WISDOM TEETH/THIRD MOLARS

The normal adult dentition has three molar teeth in the posterior regions of the upper and lower jaws on the right and left sides. The first molar typically surfaces, or erupts, when an individual is about the six years of age; the second molar appears behind the first molar at the age of twelve. The third molar, commonly called the wisdom tooth, is the last molar to develop and usually erupts posterior to the second molar during the late teens and early twenties. Since our early ancestors had short life spans, the eruption of the third molar teeth signified for them the attainment of maturity or age of wisdom.

Unfortunately for the majority of today's young adults, their jaws are not large enough to allow the eruption of the third molar tooth in a normal, healthy and functional position. A third molar tooth that is prevented from erupting is termed impacted. The impacted third molar because of insufficient space can develop at an improper angle. These teeth may sometimes appear partially through the gum, or they may remain completely encased by gum tissue and bone.

Although blocked from erupting, these teeth can exert significant amounts of pressure to the adjacent teeth and jaw structures resulting in a variety of symptoms. An individual can experience swelling of the affected area, sore throat, headaches, and ultimately infection. Adjacent teeth may shift or develop caries (decay). Impacted teeth are also known to develop cysts that can enlarge, hollowing out the jaw, causing permanent damage to the adjacent bone, teeth and nerves. Tumors can arise from the walls of these cysts further complicating treatment.

Many of the problems created by impacted third molars can develop without symptoms. When they do occur, significant and occasionally permanent damage may have already occurred. When the presence of third molars has been determined, it is best to have them evaluated. If their removal is indicated, it is frequently recommended that third molars be treated before symptoms occur. As an individual ages, the bone becomes more dense making the removal of third molars more difficult and more complications are encountered.

TREATMENT OF THIRD MOLARS

To determine if wisdom teeth are present and if removal is indicated a thorough examination of your mouth is performed. A specialized panoramic x -ray is frequently necessary for a proper evaluation, revealing characteristics of the third molars, jawbone and adjacent nerves that are not observed by visual inspection of your mouth. The results of these procedures are discussed with you and recommendations are made.

Under certain circumstances it may be recommended not to remove third molars. Many individuals have sufficient room in their mouths to accommodate third molars. Occasionally the removal of third molars can be delayed when further development of the third molars will make their removal less complicated.

The removal of third molars is frequently recommended. This requires selective surgical procedures that are individualized according to patient need. The uses of modern anesthetic techniques make the surgery virtually pain-free.

The majority of procedures are performed in the office. Most surgery is completed and the patient discharged from the office within an hour. Analgesics are prescribed to minimize post-operative discomfort. Hospitalization for the surgery on an outpatient or inpatient basis is available when medically necessary.

Recovery is usually rapid with most patients resuming normal activities within a few days following the procedure. Serious complications following the removal of third molars are infrequent; however, a discussion of potential complications is made so that an informed consent for surgery is obtained.

INSTRUCTIONS FOLLOWING THE REMOVAL OF IMPACTED TEETH

The removal of impacted wisdom teeth is quite different from the extraction of erupted teeth. The following conditions may occur, all of which are considered normal:

1. There may be swelling around the surgical site.

2. Trismus (tightness) of the muscles may cause difficulty in opening mouth.

3. You may have a slight earache and a sore throat.

4. Your other teeth may ache temporarily.

5. If the corners of the mouth are stretched, they may dry out and crack. Your lips should be kept moist with a cream or ointment.

6. There may be a visible socket where the tooth was removed. This area should be rinsed with warm salt water after meals. This cavity will gradually fill in with new tissue.

7. There may be a slight elevation of temperature.

8. Slight bleeding (oozing) may occur from area of surgery for 24 hours.