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Third molars, or "wisdom teeth", are the teeth furthest back
in the mouth. There is one in each quadrant of your mouth (Upper right,
upper left, lower right, lower left). When normal, these teeth usually
begin to erupt through the gums during the late teens to early twenties.
If you look into your mouth simply count back from the frontmost, or
first molar, past the second molar, to the third and last molar. In
many cases, you will not see it, or only see a portion of it. If it
has not been removed already, it may have never formed or may be delayed
in coming in. However, in many cases, the third molars may be impacted.
Impaction simply means that something is covering the tooth, or the
that tooth is angled improperly - in either case, something is preventing
it from eruputing through the gums properly.
Why are they removed so often?
Most third molar removal is done as an elective procedure. Unless
a patient presents with pain eminating from the third molar, the
decision of removal versus non-removal comes down to a matter of
judgment between the patient and the doctor. And this judgment is
based on the probability that the wisdom teeth will cause a problem
in the future balanced against the potential risks of removal.
There are many factors influencing the likelihood of a wisdom tooth
causing infection and pain in the future. Most of the time, the decision
is very clear-cut. Many individuals, especially those of European descent,
simply do not have sufficient room in the back of their mouths for
another tooth. Or, the tooth may be rotated horizontally, or wedged
behind the second molar. These conditions almost guarantee future problems
if not addressed at an early stage.
Most dentists now agree that in these cases early removal during the
teen to early twenties, before problems arise, is highly beneficial.
There are several reasons for this rationale:
- Young people heal much faster
and better than older individuals. This is especially true
for bone filling in the empty socket left after removal. In
young people, there is usually complete bone-fill. In older
adults, a permanent defect may persist
- . Risk of nerve damage minimal-
The nerve that supplies sensation to the lower lip and teeth
runs its course just below the roots of the third molars. Although
still low statistically, the risk of nerve damage increases
exponentially after age 25. If the wisdom teeth are removed
before the roots are fully formed, however, the risk is negligible.
It is important to note that in our practice, we have removed
several thousands of third molars in patients in all age groups,
but have yet to encounter a case of permanent nerve damage,
however we always consider this risk very seriously when evaluating
third molars.
- Ease of removal: Post-operative
discomfort is usually directly proportional to the degree of
difficulty encountered in extraction of the teeth. Since the
wisdom teeth are usually easier to remove in young people,
they usually encounter less post-operative discomfort.
- Minimizes the possibility of
an ill-timed toothache- By removing the wisdom teeth before
they cause a serious infection, one minimizes the possibility
of a problem later on. Case in point: We have seen several
patients who have experienced tooth problems while out of the
country. This can be especially disconcerting if the country's
current standard of care in Dentistry is much different than
in the U.S. In most of these instances, these patients endured
the pain until their return rather than take any chances.
PROCEDURE
For all patients, local anesthetic is used so that the mouth
is completely numb (most people still call it novocaine, but it
is no longer used, replaced usually with lidocaine). Additionally,
many patients also choose nitrous oxide (laughing gas), or IV
sedation (twilight sleep.)
Contrary to popular myth, wisdom teeth are not "pulled".
Instead, they are usually simply loosened with judicious application
of pressure to the sides of the teeth until they simply fall out.
Stitches are usually placed to accelerate the healing of the gum
tissue (which are removed a week later.)
Afterward, specific instructions are given for post-operative care,
along with prescriptions for medications such as antibiotics and
analgesics.
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