Wisdom Teeth Management

In some cases, people don’t experience any problems with their wisdom teeth, but still, just because they aren’t a source of pain doesn’t mean there’s nothing wrong — even though wisdom teeth do not always require extraction, they can still be vulnerable to tooth decay and should be checked by a dentist frequently to ensure they remain disease and decay free.  Some of the problems they can cause are:

• overcrowding teeth
• tooth decay
• impaction
• cysts
• pain
• facial numbness
• infection
• wisdom teeth headaches
• Dry sockets *

* When a tooth is extracted, a blood clot forms in the space where the tooth root was, and seals the area so that it can heal. A dry socket occurs when the blood clot breaks down or becomes dislodged, exposing the bone and nerves. The most critical time of risk for a dry socket following an extraction is the first five days or so. A dry socket can be very painful (ranging from “dull” to moderate to severe), and a foul mouth odor! If you think you have this complication, you should contact your dentist immediately.

Wisdom teeth are extracted more often than any other teeth, and because problems with them are so prevalent, their removal should be included in your future planning.  Problems with wisdom teeth and any associated discomfort usually ends with their removal.

The preferred time for dentists to remove wisdom teeth is when patients are in their late teens or early 20s, before they can cause more severe and expensive problems.  Teeth removed before age 20 have less developed roots that have not solidified in the jaw bone because the bone around the tooth root is less dense (softer) then, making it easier to remove them, and with fewer complications than in older patients. If wisdom teeth are extracted later in life there is a slightly higher risk of damage to a major nerve in the jaw, called the inferior alveolar nerve.

When there is poor alignment of wisdom teeth, they can crowd or damage not only adjacent teeth, but also the jawbone and/or nerves.  Wisdom teeth that are misaligned can be positioned almost any which way:  horizontally, angled toward or away from the second molars, twisted, or angled inward or outward.

Some of the usual reasons to remove wisdom teeth include:

• Damage to other teeth: They can push your other teeth out of a proper position, causing pain and bite problems.
• Alignment: Impacted wisdom teeth can cause problems with crowding of other teeth, especially in small mouths, and may require straightening treatment (braces) to align them.
• Jaw damage: Cysts can form around the new teeth, and if not treated, they can cause bone loss in your jaw and damage nerves.
• Sinus Issues: Can cause sinus pain, pressure, and congestion.
• Gum disease: Swelling in gum tissue may make it hard to clean, causing periodontal problems like gingivitis and infection.
• Cavities: Swollen gums can create pockets between teeth that help bacteria grow, causing decay.
• Cysts: Fluid filled growths that can cause bone loss in the jaw and/or pressure on the jaw’s nerve.
• Tumors: Rare, and usually benign, likewise, can cause pressure on the jaw’s nerve, and may even cause the removal of large sections of the jaw.
• Small mouth: Your jaw lacks space for an extra set of molars.
• Impaction: Failure to erupt, causing other dental problems.

IMPACTED WISDOM TEETH

Impaction is a common dental issue.  There is no way to prevent an impacted tooth.  Patients are often referred to an oral and maxillofacial surgeon to have an impacted tooth surgically removed.  There are several degrees of impacted wisdom teeth, based on the position of the teeth in the jaw:

• Soft tissue impaction — the crown of the tooth has penetrated through the bone, but the gum is still covering all or part of the tooth.
• Partial bony impaction — the tooth has partially erupted, but a part of the tooth remains submerged in the jawbone.
• Complete bony impaction — the tooth is entirely encased by jawbone.

When wisdom teeth become trapped in your jawbone or gums, it can be painful.  If they only partially erupt through the gum, that allows an opening for bacteria to enter around the tooth.  This can cause an infection called pericoronitis, resulting in pain, swelling, jaw stiffness, and general illness.  If untreated, this infection can spread to the throat or into the neck.  Severe infections require a hospital stay and surgery.  Partially erupted teeth are also more prone to decay and gum disease, because their hard-to-reach location in the back of the mouth and awkward positioning makes brushing and flossing difficult.

Sometimes there are no symptoms with Impacted wisdom teeth, meaning you could have impacted teeth and not even realize it.  If symptoms do arise, it is usually the result of the gum on top of the tooth becoming infected or swollen.  Symptoms can include:

• Swelling and/or bleeding of the gum in the back of your mouth
• Swelling around the jaw
• Stiffness or difficulty opening your jaw
• Bad breath
• A bad taste in the mouth
• Pain when you open your mouth
• Pain when chewing or biting
• Headache or jaw ache
• Swollen lymph nodes in the neck

Pain can occur for several days and then disappear, or it can come back weeks or months later.

SURGERY

Wisdom tooth extraction typically takes about 45 minutes or less.  You will be given anesthesia so you don’t feel pain during the procedure:

• Local: The extraction site will be numbed with a shot of Novocaine in your gums.  You may also breathe nitrous oxide, or laughing gas, to relax or even doze during surgery. You should feel alert again shortly afterward.
• IV/Conscious sedation: After numbing your mouth, anesthetic will be administered through a vein in your arm or back of the hand to make you drowsy.  There will be no memory of the procedure, but you can respond to dentist instructions like “open wide.”
• General: You’ll get anesthetic either through a vein or breathe gas in through a mask.  You’ll be asleep the whole time and might not wake up for an hour or so after the surgery.

The surgery may be a simple extraction of a fully erupted tooth versus a surgical extraction (an odontectomy) of a tooth impacted into the jawbone.  When a wisdom tooth is completely or partially underneath the gums and embedded in the jawbone, or completely underneath the bone in the jaw, it will require an incision into the gums and then removal of the portion of bone that lies over the tooth.  When a tooth is partially or totally encased in bone, the tooth will often be extracted in small sections rather than removed in one piece in order to minimize the amount of bone that needs to be removed to get the tooth out.  The gum will then be stitched together to expedite healing.  Usually in just a few days the stitches dissolve or fall out.

Most people have little to no pain after surgery. You’ll likely have swelling and mild discomfort for 2 or 3 days. Your mouth may need a few weeks to completely heal.

These are a few tips for the first 3 days after surgery:

• Use an ice pack on your face to curb swelling day 1 and 2.
• Use moist heat for a sore jaw day 3.
• Gently open and close your mouth to exercise your jaw.
• Eat soft foods like pasta, rice, or soup (but only warm, not hot), cold food is best.
• Drink plenty of fluids.
• Use an extra soft brush on your teeth starting the second day, avoiding any blood clots.
• Take the drugs your doctor prescribes to ease pain or swelling.
• Call your doctor if you have a fever, or if your pain or swelling doesn’t improve.
• Don’t drink through a straw. Sucking may loosen blood clots that help your mouth heal.
• Don’t rinse your mouth harshly, just gentle swishing.
• Don’t eat hard, crunchy, or sticky foods that may damage your wounds.
• Don’t smoke. Smoking can slow and compromise your healing.

Complications can be infection, jaw stiffness, or dry sockets.  A rare complication is Paresthesia.  Sometimes wisdom teeth encased in the jawbone are close to nerves, and these nerves can be bruised or damaged during the extraction process. The result is a numbness (called a paresthesia) of the tongue, lip, or chin that can last a few days, weeks, months, or may even be permanent.

Still not eager to part with your third molars?  Wisdom teeth may not be wise!  You should ask your dentist to explain his concerns about your teeth.  You may be able to wait several months before making your decision, to see if anything changes.  However, if you have pain or notice bleeding, swelling or a bad odor near your back teeth, don’t delay — it may be time for a second look to avoid potentially serious (and expensive) problems.

If you are interested in wisdom teeth management in Costa Rica, fill out the “Find a Dentist” form on this page.  One of our patient advocates will reply to your needs.