By the age of eighteen, the average adult has 32 teeth; 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.  The back teeth or molar teeth are used to grind food up into a consistency suitable for swallowing.  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."
 

Why Should I Remove My Wisdom Teeth?

Wisdom teeth are the last teeth to erupt within the mouth. When they align properly and gum tissue is healthy, wisdom teeth do not have to be removed. Unfortunately, this does not generally happen.  An estimated 90% of the population does not have enough room for wisdom teeth to grow into a place that is needed for good oral health. The extraction of wisdom teeth is necessary when they are prevented from properly erupting within the mouth. They may grow sideways, partially emerge from the gum and even remain trapped beneath the gum and bone. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to erupt successfully

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.

                                      

       12 years                     14 years                      17 years                       25 years

These poorly positioned impacted teeth can cause many problems. When they are partially erupted, the opening around the tooth allows bacteria to grow and will eventually cause an infection. The result: swelling, stiffness, pain and illness. The pressure from the erupting wisdom tooth may move other teeth and disrupt the orthodontic or natural alignment of teeth. The most serious problem occurs when tumors or cysts form around the impacted wisdom tooth, resulting in the destruction of the jawbone and healthy teeth. Removal of the offending impacted tooth or teeth usually resolves these problems. Early removal is recommended to avoid such future problems and to decrease the surgical risk involved with the procedure

 

Complications

such as infection (fig. a) , damage to adjacent teeth (fig. b) and the formation of cysts (fig. c) may arise from impacted teeth.

   a        b           c

                 (a) Infection                           (b) Crowding, damage                               (c) Cyst


Oral Examination

With an oral examination and x-rays of the mouth, the surgeon can evaluate the position of the wisdom teeth and predict if there may be present or future problems. Studies have shown that early evaluation and treatment result in a superior outcome for the patient. Patients are generally first evaluated in the mid- teenage years by their dentist, orthodontist or by an oral and maxillofacial surgeon.

All outpatient surgery is performed under appropriate anesthesia to maximize patient comfort. Our surgeons have the training, license and experience to provide various types of anesthesia for patients to select the best alternative.

Removal

In most cases, the removal of wisdom teeth is performed under local anesthesia, laughing gas (nitrous oxide/oxygen analgesia) or general anesthesia. These options as well as the surgical risks (i.e. sensory nerve damager, sinus complications) will be discussed with you before the procedure is performed. Once the teeth are removed, the gum is sutured. To help control bleeding, bite down on the gauze placed in your mouth. You will rest under our supervision in the office until you are ready to be taken home. Upon discharge, your post-operative kit will include postoperative instructions, a prescription for pain medication, antibiotics and a follow-up appointment in one week for suture removal. If you have any questions, please do not hesitate to call us at 908-222-7922.

Our services are provided in an environment of optimum safety that utilizes modern monitoring equipment and staff that are experienced in anesthesia techniques. 

 

Dry Socket

Dry socket is the most common complication of an extraction. It develops in about 5% of tooth extractions. It is very painful condition that is easily treated.

A dry socket is: 

Any socket in which a patient is having pain due to the loss of the blood clot thus exposing the bone to air, food, and fluids along with an offensive odor.  This often occurs two or more days after an extraction and can last about 5-6 days.  It is normal to have soreness and discomfort following an extraction.

However, pain should be lessening by the second day.
 
This condition exist when a blood clot is dislodged from the surgery site thus exposing the bone and fine nerve endings. The blood clot helps in the stopping of bleeding and lays the foundation or framework for new tissue and bone to develop over a two-month healing process.  This condition is more common in the mandibular area and in back teeth due to poorer circulation in this area, with wisdom teeth being the most common site.  Dry socket delays the healing process.

It usually takes gum tissue about 3-4 weeks to heal where as the bone can take up to six months to heal.

This condition is most often found:

  1. In individuals who smoke before their recommended time.  Smoking: decreases healing, decrease blood supply to the protective blood clot, brings toxic products to the area, injuries to the gum tissue and the negative pressure of sucking removes the blood clot from the surgery site.

  2. If you do not administor the proper care for your extraction site as instructed by staff.  

  3. Not following your home care instructions.

  4. Sucking action from smoking, sneezing, coughing, spitting or sucking, within the first 24 hours.  

  5. Women taking oral contraceptives are more susceptible.

Prevention of dry socket:

  • Avoid drinking through a straw.
  • Avoid smoking, it contaminates the extraction site.
  • Avoid excessive mouth rinsing, it interferes with blood clotting.
  • Keep food from impacting in this area. Chew on the other side of your mouth and gently rinse your mouth with warm salt water after the first 24 hours
  • Women wo use birth control pills or have their teeth removed in the first 22 days of the mentrual cycle are twice as likely to develop dry socket after an extraction.  Schedule extractions during the last week of your menstrual cycle(days 23 through 28)when estrogen levels are low or inactive.

Treatment could include the following:

  • Medication applied to the site
  • Clove oil technique
  • Gauze with medication
  • Additional home care instructions
  • Applying topical anesthetic
  • Alvogyl by Septodon


Patients usually notice pain relief in about 5-10 minutes after the dressing is applied.

We have experienced fewer cases of dry socket since every patient is asked to rinse with an antimicrobial mouthwash and each patient is instructed on how to care for their extraction site through our website, verbal instruction and home care instruction handouts. We highly recommend patients use Breath RX  in their daily oral hygiene routine to help control oral bacterial.

Continue these instructions for the next 3-4 days:

  • Good oral health care
  • Avoid food with any residuals i.e. popcorn, peanuts and pasta
  • Eat soft foods i.e. mashed potatoes, clear or cream soups, pudding

 

News Updates on Dry Socket

Oral contraceptive may increase pain after wisdom tooth extraction 

That tests on 267 women showed that those on the birth control pill were more susceptible than non-users to both postoperative pain and a condition known as "dry socket." In this condition, normal healing of the vacant tooth socket is delayed by the failure of a blood clot to form. Infection instead causes the socket to remain empty. In the study, pain on the day after the operation was experienced by 30 percent of pill takers compared to just 11 percent of non-users. Five days after the operation the difference was 14 percent compared to 5 percent. The researchers said these results suggest that the pill may reduce the pain threshold. The differential was similar when the development of dry socket was compared. Here, 11 percent of pill users were affected compared to 4 percent of non-pill users. 
SOURCE: British Dental Journal 2003;194:453-455.