Wisdom teeth are the third and final set of molars that most people get in their late teens or early twenties. Sometimes these teeth can be a valuable asset to the mouth when healthy and properly aligned, but more often, they are misaligned and require removal. When the jaw isn't large enough to accommodate wisdom teeth, they can become impacted (unable to come in or misaligned). Wisdom teeth may grow sideways, emerge only part way from the gum or remain trapped beneath the gum and bone.
Wisdom teeth present potential problems when they are misaligned – they can position themselves horizontally, be angled toward or away from the second molars or be angled inward or outward. Poor alignment of wisdom teeth can crowd or damage adjacent teeth, the jawbone, or nerves. Wisdom teeth that lean toward the second molars make those teeth more vulnerable to decay by entrapping plaque and debris. In addition, wisdom teeth can be entrapped completely within the soft tissue and/or the jawbone or only partially break through or erupt through the gum. Teeth that remain partially or completely entrapped within the soft tissue and /or the jawbone are termed "impacted." Wisdom teeth that only partially erupt allows for an opening for bacteria to enter around the tooth and cause an infection, which results in pain, swelling, jaw stiffness, and general illness. Partially erupted teeth are also more prone to tooth decay and gum disease because their hard-to-reach location and awkward positioning makes brushing and flossing difficult.
Extraction of wisdom teeth is generally recommended when:
How Is a Wisdom Tooth Removed?
In addition, wisdom teeth can be entrapped completely within the soft tissue and/or the jawbone or only partially break through or erupt through the gum. The relative ease at which your dentist or oral surgeon can extract your wisdom teeth depends on the position of the impacted teeth. Your oral health care provider will be able to give you an idea of what to expect during your pre-extraction examination. A wisdom tooth that is fully erupted through the gum can be extracted as easily as any other tooth. However, a wisdom tooth that is underneath the gums and embedded in the jawbone will require an incision into the gums and then removal of the portion of bone that lies over the tooth. Oftentimes for a tooth in this situation, the tooth will be extracted in small sections rather than removed in one piece to minimize the amount of bone that needs to be removed to get the tooth out.
What Happens During the Procedure?
Before your wisdom tooth is extracted, the tooth and the surrounding tissue will be numbed with a local anesthetic – the same injection with the same medication you would receive to numb a tooth prior to having a cavity filled. In addition to the local anesthetic to numb the pain, you and your dentist or oral surgeon may decide that a sedative is desired to control your anxiety. Sedating medications that could be selected include: nitrous oxide (otherwise known as "laughing gas"), an oral sedative (for example, Valium), or an intravenous sedative (administered via an injection into your veins). If nitrous oxide is given, you will be able to drive yourself home. If any of the other medications is selected, you will need someone to drive you both to and from the appointment in which your tooth will be extracted.