Wisdom Teeth - Your Treatment Options

Wisdom teeth (your third molars) are the last teeth to come in - and the ones least needed for good oral health. They may not erupt, or emerge from your gums, until your late teens or early twenties - if they erupt at all. Most often, they're impacted, or trapped in the jawbone and gums, usually because there's not enough room for them in your mouth. Our jaws are smaller than those of early humans, who needed larger jaws and more teeth for their tougher diet. We don't need that extra chewing power anymore. In fact, wisdom teeth often do more harm than good, and your dentist may recommend removing them.

Most people have four wisdom teeth, one in each corner of the mouth, but each tooth can be at a different stage of eruption and position of impaction. Since wisdom teeth develop over a period of many years, harmful changes in your mouth may be gradual. But these changes could result in sudden and severe pain.

Removal may be wise

Whether or not you have obvious symptoms or not, you can rely on Dr. Marlais' expertise to diagnose existing or potential problems caused by your wisdom teeth. If Dr. Marlais recommends their removal, it may be the wisest choice for the health of the rest of your mouth. 

How your wisdom teeth grow

By your late teens, your jawbone has nearly reached its adult size. But sometimes it isn't big enough to hold developing wisdom teeth. When this happens, your teeth become trapped in the bone and grow wherever they can. The crown (chewing surface of the tooth) may only partially break through the gum. In other cases, it may remain completely in the bone. The roots, which hold the tooth in place, may become mis-shapen or grow dangerously close to a sinus cavity or to the nerve located in your lower jaw.

The advantages of early removal

Like all teeth, wisdom teeth develop inside an opening (socket) in your jaw, protected by bone and gum tissue until they erupt. Over time, your wisdom teeth become more firmly anchored in your jaw as their roots lengthen and the jawbone becomes more dense. So the older you are, the more difficult it is to remove your wisdom teeth.

Deciding on your treatment plan

Depending on the diagnosis, Dr. Marlais may recommend surgical removal of one or more wisdom teeth, close follow-up, or another treatment option. Removal is the most frequently recommended treatment. It can eliminate existing symptoms or protect your mouth from future problems. Or, your wisdom teeth may need to be closely watched if they haven't yet caused changes in your mouth, or if there are medical reasons why surgery would be unwise. Dr. Marlais may also treat some wisdom tooth problems with medications or minor surgery.

The surgery experience

You may need to take some days off work or school to give yourself enough time to recover. If your surgery is going to include anesthesia or intravenous (IV) medication, don't eat or drink anything after midnight the night before. Otherwise, don't eat or drink anything for at least six hours before surgery. You'll probably be tired and not alert enough to drive home safely after surgery. Arrange to have a responsible adult come with you on the day of surgery who can drive you home. Wear comfortable clothes. Choose a top with sleeves that roll up easily, so if you receive an IV anesthetic, it can be administered easily. To help you relax, you may be given a sedative (by pill or IV), which may even put you to sleep. Once you are fully relaxed or asleep, you will be given a local anesthetic to numb the wisdom tooth area. Expect the surgery to take about an hour. If your tooth is erupted it may be removed from its socket without an incision in your gum. For impacted teeth, an incision will be necessary. Stitches may be used to close the incision.

Recovering after surgery

The healing process begins immediately after surgery. The body sends blood to nourish the tooth socket. To control excessive bleeding, you may be instructed to bite down on a piece of gauze, applying constant direct pressure to the area. This helps a blood clot to form in the socket. In a day or two after surgery, soft tissue begins to fill in the opening. New bone tissue also begins to grow in the socket, becoming denser over the next 2-3 months.

Healing tips

• Apply pressure to stop the bleeding by placing the gauze directly over the extraction site

• Apply ice packs to your face to reduce swelling

• Eat soft foods after the bleeding stops

• Drink lots of fluid after the bleeding stops

• Take antibiotics or pain medication, if prescribed

• Keep your mouth clean

• Don't chew hard or crunchy foods in the area for 6-8 weeks

• Don't brush the teeth in the area of surgery until the day after surgery

• Don't rinse your mouth or spit forcefully the day of surgery

• Don't smoke after surgery

• Don't overexert yourself

Call Dr. Marlais' office if you have...

• Excessive bleeding

• Excessive and persistent swelling

• Persistent and severe pain

• Fever

• Reaction to medications

* This article was excerpted and adapted from "Wisdom Teeth: Your Treatment Options," © 1991, Krames Communications.