Wisdom Teeth

 What is an impacted tooth?

Each tooth is formed within your upper or lower jaw bones. As it develops, it travels upward or downward towards its appropriate place in your dental arch. This is normal. However, if the tooth travels in the wrong direction, or if its progress is blocked by another tooth, or impeded by dense bone structure of your jaw, the tooth becomes impacted.

How serious is an impacted tooth?

It isn’t normal for a 3^rd molar, or wisdom tooth, to remain beneath the surface beyond the age of about 21, and difficulties probably will develop. For example, decay can occur even though an impacted tooth is not visible from the outside. Saliva, with all the bacteria normally present in the mouth, can reach the crown of an impacted wisdom tooth. If decay does occur, there is no way for a dentist to fill such a cavity and severe pain may result.

Another problem is called peri-coronitis. This is an infection that forms around the crown of the tooth, and as with any infection that goes unchecked, it may spread to the surrounding tissues with the potential of general body illness.

A third problem has to do with the pressure the impacted wisdom tooth produces by pressing on those good teeth that have erupted. This pressure may injure the roots of healthy teeth, or push them out of position, and, ultimately, affect your ability to chew food normally.

The last type of problem which can occur has to do with the possible formation of a cyst around an impacted tooth. This form of abnormality can result in the destruction of bone tissue as well as damage to other teeth.

Must the tooth come out if it hasn’t caused trouble yet?

The main problem is no one can tell when an impacted wisdom tooth will begin to cause trouble. About the only thing that can be said, is that trouble probably will arise, and when it does, it will arrive unexpectedly and at inconvenient times. If trouble arises when you are older, it is unlikely that you will tolerate the procedure as well as you would have, if you had had the surgery at an early age. Also, if trouble arises, sometimes the wisdom tooth cannot be removed until the infection, or other complications, have been treated. Pain may be the last symptom of a problem that is slowly worsening, so that if you wait until it hurts, the problem has already become more difficult to treat and more likely to involve other adjacent structures and teeth. Complications are more frequent and recoveries are generally longer. It’s best to have impacted wisdom teeth removed before trouble begins.

What is the procedure like?

The removal of an impacted wisdom tooth is a surgical procedure. It requires incision of the gum, cutting the tooth, and possibly, removal of some bone. The actual removal of the tooth will be performed utilizing local anesthetic, sometimes by itself, but usually in combination with sedation. Sedation options include nitrous oxide, oral medications and intravenous deep sedation.  Drs. Randolph and Jackson use special surgical instruments, special lighting, strict attention to sterile procedure, and gentle handling of the tissues and bone to assure the best results possible. The appointment may last from twenty minutes to sixty minutes, depending on the difficulty of the procedure and the number of teeth being removed. The area is usually closed with sutures, which generally dissolve and fall out within 5-10 days.

After surgery, you may have some swelling and discomfort. Medications are prescribed to reduce swelling and help you stay comfortable. Temporary symptoms, such as limited jaw opening, jaw muscle soreness, and bruising may also occur.

What complications may arise?

No complications are expected, but all operations carry some risk. Healing will depend on the ability of your body to generate tissue and your oral hygiene.

If the impacted tooth is located in the lower jaw, it may rest on the main nerve that travels in the jaw. While all precautions will be taken, it is possible that the nerve will be bruised. This will result in some numbness of the lower lip or tongue-along the side. This numbness usually does not last more than a few weeks, in most cases, as the nerve repairs itself.

If your impacted tooth is in the upper jaw, the surgeon will take care to see that no unnecessary injury occurs to the wall of the maxillary sinus. Occasionally, the thin wall may crack slightly and some blood may seep into the sinus. If so, you may notice a trace of blood in the nose, but this normally heals within a few days without complications.

Post-operative care instructions will be provided to you. It is essential that you follow them as they will help you to avoid the complications which can lead to unnecessary discomfort and delayed recovery.