By the age of eighteen, the average adult has 32 teeth; 16 teeth on the top and 16 teeth on the bottom. Each tooth in the mouth has a specific name and function. The teeth in the front of the mouth (incisors, canine and bicuspid teeth) are ideal for grasping and biting food into smaller pieces. The back teeth or molar teeth are used to grind food up into a consistency suitable for swallowing.
The average mouth usually has room for only 28 teeth. It can be painful when the last 4 teeth try to fit in a mouth that has room for only 28 teeth. These four other teeth are your third molars, also known as “wisdom teeth”. They are the last to develop and if normal eruption occurs, these teeth should come in just behind the 2nd molars (twelve year molars).
Why Should I Remove My Wisdom Teeth?
Wisdom teeth are the last teeth to erupt within the mouth. When they align properly and gum tissue is healthy, wisdom teeth do not have to be removed. Unfortunately, this does not generally happen. The extraction of wisdom teeth is necessary when it appears that they will not properly erupt into the mouth. They may grow sideways, partially emerge from the gum and even remain trapped beneath the gum and bone. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to erupt successfully.
These poorly positioned impacted teeth can cause many problems. When they are partially erupted, the opening around the tooth allows bacteria to grow and will eventually cause an infection. The result: swelling, stiffness, pain and illness. The pressure from the erupting wisdom tooth may move other teeth and disrupt the orthodontic or natural alignment of teeth. This pressure can even injure other teeth, especially if the impacted tooth is leaning against the root surface of the adjacent 2nd molar. Erupted and partially erupted wisdom teeth are also more prone to decay and periodontal disease, which could cause decay and periodontal problems for the adjacent 2nd molar tooth.
Impacted wisdom teeth also weaken the jaw bone. Just as a knot in a wooden board decreases the strength of the board, a wisdom tooth acts as the ‘weak’ area of the jaw, predisposing the jaw bone to fractures, especially for athletes in contact sports. The most serious problem occurs when tumors or cysts form around the impacted wisdom tooth, resulting in the destruction of the jawbone and healthy teeth. Removal of the offending impacted tooth or teeth usually resolves these problems. Early removal is recommended before they cause problems and to decrease the surgical risk involved with the procedure
With an oral examination and x-rays of the mouth, the doctors can evaluate the position of the wisdom teeth and predict if there may be present or future problems. Studies have shown that early evaluation and treatment result in a superior outcome for the patient.
When should wisdom teeth be removed?
Wisdom teeth should be removed before they cause the problems that they are prone to cause. Your dentist can best determine when you should be evaluated, and refer you to an oral and maxillofacial surgeon, who can determine precisely when and if you need to have them taken out. Patients are generally first evaluated in the mid- teenage years. Usually an x-ray called a panorex will need to be taken to evaluate the presence and position of wisdom teeth. The x-ray helps to show if there is enough room for the wisdom teeth to erupt normally, or if consideration should be given to their removal. Extracting wisdom teeth is usually done during the late teen years or early 20’s. In this earlier time interval, the surgery is technically easier and involves less risk to the patient. Recovery in the earlier years is usually quicker and less painful. When extraction of wisdom teeth is indicated, it is best to remove them when the roots are about half formed.
All outpatient surgery is performed under appropriate anesthesia to maximize patient comfort. Drs. Gorab and Marsh have the training, license and experience to provide various types of anesthesia such as local anesthetic, nitrous oxide, and IV sedation or general anesthesia.
Wisdom tooth Removal
In most cases, the removal of wisdom teeth is performed under local anesthesia, laughing gas (nitrous oxide/oxygen analgesia) or “sleep anesthesia”. These options as well as the surgical risks (i.e. sensory nerve damager, sinus complications) will be discussed before the procedure is performed. After surgery, if you had an IV anesthetic, you will rest under our supervision in the office until you are ready to be taken home. Upon discharge, your post-operative kit will include postoperative instructions, a prescription for pain medication, and a packet of gauze. If you have any questions, please do not hesitate to call us at 973-778-7171
Most patients elect to have an IV anesthetic or ‘go to sleep’ for their surgery. We use a safe, simple, and time honored method to accomplish this.
On the day of your surgery you will need to be NPO. This means that you cannot have anything to eat or drink for at least 8 hours prior to surgery to ensure that your stomach is empty. Most health care providers say ‘nothing to eat after midnight’ which ensures that you have not eaten for at least 8 hours as traditionally no surgery is scheduled prior to 6 AM. An exception to this is if you need to take a routine morning medication or you are prescribed a medication for your surgery. You may take medication with a small amount of water. Our doctors will go over these exceptions with you.
Once you arrive at our office, you will be taken back to the operating suite and the surgical assistant will interview you to ensure that you have complied with your pre-anesthetic instructions. Next, she will seat you and apply the anesthesia monitors. Drs. Gorab, Marsh and Scoggins will then start an IV and administer the medications that will put you to sleep.
The usual medications may include Versed, Fentanyl, Propofol, Ketamine, and Decadron. The doctor keeps you lightly asleep during your procedure with small additional doses of the anesthetic medications until surgery is finished. Very few patients have any unpleasant sensations such as nausea or vomiting. After you have fallen asleep, the doctor administers a local anesthetic to the surgical sites. After surgery is over and you wake up, you will have a numb feeling in your jaws, and no pain.
The IV anesthetic medications wear off pretty fast after surgery making it possible to leave the office soon after your surgery. Operating machinery and driving should not be done the remainder of the day after an IV anesthetic. Even if you feel completely sober, a blood test would still detect the anesthetic medications in your system and some of these are narcotic in nature which makes it mandatory that you have a ride home.