Extractions

Some people have their wisdom teeth, the last teeth to emerge in the mouth, for the rest of their lives. Other people choose to have their wisdom teeth removed, sometimes before they have emerged through the gums.

Consider the following when making your decision.

• You should have your wisdom teeth evaluated if you are 16 to 19 years old.
• Your dentist may recommend removal of a wisdom tooth if it is crowding your other teeth, causes pain, or has become stuck (impacted) as it tries to emerge. Removal also may be recommended if infection has developed as a wisdom tooth is breaking through the gum.
• Oral surgeons generally advise that wisdom tooth extraction is easier in younger people, when the roots and bone are softer because they are not completely developed. In general, the younger you are when you have your wisdom teeth removed, the easier the procedure will be and the faster you will heal. Some dentists think it is best to have impacted wisdom teeth extracted before you are 20 years old, to prevent future problems.
• You may never have any problems with your wisdom teeth. If you are older than 30 and have not had any wisdom tooth problems, you probably will not have these problems in the future. Wisdom teeth that are healthy and properly positioned do not cause problems.

Wisdom Tooth Extraction

Before removing a wisdom tooth, your dentist will give you a local anesthetic to numb the area where the tooth will be removed. To remove the wisdom tooth, your dentist will open up the gum tissue over the tooth and take out any bone that is covering the tooth. He or she will separate the tissue connecting the tooth to the bone and then remove the tooth. Sometimes the dentist will cut the tooth into smaller pieces to make it easier to remove.

After the tooth is removed, you may need stitches. Some stitches dissolve over time and some have to be removed after a few days. Your dentist will tell you whether your stitches need to be removed. A folded cotton gauze pad placed over the wound will help stop the bleeding.

What To Expect After Surgery

In most cases, the recovery period lasts only a few days. Take painkillers as prescribed by your dentist or oral surgeon. The following tips will help speed your recovery.

• Bite gently on the gauze pad periodically, and change pads as they become soaked with blood. Call your dentist or oral surgeon if you still have bleeding 24 hours after your surgery.
• While your mouth is numb, be careful not to bite the inside of your cheek or lip, or your tongue.
• Do not lie flat. This may prolong bleeding. Prop up your head with pillows.
• Try using an ice pack on the outside of your cheek for the first 24 hours. You can use moist heat-such as a washcloth soaked in warm water and wrung out-for the following 2 or 3 days.
• Relax after surgery. Physical activity may increase bleeding.
• Eat soft foods. Gradually add solid foods to your diet as healing progresses.
• Do not use a straw for the first few days. Sucking on a straw can loosen the blood clot and delay healing.
• After the first day, gently rinse your mouth with warm salt water several times a day to reduce swelling and relieve pain. You can make your own salt water by mixing 1 tsp (5 g) of salt in a medium-sized glass [8 fl oz (240 mL)] of warm water.
• Do not smoke for at least 24 hours after your surgery. The sucking motion can loosen the clot and delay healing. Also, smoking decreases the blood supply and can bring germs and contaminants to the surgery area.
• Avoid rubbing the area with your tongue or touching it with your fingers.
• Continue to brush your teeth and tongue carefully.

Your dentist will remove the stitches after a few days, if needed.

Why It Is Done

A wisdom tooth is extracted to correct an actual problem or to prevent problems that may come up in the future. When wisdom teeth come in, a number of problems can occur:

• Your jaw may not be large enough for them, and they may become impacted and unable to break through your gums.
• Your wisdom teeth may break partway through your gums, causing a flap of gum tissue to grow over them. Food and germs can get trapped under the flap and cause your gums to become red, swollen, and painful. These are signs of infection.
• More serious problems can develop from impacted teeth, such as infection, damage to other teeth and bone, or a cyst.
• One or more of your wisdom teeth may come in at an awkward angle, with the top of the tooth facing forward, backward, or to either side.

How Well It Works

Wisdom tooth removal usually is effective in preventing:

• Crowding of the back teeth.
• A wisdom tooth becoming stuck in the jaw (impacted) and never breaking through the gums.
• Red, swollen, and painful gums caused by a flap of skin around a wisdom tooth that has only partially come in.
• Gum disease and tooth decay in the wisdom tooth, which may be harder to clean than other teeth, or in the teeth and jaw in the area of the wisdom tooth.