Wisdom Teeth Removal

Wisdom teeth, or third molars, are the last teeth to form during dental development and subsequently, the last to erupt through the gum tissue and begin to function, typically in the late teens or early twenties. Because they are the last teeth to erupt, there is often not enough room for the teeth to come in, and they often become impacted, or stuck, in a partially erupted or un-erupted position.

Because the un-erupted teeth cannot be cleaned or maintained, they often decay, become infected, become painful, damage adjacent teeth, or are associated with cyst formation. When these conditions occur, removal of the wisdom teeth is undertaken and the accompanying clinical complication is treated. This clinical scenario can occur at any age. Patients with impacted wisdom teeth have two options with respect to the timing of impacted wisdom tooth removal. The patient can wait until the impacted teeth become symptomatic, and then have the teeth removed. The second option is to have the wisdom teeth removed as a preventive measure, as soon as it becomes apparent that the teeth will not erupt into function. When impacted wisdom teeth are removed in the teens or early twenties, the procedure is easier on the patient; there is less swelling and pain, a quicker recovery, and fewer complications. Not all wisdom teeth need to be removed. If the wisdom teeth have enough room to erupt and to function, they can be maintained and cared for like any other tooth.

Exparel is a long acting numbing agent that can be used to minimize post-operative pain and decrease the need for post-operative narcotic use after wisdom tooth removal.  The medication is injected around each wisdom tooth site and slowly diffuses numbing medication across the site for approximately 3 days after surgery.  With the use of Exparel, many of our wisdom tooth removal patients report using very little or no narcotic pain medication after surgery.

If the wisdom tooth in the lower jaw is intimately associated with the sensory nerve in the lower jaw, nerve injury can occur as a result of the tooth removal.  If the risk for this unwanted side effect is significant, the part of the tooth associated with the nerve is left behind and the top potion of the tooth is removed.  When this occurs, the bone will often heal over the retained tooth root.  Another possible outcome is that the retained tooth root will slowly move away from the sensory nerve and then can be removed safely at a later date.

Wisdom teeth can be difficult to remove due to their position in the dental arch, the degree of impaction, and the density of the surrounding bone. For these reasons, wisdom tooth removal is often performed under IV sedation, to maximize patient comfort. Patients who have special medical needs can be treated surgically in conjunction with monitoring by board certified medical anesthesiologists associated with our practice.

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