Oral Surgery

Wisdom Tooth Removal

What Are Wisdom Teeth and Why Are They Removed?

Wisdom teeth, also referred to as your third molars, are the very last teeth in the mouth.  They are the last teeth to come in, usually somewhere between the ages of 15 and 25, which is considered to be the “age of wisdom,” hence their name.  While some people have never have a problem with their wisdom teeth erupting, most others find that they present a challenge and can be damaging to the health of the other teeth.

The eruption of the third set of molars may be associated with the following problems:
 
Impaction – Wisdom teeth are the most common teeth to become impacted. When a tooth is impacted, it means that the tooth has failed to emerge through the surface of the gum, or that only a portion of it has emerged.
 
Caries – An impacted third molar leads to a high probability of creating dental caries, or cavities, both in that tooth and in the one next to it, as well. This is because they often trap plaque in the area, which is difficult to reach and to clean.
 
Cysts – When wisdom teeth are impacted, it can cause cysts and tumors to form around the area. This can lead to additional problems because it can affect the bone, and even damage the jaw. Risks with this involve infections, as well as tooth abscesses.
 
Misalignment – The emerging wisdom teeth may not come in straight or, even if they do, can cause problems with other teeth. As they emerge, they often push the other teeth out of alignment.
 
Discomfort – From headaches to toothaches, pain, swelling, and feeling ill, the discomfort associated with wisdom teeth can make you miserable.
 

When to Remove Wisdom Teeth?

The best time to have your third set of molars removed really depends on the tooth’s development. A good professional rule of thumb is to have them removed when two-thirds of the root has formed. Ideally, it is recommended that people have them removed by the time they turn 24 years old. This is because it will help prevent all of the problems listed above, and because the ability to re-grow bone in that area of the jaw is reduced as time goes on. Also, the third set of molars are usually easier to remove when you are younger, and the recovery period is also shorter during that time.

The presence of your third set of molars is usually associated with an increased risk of periodontitis, which is inflammation of the gums and bone which can lead to tooth loss, accesses, infections, and tooth shifting. It is important to note, as well, that the absence of symptoms does not mean that there isn’t a problem or disease.

Additionally, research regarding people who did not have their wisdom teeth removed demonstrates that, the older they got, the more common it was for them to have cavities in those teeth, as well as in the adjacent ones, due to difficulties in keeping them properly cleaned.  In fact, a 2011 study published in the Journal of Oral and Maxillofacial Surgery reported that, of the nearly 7,000 older adults they studied who had at least one third molar, most of those people had caries or periodontal pathology involving those teeth, and that fewer than 2% had visible molars that were free of disease.
 

Additional Concerns

There is some controversy regarding whether those who wear a retainer or have had braces in the past need to continue wearing their retainer once the wisdom teeth have been removed. Because there is a risk of relapse if the retainer is not worn, it is recommended that patients continue wearing theirs, as recommended by their orthodontist. Doing so will help eliminate the risks associated with shifting teeth.

If you are experiencing the emergence of your wisdom teeth, or someone in your family is, be sure to know the facts, risks, and options that are currently available. Having wisdom teeth removed is a common procedure today, one that most people recover from without issue. Removing third molars can be an important step to take if you are having problems now, or as a preventative measure to avoid issues that can arise later.

Gingivectomy

You may need surgery for severe gum disease (periodontitis) if it cannot be cured with antibiotics or root planing and scaling. A gingivectomy removes and reshapes loose, diseased gum tissue to get rid of pockets between the teeth and gums. A gum specialist (periodontist) or oral surgeon often will do the procedure.

The doctor will start by numbing your gums with a local anesthetic. He or she may use a laser to remove loose gum tissue.

After removing the gum tissue, the doctor may put a temporary putty over your gum line. This will protect your gums while they heal. You can eat soft foods and drink cool or slightly warm liquids while the putty is in place and your gums are healing.
 

What To Expect After Surgery

You can return to your normal activities after the anesthetic wears off. It usually takes a few days or weeks for the gums to heal. The contour or shape of your gums may change.

Most gum surgeries are fairly simple and are not too uncomfortable. You can take ibuprofen (such as Advil or Motrin) or acetaminophen (such as Tylenol) to reduce pain. Be safe with medicines. Read and follow all instructions on the label.

After a gingivectomy, it will be easier for you to keep your teeth and gums clean.
 

Why It Is Done

A gingivectomy is necessary when the gums have pulled away from the teeth, creating deep pockets. The pockets make it hard to clean away plaque. Gingivectomy is usually done before gum disease has damaged the bone supporting your teeth.
 

How Well It Works

If you maintain good dental care after surgery, a gingivectomy is likely to help stop gum disease. Your gums should become pink and healthy again.
 

Risks

Gum surgery can introduce harmful bacteria into the bloodstream. Gum tissue is also at risk of infection. You may need to take antibiotics before and after surgery if you have a condition that puts you at high risk for a severe infection or if infections are particularly dangerous for you. You may need to take antibiotics if you:

  • Have certain heart problems that make it dangerous for you to get a heart infection called endocarditis.
  • Have an impaired immune system.
  • Had recent major surgeries or have man-made body parts, such as an artificial hip or heart valve.

 

What To Think About

  • Gingivectomy may help keep gum disease from further damaging your gum tissue, teeth, and bones by helping you to clean better around and between your teeth. If bones are damaged, it is more likely that you will lose your teeth.
  • Gum disease usually will progress if you do not brush and floss regularly after surgery or if you continue to use tobacco.
  • To promote healing, stop all use of tobacco. Smoking or using spit tobacco reduces your ability to fight infection of your gums and delays healing. To learn more, see the topic Quitting Smoking.

Regular follow-up with your dentist is important. If your gum disease gets worse, you may need a different type of surgery.