Evolution and genetics are the primary factors which have caused some 90% of the earth’s population to not have enough room in their mouths to allow the wisdom teeth, the third molars, to come in as normal healthy teeth.

Evolution over millions of years has been put forward as one cause, theoretically, and scientists speculate that as the human diet has changed, we have developed smaller jaws.

Genetics may also be a factor as we inherit large teeth from dad and a small jaw from mom.  The tooth size and jaw size discrepancy is what leads to both crooked teeth and inadequate room for the wisdom teeth.

Toward the end of high school, the last molars begin to erupt, pushing up through the soft gums.  Your teenager’s “Age of Wisdom” and the concurrent eruption of the last molars, has given them their popular name.

Pain
Pain is the great motivator that propels patients to seek removal of their wisdom teeth, and this pain is usually accompanied by jaw stiffness and swelling.  As the wisdom teeth begin to erupt, bacteria and food can accumulate under the gum and cause this problem. Undergoing wisdom teeth removal before the teeth start hurting is the best approach.  Even when there is enough room in your mouth for the wisdom teeth, they are difficult to get to with a tooth brush and frequently become decayed, infected, and painful later on. Your dentist can help to advise you of the correct timing for the removal of your wisdom teeth with an examination and x-ray.

Crooked Teeth
If you have worn braces or need to wear braces, chances are you won’t have room for your wisdom teeth to come in as normal, healthy teeth. Even if you have straight teeth now, the eruption of the wisdom teeth in the back of your jaw can push and crowd the teeth in the front. Once this happens, braces are the only way to correct the problem.

Cysts and Tumors
All teeth develop in a sack inside the jaw, and this fluid-filled sack disappears when a tooth breaks through the gum.  However, a trapped wisdom tooth sack can continue to grow and destroy bone in the jaw and can even cause the bone to fracture while under the stress of chewing.  Other tumors develop around the impacted teeth, such as keratocysts, ameloblastomas, and even rare cancers.  Treatment is then extensive and could have been avoided with early detection of impacted wisdom teeth.

When a wisdom tooth is blocked from erupting, it is termed “impacted.” Wisdom teeth impacted in the gum tissue overlying them are called soft tissue impactions. Occasionally, these impacted teeth (and even some fully erupted teeth) can be more difficult to remove than your dentist expects or predicts because of root curvatures that are not fully seen on x-rays or because of other anatomical conditions. Wisdom teeth are more commonly still encased in some bone, which is called a partial or full bony impaction. They are either only partially exposed in the mouth or completely under the gum surface and identifiable only on an x-ray.  These complicated issues make the extraction difficult, however, our doctors consider all factors, including age, jaw size, body type, gender and level of anxiety, to make your procedure as easy as possible for you.

Wisdom teeth removal begins by making a window in the gum so that the top of the tooth can be seen.  Most teeth are removed in pieces to avoid making a large and more painful incision. Usually only one-2 stitches are required to close the window in the gum. The stitches may fall out on their own, however you will be scheduled for a one week post-operative visit. It is recommended that IV anesthesia be used in most cases for the removal of wisdom teeth.  Local anesthesia is used after you are asleep so that you will be comfortable after you wake up.

Wisdom teeth removal is a common procedure, but complications can occur.  The following are potential complications that the patient should understand:

• Infection
  This is NOT a common complication, but can occur as late as 3-4 weeks following surgery.  Swelling and pain are indications of infection and should be reported to your doctor immediately.

• Dry Socket
  There is a 5-10% risk of this complication.  Dry socket is a term used to describe a breakdown in the healing process following tooth removal, and the problem generally starts 3-4 days after oral surgery.  Dry sockets respond to treatment rapidly in most cases.

• Nerve Injury
  There is less than a 1% chance of this complication.  Nerves that are in the jaw can become swollen or damaged during wisdom teeth removal, causing the loss of sensation in the lower lip, chin, or tongue.  Occasionally the ability to taste can be altered.  Your risk for this complication depends on the position of the tooth and your specific jaw and nerve anatomy.  Most patients are at a low risk for this complication.

• Sinus Perforation
  This is NOT a common complication.  The roots of the upper wisdom teeth are close to the maxillary sinus, and perforation of the sinus can cause a sinus infection or a persistent fistula that may require closure with a second surgery at a later date.

• Tooth Damage
  Adjacent tooth restorations may be damaged during the removal of a wisdom tooth, but this is usually due to dental decay that is already under the restorations, indicating that the teeth are already in a state of failure.

• Incomplete Removal
  Occasionally, root tips remain after the removal of the wisdom teeth.  Sometimes it is prudent to leave a portion of the root if it is close to the sinus or the nerves in the jaw.  These roots can been seen on dental x-rays, but very seldom cause any problems afterward.