15 Jan 2019
YOU MIGHT BE HAVING A routine teeth cleaning when your dentist breaks it to you: “It looks like your wisdom teeth are coming through.”
Unfortunately, these teeth won’t bring you bouts of wisdom. (They typically appear between ages 17 and 25, known as an “age of wisdom” – hence the name.)
Not everyone develops the third set of molars, but the American Association of Oral and Maxillofacial Surgeons reports about 90 percent of people have at least one impacted wisdom tooth, meaning there’s not enough space for it to break through the gums. The average person has four wisdom teeth, although it’s possible to have more, says J. David Johnson, an oral surgeon in Oak Ridge, Tennessee. He removes up to 1,500 wisdom teeth a year and once treated a patient with nine.
Regardless the number, “the worst thing the patient can do with their wisdom teeth is ignore them,” Johnson says.
Whether you’re guilty of ignoring them (what harm could a few extra teeth do?) or they’re just coming through, Johnson, an American Dental Association spokesman, and Edward Lahey, an attending in oral and maxillofacial surgery at Massachusetts General Hospital and instructor at Harvard School of Dental Medicine, break down what you need to know about wisdom teeth and getting them removed.
Why do people have wisdom teeth?
In prehistoric times, humans had larger, stronger jaws, and wisdom teeth helped with chewing coarse foods such as raw meat and plants. Our ancestors also tended to lose teeth, so
How do I know if I have wisdom teeth?
Your dentist can detect if you have an erupted or impacted wisdom tooth. Depending on your dentist’s expertise, he or she may recommend you visit an oral surgeon who specializes in wisdom teeth care.
In some cases, patients may experience symptoms such as swelling in the back of the oral cavity; limited jaw mobility; or pain when chewing. However, the majority of people with wisdom teeth don’t feel any symptoms, which can be just as problematic.
“Just because wisdom teeth are asymptomatic, it doesn’t necessarily mean they’re disease-free,” Johnson says. “It’s really important to have someone monitor them because a disease process can occur, and you may not feel it.”
Wisdom teeth can lead to infections, lesions, cysts, tumors or damage to adjacent teeth. Johnson says about 25 percent of the population with asymptomatic wisdom teeth develop periodontal disease, also known as gum disease. If ignored, some conditions can escalate and become life-threatening. But if your tooth is disease-free and has room to erupt, then it may be OK to keep. Just make sure to schedule regular checkups, so your dentist can track if the tooth moves or diseases develop, Johnson says.
When’s the best age to remove wisdom teeth?
Wisdom teeth roots typically form during the teenage years. The teeth are easiest to extract and present the least complications up until the roots are two-thirds developed. “Many patients will elect to go ahead and remove their teeth during that time period where the roots are incompletely formed,” says Johnson, who adds that it’s important for teens with wisdom teeth to consult with a professional so they “don’t lose that window of opportunity for removal.”
As people age, the roots continue to grow. Teeth also reposition, and the difficulty of extraction and related risks – like injuring a nerve – increase as you get older. Once patients reach their 30s or 40s, the recovery can be longer, Lahey says.
When I have the procedure, should I choose laughing gas or anesthesia?
“It’s really the patient’s preference,” Lahey says. The question is: Do you want to be awake to see your teeth pulled out or wake up unaware of what happened inside your mouth? In either case, you’ll receive local anesthesia to numb the area – so you won’t feel pain during the procedure – and you’ll need someone to drive you home after.
- The anesthesia route: You’ll receive a dose of antibiotics to take before the appointment and should not have anything to eat or drink at least six hours prior. During the procedure, you’ll be sedated as the surgeon does his work. When it’s all over, you’ll likely feel sleepy and less alert. Johnson advises that a family member or friend dispense any drugs the first day. “You wouldn’t want a situation where the patient is confused and took the medication inappropriately,” he says.
- The laughing gas route: Remember, it won’t hurt, but you’ll see – and hear – everything. “If their teeth are impacted, the teeth are sometimes sectioned with a surgical drill, so they’re aware of the vibration and the chatter,” Lahey says. “And then there’s often brief but sort of intense moments of pressure when (the surgeon) is pushing on the tooth.” But inhaling the nitrous oxide should relax you and relieve any anxiety about the drill in your mouth.
Will I be in a lot of pain after?
The level of discomfort depends on the person. Your surgeon can prescribe narcotics such as hydrocodone, oxycodone, Percoset or Vicodin that will alleviate pain.
Patients also don’t have to take narcotics. “You can combine ibuprofen and Tylenol,” Johnson suggests. “That’s a very effective way to use less narcotic pain medication and still get extremely effective relief.” However, he warns not to take more than 2,400 mg of ibuprofen or more than 3,000 mg of Tylenol in a 24-hour period.
Will my face be puffy?
Sorry, but yes, your cheeks will likely look a chipmunk. In fact, “swelling gets worse before it gets better,” Lahey says. Swelling often peaks 48 to 72 hours later and resolves within a week, but keeping your head elevated and applying ice pack compresses will help the swelling go down. Don’t be alarmed if you also see bruising or yellowing appear several days later.
When does the bleeding stop?
You might experience intermittent bleeding the first few days. Patients are usually given gauze to bite for 15 to 30 minutes to make it stop. Another trick: Biting on a moist tea bag. “It’s not just a wives’ tale,” Johnson says. “That actually has natural constrictors in it that will control the bleeding probably even better than the gauze pad.”
What can I eat?
If you’re an ice cream fan, here’s some good news: You can eat as much as you want! A liquid diet (yogurt, pudding, smoothies) is recommended the first 24 hours, but do not drink from a straw, since the suction can loosen blood clots. Then it’s a soft foods diet for four to five days: Think mashed potatoes, scrambled eggs and pastas. Avoid anything that requires significant chewing – so no steak! – and opt for colder foods that will feel soothing. And be careful when chewing: “Let the knife and fork do the work for you,” Johnson says.
Also minimize smoking and alcohol, especially if you’re taking medication. As for you gum chewers – hold off for a few days. “It’s best just to rest the muscles of mastication,” Johnson says.
Should I brush my teeth?
As Lahey puts it, “We like clean mouths.” Just don’t brush vigorously or floss around the surgical sites. Also avoid rinsing the first 24 hours. After that, Lahey recommends warm salt water rinses to clean the area.
Maintaining good oral hygiene the following four to six weeks is key to prevent food debris and bacteria from collecting. “Sometimes people will have their teeth removed, and a week later they feel so good they forget to keep it clean, and they get an infection,” Johnson says.
When can I return to work?
Many patients schedule the procedure on a Thursday or Friday, and they’re back to work or school by Monday, but it depends on the individual. “If you’re requiring strong pain medication to stay comfortable, that is an indicator you shouldn’t be back at work,” Johnson says, adding that you should not drive or operate machinery when taking narcotics.
Patients also shouldn’t do heavy lifting, strenuous workouts or play a wind instrument the first week after the surgery.
Have more questions?
Ask your doctor. Lahey emphasizes that you should feel comfortable with your oral surgeon, who should review potential complications with you before the procedure. “I think people might be dismissive of, ‘Oh I’m getting my wisdom teeth out, everyone does it,’ but there are risks involved,” he says. “It’s important to pay attention, and ask questions.”