The average adult has 32 teeth by age 18 — 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 while the back teeth, or molar teeth, are used to grind food up into a consistency suitable for swallowing.
However, the average mouth is made to hold only 28 teeth. It can be painful when 32 teeth try to fit in a mouth that holds only 28 teeth. These four other teeth are your Third Molars, also known as “wisdom teeth.” Wisdom teeth, or third molars, are the last teeth to develop and appear in your mouth. They come in between the ages of 17 and 25. Anthropologists note that the rough diet of early humans resulted in the excessive wear of their teeth. Normal drifting of the teeth to compensate for this wear ensured that space was available for most wisdom teeth to erupt by adolescence. The modern diet, which is much softer, and the popularity of orthodontic tooth straightening procedures produce a fuller dental arch, which quite commonly doesn’t leave room for the wisdom teeth to erupt, thereby setting the stage for problems when the final four molars enter the mouth.
Oral Examination
With an oral examination and a panoramic x-ray of the mouth, Dr. Farbod evaluates the position of the teeth and predicts if there are present or may be future problems. Studies have shown that early evaluation and treatment result in a superior outcome for the patient.
What is an Impacted Tooth?
When a tooth is unable to fully enter the mouth, it is said to be “impacted.” In general, impacted teeth are unable to break through the gums because there is not enough room. Nine out of ten people have at least one impacted wisdom tooth.
How serious is an impacted wisdom tooth?
If left in the mouth, impacted wisdom teeth may damage neighboring teeth, or become infected. Because the third molar area of the mouth is difficult to clean, it is a site that invites the bacteria that leads to gum disease. Furthermore oral bacteria may travel from your mouth through the bloodstream, where it may lead to possible systemic infections and illnesses that affect the heart, kidneys and other organs.
Research has shown that once periodontal disease is established in the third molar areas, the problem is persistent and progressive, but may improve following extraction of the teeth.
In some cases a fluid-filled cyst or tumor may form around the base of the untreated wisdom tooth. As the cyst grows, it may lead to more serious problems as it hollows out the jaw and damages surrounding nerves, teeth and other structures.
(a) Infection
(b) Damage to Neighboring Teeth
(c) Cyst Formation
Complications such as infection (fig. a) , damage to adjacent teeth (fig. b) and the formation of cysts (fig. c) may arise from impacted teeth.
Must the tooth come out if it hasn’t caused any problems yet?
Many people believe that as long as they are not in pain, they do not have to worry about their wisdom teeth. However, pain free does not mean disease or problem free. In fact, wisdom teeth that come in normally may still be prone to disease, according to a study by the American Association of Oral and Maxillofacial Surgeons and the Oral and Maxillofacial Surgery Foundation. AAOMS strongly recommends that third molars be evaluated by an oral and maxillofacial surgeon by the time a patient is a young adult in order to assess the presence of third molars, disease status, and to suggest management options ranging from removal to a monitored retention plan to ensure optimal patient-specific outcomes.
In general, dental and medical professionals agree that wisdom teeth should be removed in the following instances:
- infections and/or periodontal disease;
- cavities that cannot be restored;
- pathologies such as cysts, and tumors, and
- damage to neighboring teeth.
Wisdom teeth that are completely erupted and functional, painless, cavity-free, in a hygienic environment with healthy gum tissue, and are disease-free may not require extraction. They do, however, require regular, professional cleaning, annual check-ups and periodic radiographs to monitor for any changes.
Wisdom Teeth Growth by Age
12 years
14 years
17 years
25 years
Wisdom teeth are easier to remove when the patient is younger, since their roots are not completely formed, the surrounding bone is softer, and there is less chance of damaging nearby nerves or other structures. Removal of wisdom teeth at a later age becomes more complicated as the roots have fully developed (may involve the nerve), and the jawbone is denser.
It isn’t wise to wait until your wisdom teeth start to bother you. In general, earlier removal of wisdom teeth results in a less complicated healing process.The AAOMS/OMSF study strongly recommends that wisdom teeth be removed by the time the patient is a young adult in order to prevent future problems and to ensure optimal healing.The researchers found that older patients may be at greater risk for disease, including periodontitis, in the tissues surrounding the third molars and adjacent teeth. Periodontal infections, such as those observed in this study, may affect your general health.
What Happens During Surgery?
If your dentist or healthcare professional recommends that your wisdom teeth be removed, you will most likely be referred to an oral and maxillofacial surgeon for the procedure. Before surgery, your oral surgeon will discuss the procedure with you and tell you what to expect. This is a good time to ask questions. Also talk to your surgeon about any concerns you have. Be sure to let your doctor know about any illness you have and medications you are taking.
There are several conditions that affect how easy it will be to remove a wisdom tooth. These conditions include how the tooth is positioned and the stage of root development. If the wisdom teeth are impacted the surgery might be more complicated.
Most of the time third molars can be removed with little or no pain. Usually they can be extracted at the oral and maxillofacial surgery office. Patients are given either local anesthesia, intravenous sedation or general anesthesia. Your surgeon will recommend the anesthetic option that is right for you.
In most cases, because of the amount of bone that may need to be removed or the fact that teeth must be sectioned for removal, the surgical removal of wisdom teeth is performed under IV sedation or general anesthesia. There is the option of local anesthesia with or without nitrous oxide (“laughing gas”), in which the patient is awake and aware during the entire procedure. These options, as well as the possible surgical risks, will be discussed with you before the procedure is performed. Once the teeth are removed, the gum is sutured. To help control bleeding, gauze is placed in your mouth. You will rest under our supervision in the office until you are ready to be taken home.
What Happens after Surgery?
Following surgery, you may experience some swelling and mild discomfort, which are part of the normal healing process. Cold compresses may help decrease the swelling, and medication prescribed by your Oral and Maxillofacial Surgeon can help manage the discomfort. You may be instructed to modify your diet following surgery and later progress to more normal foods.
What if I decide to keep my wisdom teeth?
If after discussing your situation with your oral and maxillofacial surgeon, you decide to keep your wisdom teeth, be sure to take particular care in cleaning and flossing your teeth, especially the third molars. Your third molars must be professionally examined regularly and x-rays of your wisdom teeth should be taken every year to make sure that the health of your teeth and gum tissue does not change. Remember that as you age, the risks and complications of third molar surgery increase, particularly permanent nerve damage and jaw fracture.