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There are 32 teeth in a permanent dentition (set of teeth), including incisors, canines, premolars, and molars. Wisdom teeth, also referred to as third molars, erupt behind the 12-year-molars (second molars) about five to nine years later.
Patients, typically between 16 and 20 years of age, get wisdom teeth removed because they don’t grow in properly. The teeth can grow in at various angles, even horizontally, because the jaw isn’t large enough for them to erupt naturally.
Dentists and oral surgeons extract ten million third molars from five million people in the U.S. every year.
When a tooth is stuck under the gums and blocked by other teeth, it is referred to as an impacted tooth. Dentists recommend extractions to reduce the chance of disease and misalignment. Many people don’t notice any pain at first. Although, if the pain and discomfort are ignored, more serious dental conditions may develop over time. Common signs that third molars need to be extracted include:
The force from wisdom teeth is not strong enough to make the front teeth crooked. Crowding is a natural process of aging. Over time, everyone's teeth will become more crooked, whether they have wisdom teeth or not. The only thing people can do to prevent this is to wear retainers to hold the teeth in place.
Some patients do not require third molar extractions. In fact, some people are born without third molars or have less than four. Signs of healthy growth without the need for removal include:
35 percent of Americans are born without any wisdom teeth.
Oral and maxillofacial surgeons commonly remove wisdom teeth. They are also highly trained in performing these procedures. If a patient is at a higher risk for serious complications or prefers an I.V. sedation, oral surgeons are the ideal option. This is because they are qualified to use deeper levels of sedation and understand how to do it safely.
General dentists also perform tooth extractions, including wisdom teeth. The main difference between an oral surgeon and dentist, in terms of third molar removal, is the level of sedation they are qualified to use on patients.
Local anesthesia (Lidocaine) is administered to the patient, which numbs the surgical area. It may be used by itself or in combination with nitrous oxide (laughing gas), an oral premedication, or I.V. sedation. The surgery does not start until it is in full effect. Patients will not feel any pain during the procedure.
During the surgical extraction, the dentist cuts the gingiva (gums) surrounding each tooth with a scalpel. The gums are peeled back from the underlying bone using surgical instruments. The dental nurse draws the soft tissues back and uses high-speed suction to keep the area clean and dry.
The entire tooth, root pieces, and excess bone are removed by the dentist. Once this step is complete, the socket is examined for any remaining fragments that need to be removed. The entire procedure takes 30 minutes or less.
Once the extraction is complete, the gum tissue may be sutured back into place to cover the underlying bone and promote healing. Although, not all surgeons use stitches.
A patient bites on gauze or a bite pack directly after the procedure to ensure the sockets are isolated and to help stop any bleeding. Antibiotics, pain medications, and anti-inflammatory medications are prescribed to prevent infection and manage postoperative pain.
Recovery Time and Activity — the surgery often causes swelling, pain, and minor bleeding during the first week. Bruising and swelling of the facial region, such as the cheeks and chin, are also common. Avoid strenuous activity for a week post-surgery. Everything should heal within two to three weeks.
Food and Drink Restrictions — during the first two days, only soft food should be ingested, such as smoothies, soups, mashed potatoes, and scrambled eggs. Patients should also refrain from using straws after surgery to reduce the chance of a dry socket forming. Do not drink alcohol, caffeine, hot, or carbonated beverages for at least a week to prevent dry socket formation.
Pain Management — as mentioned above, pain medications, antibiotics, and anti-inflammatories (such as Ibuprofen) are prescribed to most patients after surgery. Ice packs are also provided to reduce swelling and bruising of the facial region.
Tobacco Use — refrain from smoking for one week after surgery to prevent dry socket formation.
Oral Care — brushing, spitting, and rinsing the mouth are not recommended during the first 24 hours after surgery.
Stitches — most extraction stitches dissolve within 7 to 10 days.
A dry socket, also known as alveolar osteitis, is a painful dental condition that occurs in only 2 to 5 percent of extraction patients. After a tooth is removed, a blood clot normally forms to protect the underlying bone, tissues, and nerve.
In rare cases, a dry socket may form within 3-5 days of surgery, which results in the exposure of the bone and nerves.
Severe pain, bad breath, and a bad taste in the mouth are common symptoms. Bleeding should not continue because the socket is dry. Treatment includes returning to the dentist for a dry socket dressing to seal and protect the healing extraction site.
Other side effects and risks of tooth extractions include:
Depending on how many teeth need to be extracted, the price for treatment varies:
Simple Wisdom Tooth Extraction
$75-$200 (per tooth)
$300-$800 (all four teeth)
Impacted Wisdom Tooth Removal
$225-$600 (per tooth)
$250-$800 for general anesthesia
If the procedure is medically necessary, most dental insurance plans cover up to half of the total cost for a patient’s wisdom teeth removal. Dental plans are usually capped at $1,000 to $1,500 annually.
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Friedman, Jay W. “The Prophylactic Extraction of Third Molars: a Public Health Hazard.” American Journal of Public Health, © American Journal of Public Health 2007, Sept. 2007, www.ncbi.nlm.nih.gov/pmc/articles/PMC1963310/.
Hollins, Carole. Basic Guide to Dental Procedures. John Wiley & Sons, Inc., 2015.
Koerner, Karl R. Manual of Minor Oral Surgery for the General Dentist. Blackwell Munksgaard, 2006.
“Who Should Remove My Wisdom Teeth?” U Of U Health, healthcare.utah.edu/the-scope/shows.php?shows=0_kbsgyupm.
Syrbu, John DDS. The Complete Pre-Dental Guide to Modern Dentistry. 2013.