?
Wisdom teeth surgery does not have to be traumatic. Poor experiences in a dental
or oral surgery offices can change one’s outlook on dentistry for life, especially for
young adults. Wisdom teeth removal, while routine, is not simple, and the right
choice in anesthesia can make all the difference in your experience.
There are three options for anesthesia:
• IV sedation: This is the most common approach and desired by most patients. The patient is asleep during the procedure and awake immediately upon completion. This is a very safe technique with continued monitoring of breathing, heart rate, blood pressure, EKG, and oxygenation during the
procedure. Patients are discharged home after a 20 to 30 minute recovery.
• Nitrous oxide: This is commonly referred to as laughing gas. While it provides some relaxation, the patient is still awake and aware of the procedure. This approach may be good for simple procedures or those who are less anxious.
• Local anesthesia: This is the ‘numbing’ only approach. The patient is fully awake. Although the patient is numbed adequately so there is no pain, there are other sensations that may be uncomfortable, like pressure, vibrations, or sounds. Oral sedatives such as Valium or Xanax can provide some relaxation when taken one hour prior to a procedure. The medication is absorbed through the digestive system, therefore its clinical effect and degree of relaxation is highly variable and unpredictable.

How much pain will I have?
Level and duration of pain depends on the complexity of the surgery, technique,
and patient’s tolerance. Most patients experience three to four days of elevated
pain, commonly managed with pain medications such as Vicodin, or Percocet.
Tylenol #3 is an effective analgesic for relieve of mild to moderate pain. As pain
gradually diminishes over the next two to three days, Ibuprofen (Advil) or
Acetaminophen (Tylenol) can be used for relief. After seven to ten days, most
patients no longer have pain and may stop their medications.

Will I have any swelling?
In many patients, Dr. Kazemi can perform a non-invasive procedure that will eliminate or minimize any swelling after surgery.  Any swelling related to surgery will maximize in 36 to 48 hours following the
procedure, and gradually reduce over the next five to seven days. Ice helps to reduce
swelling in the first 24 hours. If extractions were done in a conservative fashion,
you may experience no swelling at all.

How soon can I return to work or school?
Most patients return to school or other normal activities 1-2 days after surgery. Most schedule their surgery on a Friday and are ready to go back to the classroom by that Monday. There is no problem with traveling or flying the following day, although it’s best to rest for a day or two. Each patient is different, however, and there are always variations in overall response and recovery.

Why remove wisdom teeth that are visible and not causing problems?
Effective oral hygiene is very difficult around wisdom teeth, resulting in frequent decay and gum disease. Extractions are recommended to preserve long-term health of bone and gum tissues behind the second molars.

I experience occasional pain only. Can I just leave them?
You are experiencing pericoronitis, inflammation of gum tissue around the crown of wisdom teeth. This type of inflammation recurs frequently, but it can progress to significant infection, pain, and swelling. Chronic inflammation often causes gradual bone loss (gum disease) or decay to adjacent teeth. Early extraction is the best approach for prevention.

Will crowded wisdom teeth eventually erupt in time?
Highly unlikely. There is usually inadequate space between the second molars and jaw bone to allow proper eruption of the wisdom teeth. Their position does not significantly change with growth or time. Furthermore, once the roots are fully formed, usually between the ages of 18 to 21, teeth do not erupt any more. Even if they change position, it is usually minor and not enough to allow for proper hygiene.

Do asymptomatic wisdom teeth in older patients need removal?
Long-standing wisdom teeth are highly susceptible to bone loss and gum disease. Extraction is the best-long term treatment. If there is no pocketing in the gums and the area can be easily cleaned, then the teeth may be observed. Healthy and asymptomatic erupted or impacted wisdom teeth in individuals older than 65 may be monitored closely with X-rays every six months.

Is it necessary to remove broken down wisdom teeth that are not painful?
Broken teeth, even if asymptomatic, harbor bacteria which can progress to further decay, gum disease, bone loss, and infection. Root canal procedures and fillings are significantly more difficult to perform on wisdom teeth and therefore not recommended.

Can wisdom tooth removal change jaw position, bite, or my appearance?
No, extraction of wisdom teeth does not affect jaw position or appearance in any way. The bite also does not change, as teeth do not shift backward. There are changes from the outside and your appearance is not affected.

Will removing wisdom teeth correct teeth crowding?
No. Crowding of teeth is caused by many things. There is some belief that wisdom teeth cause crowding of other teeth, but this is not completely understood. They may be a contributing factor, but are unlikely to be the sole cause. Removal of wisdom teeth does not correct teeth that have shifted or crowded. Orthodontic treatment is recommended to correct teeth crowding.

Is it possible to do fillings on  decayed wisdom teeth?
While placing restorations on wisdom teeth is possible, they are extremely difficult to do well. Lack of space and access create challenges for a dentist to place a proper restoration. Plus, they are always prone to additional decay due to difficult access for hygiene. Any wisdom tooth with decay or an old filling that is deteriorating should be extracted.

Can wisdom teeth removal cause or worsen TMJ problems?
Very unlikely if special precautions are taken. Routinely, the jaw and its joint (TMJ) are protected during surgery by use of a special rubber block that the patient can rest their teeth on. Excessive pressure on the joints are prevented by gentle surgical technique and use of proper instruments.

How soon can I start wearing my retainer after extractions?
Most retainers are made for upper teeth and they extend only to the second molars. Patients can safely wear their retainers in 24 hours and it will not interfere with the healing process. If not comfortable, patients may wait up to a week before using their retainers again without any concerns.

What is dry socket and how can I prevent it?
Dry socket is a type of wound healing complication where the initial blood clot is lost, leaving the socket bone exposed. It occurs three to five days after surgery and is characterized by sudden increase in severe pain. Treatment includes special packing placed by the surgeon, antibiotics, pain medication, and time. It gradually resolves over 7-10 days. Dry socket can be prevented with good surgical techniques and adherence to post operative instructions. Smoking and traumatic surgery by inexperienced dentists can contribute to dry socket.

What is the best age for wisdom teeth removal?
The optimal age for extraction of wisdom teeth is between 15-20. At this age, the wisdom teeth are partially developed with shorter roots. The extraction is less traumatic and safer when performed in this age range. As you get older, the roots become longer and bone becomes more dense, which can make extraction more difficult. As the roots get longer, they become closer to a sensory nerve that can be irritated during extraction, resulting in prolonged numbness. Considering all factors (safety, ease of surgery, recovery) it is best to remove wisdom teeth between ages 15-20.