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Why do we take wisdom teeth out?
According to the American Association of Oral and Maxillofacial Surgeons, we remove wisdom teeth when they cause cavities in adjacent teeth or have disease themselves. Wisdom teeth can lead to periodontal issues, cavities, and severe infections, which may result in hospitalization.
The optimal age to remove wisdom teeth is between 14 and 23 or 24 years of age, or when the roots of the wisdom teeth are not fully formed. In younger patients, such as a 14-year-old, a wisdom tooth leaning towards an adjacent tooth can eventually cause a cavity if left untreated. In older patients, untreated wisdom teeth can cause significant cavities. Generally, I prefer not to wait and see what happens; instead, we remove wisdom teeth to prevent damage and infections. Wisdom teeth can also cause periodontal disease, as seen in cases where bone levels drop significantly around adjacent teeth. For patients under 23 or 24 years old, the bone may recover once the wisdom tooth is removed. However, after 24 or 25 years of age, bone recovery is unlikely, leading to periodontal disease. Wisdom teeth can also lead to cystic lesions or tumors.
Wisdom teeth can cause moderate bone loss in adjacent teeth. Sometimes, wisdom teeth are located near the nerve, requiring careful removal. For instance, a patient who received a restoration by a dentist later developed a cavity underneath the filling due to the difficulty of cleaning teeth positioned far back in the mouth. This situation often results in the need for a root canal and crown, which can be costly. I prefer to remove wisdom teeth before cavities form to ensure proper cleaning and avoid further complications.
Fillings on wisdom teeth are often ineffective. Patients frequently develop cavities again, even after fillings. It is typically a waste of time and money to perform fillings on wisdom teeth, as seen in patients who develop substantial cavities under the fillings. When lower wisdom teeth are removed, the upper wisdom teeth may shift downward due to gravity, causing discomfort by chewing on the lower gums or cheeks. This issue is quite common and occurs frequently in my practice.
In younger patients, typically around 23-24 years old, wisdom teeth may start to erupt without sufficient room, leading to partial coverage by the gum. This allows bacteria to enter and cause inflammation. If the patient has an upper tooth, it may bite down on the inflamed gum, causing pain. This situation can sometimes prevent the patient from opening their mouth wide, either due to guarding or a true infection. Immediate evaluation by an oral and maxillofacial surgeon is necessary in such cases.
Wisdom teeth are not always removed. In some cases, such as with a patient whose upper teeth posed a risk of sinus damage if removed, the teeth were retained. However, the top part of the lower teeth was removed due to problems caused to adjacent teeth. The decision to retain or remove wisdom teeth is based on a careful assessment of risks and benefits.
What should I do immediately after my wisdom teeth are removed?
Immediately after your wisdom teeth are removed, I place two pieces of gauze, and it is important that you do not replace them. Please bite down firmly for 45 minutes without talking to your escort. The pressure will help stop the bleeding.
What should I do when I get home?
Once you arrive home, remove the gauze and consume some yogurt or ice cream. Take your medications immediately before the numbing wears off to avoid chasing the pain. After that, it is best to rest.
Is some bleeding normal?
Some oozing is normal. Blood will mix with your saliva, making it seem like you are bleeding more than you are. This is normal, and there is no need for concern. For this reason, I do not provide many gauzes, as excessive use can actually cause more issues.
What should I do if there is more than oozing?
If you experience more than just oozing and see red blood, use the 2-3 gauzes provided. Place one gauze on each side and bite down for about 30 minutes without talking. Sitting down is best to keep your heart rate down. If this does not work, use a dark tea bag soaked in cold water, place it around the area, and bite down gently for 10 minutes to stop the bleeding.
What precautions should I take on the first day?
On the first day, avoid brushing your teeth and stick to a liquid diet. Do not exercise for 10 days, and avoid smoking and alcohol as they can cause pain and increase the risk of dry socket, which is extremely painful. Avoid hot beverages for 48 hours to slow down the bleeding. Refrain from touching the surgical site or pulling the cheek to check the stitches, as this can disrupt the healing process.
What should I do on the second day?
On the second day, you can gently rinse your mouth with salt water and resume brushing your teeth, avoiding the surgical sites.
What diet should I follow post-surgery?
For the first 2-3 days, stick to a liquid diet such as soup or yogurt. For the following two weeks, consume soft foods like fish, noodles, and pasta. The softer and more liquid-based your diet, the less pain you will experience, and the faster the surgical site will heal, ensuring your comfort.
What should I do if I'm experiencing severe pain and the prescribed medication does not work?
If you experience severe pain and the prescribed medication does not alleviate it, please call our office immediately for assistance.
What Is A Wisdom Tooth Extraction?
A wisdom tooth extraction is a type of procedure designed to safely remove wisdom teeth that are no longer necessary. Wisdom teeth are the final molars on each side of the jaw. These are the very last teeth to emerge from the gums. This typically occurs between the ages of 15 and 20.
Because most people do not have extra room in their mouth for these teeth, a wide range of issues can begin to occur if they are left in the mouth. They could become trapped under the gums or impacted with other teeth, which can lead to swelling and bleeding. Only in rare cases will these teeth be able to emerge from the gums and have sufficient room to stay in the mouth and remain healthy. In all other cases, a wisdom tooth extraction procedure is advised. It’s a very common procedure that doesn’t come with many adverse effects. The length of the procedure largely depends on the position of your wisdom teeth and how many teeth you’re having removed.
How Do You Prepare For Wisdom Teeth Removal?
During your first visit with an oral surgeon or another dentist, you can expect him or her to lay out a plan for treatment. You will most likely have X-rays performed at the time of your visit, too, so make sure you tell the dentist if you’re pregnant or have any condition that can be affected by the X-rays.
Dr. Jamali and his team at Oral & Maxillofacial Surgery of New York hope your first visit is a great one. If you have any questions about what to expect or what to bring along to your first appointment, call (332) 244-0554 and a member of our team will help you out.
Why Should I Remove My Wisdom Teeth?
Wisdom teeth can erupt in various positions. No individual’s teeth will be exactly the same, and the way that the wisdom teeth develop is different for each individual. It is possible for the teeth to develop healthily and correctly for some. Most wisdom teeth are positioned at a horizontal angle, or towards the second molars. These unhealthy angles can impact the nerves in the gums, the jawbone, or other teeth located nearby. Some wisdom teeth become partially trapped in the bone as they attempt to emerge. When this occurs the wisdom teeth are said to be impacted. Being impacted allows them to become enclosed in the tissue and only become partially visible. This can create many issues and the opening will let bacteria from around the tooth enter the gums and jawbone. An infection can occur which creates pain, jaw stiffness, swelling, and many other possible illnesses from the infection. Tumors and cysts can also occur around the impacted wisdom teeth. This can cause the jawbone to be destroyed and infected which can cause further issues for the jaw and other surrounding teeth.
The wisdom teeth that are visible through the gums are also more prone to become decayed and develop gum disease because of their location. Since wisdom teeth are located on the third molar they can be difficult to reach in the back of the mouth. This can create challenges when brushing and flossing.
It is often highly recommended that wisdom teeth are removed in their very early stages to avoid the many problems that can occur. The risks of the surgery are decreased when they are removed at an early stage and it can prevent other teeth from being negatively affected. This is very important when other orthodontic measures such as braces have already been put in place on the other teeth.
Why Are Wisdom Teeth Removed?
There are plenty of reasons as to why you might choose to undergo a wisdom tooth extraction procedure. This procedure is highly beneficial for any individual who is experiencing issues because of the presence of these teeth. Impacted wisdom teeth can result in a myriad of problems, including everything from general pain and damage of a nearby tooth, periodontal disease, tooth decay or in some cases, severe face and neck infection.
Having these teeth removed early will alleviate these symptoms and prevent related dental problems from occurring in the future. Even wisdom teeth that are symptom-free could still hold some form of the disease. When a tooth doesn’t erupt as it should, it can be very difficult to clean properly, which may result in the development of a cavity or tooth decay. It’s also recommended that you seek this procedure as young as possible.
As you get into middle age, the risks from the surgery increase somewhat. If a wisdom tooth becomes impacted, the chance for the development of tiny cysts and tumors increases. The removal of these would require the assistance of an oral and maxillofacial specialist. These are just some of the reasons as to why you should consider a wisdom tooth extraction. The oral and maxillofacial procedure is very successful, especially for those in their late teens and early 20’s. There are hardly any possible long-term complications, so the downside to having this procedure done is minimal.
What Can You Expect During The Extraction?
In the hands of an oral & maxillofacial surgeon, the wisdom tooth extraction procedure is pretty straightforward. It begins with the application of a local anesthetic by the oral surgeon. The area directly surrounding the teeth that are set to be pulled will be numbed so that you don’t feel any pain during the procedure. If more than one tooth is being pulled, a general anesthetic may be administered instead so as to keep you unconscious throughout the extractions. If you choose to have IV sedation, you should not eat or drink 8 hours before the procedure. Once the extraction begins, the gum tissue that’s over or around the tooth will be opened up. If any bone is covering the tooth, it will be removed.
Once this is completed, the tooth may be cut into separate pieces so as to make the removal process a simpler one. Following the surgical procedure, stitches may be placed in the area where the tooth was extracted. In most cases, these stitches will dissolve. In general, the entire recovery process is just a few days long.
How Long Will The Procedure Last?
The time it takes for your wisdom teeth to be removed all depends on:
- The qualification and expertise of your surgeon. An oral and Maxillofacial (OMS) surgeon has 4-6 years of additional training past dental school. Dr. Jamali, an OMS is an expert in removing wisdom teeth.
- Location of the teeth and how many are being removed. If only one wisdom tooth is being extracted, expect the procedure to last a total of 20-30 minutes. In the event that you are having all four wisdom teeth removed, it’s possible that the procedure can last up to 30-45min.
- If IV sedation is chosen, plan to be in our office for about 90 minutes.
What Is The Follow-up And Recovery Like For Wisdom Teeth Removal?
Once the procedure has been successfully completed, you should expect the recovery process to take anywhere from a single day to a few days. Initially, you will experience small amounts of bleeding, swelling, and pain. Bleeding typically dissipates after a day, while swelling and pain can last 2-3 days. Bruising of the area may occur, lasting upwards of four days. Make sure to drink lots of water and eat only liquids like soup for the first 2-3 days and soft foods for the next 10 days following the procedure. Stitches may be placed in the treatment area. These dissolve in a couple of weeks. Only resume brushing your teeth and rinsing with warm salt water after 24 hours have passed. Do not use mouth wash for the first 7 days.
The removal of impacted teeth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully.
Immediately following surgery:
- The gauze pad placed over the surgical area should be kept in place for a 45 min. After this time, the gauze pad should be removed and discarded.
- Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
- When arriving at home, take the gauze out and eat something cold like ice cream or yogurt. Then take the pain medication and antibiotics (if given) immediately after. This must be done before you feel discomfort. This will usually coincide with the local anesthetic becoming diminished.
- Restrict your activities the day of surgery and resume normal activity when you feel comfortable. If you increase your heart rate for the first 10 days after surgery, you will experience throbbing pain. Long walks or talking a lot may cause pain as well.
- Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.
Bleeding
A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding can be controlled by placing a gauze pad over the area and biting firmly for thirty minutes. No talking during this period! Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.
Swelling
The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the body’s normal reaction to surgery and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, or ice packs should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 24 hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Thirty-six hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.
Pain
For mild pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every four hours or Ibuprofen, (Motrin or Advil) three to four 200 mg tablets may be taken every 6-8 hours.
For severe pain, take the tablets prescribed as DIRECTED. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.
Diet
After general anesthetic or I.V. sedation, liquids should be initially taken. DO NOT USE STRAWS FOR THE FIRST 10 DAYS. Drink from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. You may eat anything soft by chewing away from the surgical sites. High calorie, high protein intake is very important. Refer to the section on suggested diet instructions at the end of the brochure. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 5-6 glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat.
Caution: If you suddenly sit up or stand from a lying position you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing.
Hygiene
No rinsing of any kind should be performed until the day following surgery. You can brush your teeth the DAY AFTER of surgery but rinse gently. The day after surgery you should begin rinsing at least 1-2 times a day especially after eating with a cup of warm water mixed with a teaspoon of salt.
Discoloration
In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.
Antibiotics
If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Call the office if you have any questions.
Nausea and Vomiting
In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on coke, tea or ginger ale. You should sip slowly over a fifteen-minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine.
Other Complications
If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, this is usually temporary in nature. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. So be careful. Call Dr. Jamali if you have any questions.
What Are The Potential Costs For Extracting Wisdom Teeth?
Cost is based on the level of impaction of the teeth. There are codes that are sent to your insurance company and based on those codes, you or your surgeon is reimbursed. This is done nationally.
What Are The Potential Risks For Removing Wisdom Teeth?
There are several risks that you should be aware of when considering this procedure. Swelling and pain are common around the socket where the tooth was removed. You may experience bleeding that continues almost constantly for 24 hours. Difficulty with opening your jaw and slow-healing gums are also possible. If the blood clot that protects the treated area is removed too quickly, a substantial amount of pain will occur, which is referred to as a dry socket. Rarer risks include a fractured jaw and an opening in the sinus cavity.