Best to Have Wisdom Teeth Removed as a Teenager

For many Americans, having their wisdom teeth removed is part of growing up. Wisdom teeth, also known as third molars, are the last teeth to erupt, or push through the gum. This usually occurs during the teenage years and, according to many dentists, that's the best time to have them removed.

Why remove new teeth if they aren't causing any trouble? Because they're likely to trigger problems eventually, says Mary Lou (Ma'Lou) Sabino, DDS, Assistant Professor of Oral and Maxillofacial Surgery, part of the Medical College of Wisconsin Department of Surgery. And after age 25, extracting wisdom teeth becomes much more complicated than if it's done when patients are between about 15 to 20 years old.

"It's easier when you're younger, because the bony structures under the teeth are still forming and relatively soft," says Dr. Sabino. "After 25, bones have hardened, and extractions can become more difficult," she says. "And the healing process is usually faster in younger patients."

Wisdom teeth are sort of an evolutionary throwback, left over from the time when early man's diet consisted of unrefined food that required considerably more chewing than the modern diet. It's thought they got their name because with age comes wisdom (and wisdom teeth).

Often, wisdom teeth cannot erupt normally because the jaw is not large enough to accommodate them plus all the other teeth that are growing in. Wisdom teeth that are not fully erupted are termed "impacted," because they either remain below the jaw line or don't grow in properly.

Potential Problems
Some of the problems wisdom teeth can trigger include:

• Gum infection (pericoronitis): When wisdom teeth don't fully erupt, food and bacteria can collect under the gum and cause local inflammation, which can produce bad breath, pain, swelling and difficulty opening the mouth. Such an infection could even trigger life-threatening problems, Dr. Sabino says. "When gum tissue becomes inflamed, it can develop a secondary infection or abscess that can rapidly travel to areas where it compromises breathing. This is a medical emergency."
• Decay: Saliva, bacteria and food particles can collect around an impacted wisdom tooth, causing it, or the adjacent tooth, to decay.
• Periodontal problems: Even a fully erupted wisdom tooth can emerge crooked and press against the next tooth, Dr. Sabino says. That can shift the alignment of other teeth. And because these teeth are more difficult to clean, it can also lead to cavities on the back of the adjacent molar.

Impacted wisdom teeth can vary depending on their level of eruption, Dr. Sabino notes. The least severe is a soft-tissue impaction, where part of the tooth remains under the gum or soft tissue. Next is a partial bony impaction, where part of the tooth lies in the bony structure of the jaw. Finally, there is a full, or complete, bony impaction, where the tooth is seated entirely in the bone. Depending on the level of impaction, some extraction procedures might be covered by medical insurance, Dr. Sabino says.

Procedure Usually Brief
Many patients dread the thought of having their wisdom teeth removed, but generally all four wisdom teeth can be removed in 20 to 30 minutes, says Dr. Sabino. The procedure is performed under local anesthesia (nitrous oxide, sometimes called "laughing gas"), so the patient shouldn't feel any pain, just a sensation of pushing. In more anxious patients, intravenous sedation can be used. Patients are then sent home with instructions about aftercare and pain medication, which they might or might not require.

For the next few days after the procedure, Dr. Sabino says, some patients could experience discomfort. All patients should avoid chewing and eat only a soft diet for the next two or three days - soups, puddings, and pureed or mashed food. By the fifth day, they should be able to resume a normal diet.

"Whether a patient experiences pain after a wisdom teeth extraction procedure may depend on the level of the impaction and on the individual," says Dr. Sabino. Sometimes, a patient may develop a "dry socket." This occurs as a result of a prematurely lost blood clot, which can be very painful. Normally, the hole fills with blood that forms a clot, which eventually forms bone and fills in the space. A dry socket can occur if the clot dissolves too quickly or is dislodged. Dry sockets can usually be prevented if patients follow the post-treatment instructions provided by the dentist or oral surgeon. If a dry socket does occur, patients should call the dentist or oral surgeon for additional medication and treatment.

Like any surgery, a wisdom teeth extraction procedure carries potential risk, Dr. Sabino notes. "In addition to a dry socket, some patients experience bleeding or infection, nerve damage, or sinus perforation if the roots of the upper teeth lie close to the wall of the nasal sinuses." These complications are relatively rare, she adds.

Wisdom teeth can be removed by family dentists, but increasingly, more and more dentists refer patients - especially if their wisdom teeth are impacted, or if they are older patients - to an oral surgeon, Dr. Sabino says.

Barbara Abel
HealthLink Contributing Writer

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.