To Keep or Not to Keep. Wisdom teeth, also known as third molars are the last teeth to erupt. This occurs usually between the ages of 17 and 25. There remains a great deal of controversy regarding whether or not these teeth need to be removed. It's generally suggested that teeth that remain completely buried or un-erupted if they are in a position where they are unlikely to cause future harm. However, if they present in an abnormal position (ie. infringing on adjacent teeth), their potential  for harm is great and removal should be strongly considered.

When wisdom teeth lack the necessary space for eruption, they cause problems. Lack of space is a common problem since our jaws are actually evolving smaller. If there is pain or swelling due to the eruption of wisdom teeth, an aspirin or Tylenol and warm saltwater rinses (1 teaspoon salt to 8oz of warm water) will help to relieve some of the discomfort. It is important to remember that aspirin should never be placed anywhere in the mouth as a means of relieving pain - It burns tissue.

Indications for Removal

It’s generally accepted that wisdom teeth should be removed if they present with any of the following:

Decay - Saliva, bacteria and food particles can collect around an impacted wisdom tooth, causing it, or the tooth next to it to decay. Pain and infection usually follow.

Gum Infections (Pericoronitis) - When a wisdom tooth is partially erupted, food and bacteria collect under the gum causing a local infection. This may result in bad breath, pain, swelling and/or trismus (inability to open the mouth fully). The infection can spread to involve  the cheek and neck. Once the initial episode occurs, each subsequent attack becomes more severe.

Pressure Pain - The physical pressure of the erupting wisdom tooth upon adjacent teeth causes discomfort. In some cases, this pressure may cause the roots of neighboring teeth to resorb (basically, their roots begin to wear away).

Cysts

Tumors

Destruction of adjacent teeth and bone.

Please note that the effectiveness of removing third molars to prevent lower incisor crowding has not been proven. Lower incisors crowd due to changes in bone growth and have nothing to do with wisdom teeth.

Wisdom teeth may be hard to access with your toothbrush or floss. Over time, the accumulation of bacteria, sugars and acids may cause a cavity to form in the tooth. If the cavity goes unrestored, it may spread and destroy additional tooth structure causing severe consequences. Due to the difficulty of keeping wisdom teeth clean, the accumulation of bacteria and food debris often leads to bad breath. Wisdom teeth that remain under the gums in a horizontal position may exert pressure on the surrounding teeth, causing root resorption. A wisdom tooth that is still under the gums may become irritated. The gum tissue that lays over the tooth may harbor food debris and bacteria, resulting in an infection.

   Depending on the size, shape, and position of the tooth, as well as the degree of root formation, removal can vary from a simple to complex. With simple extractions, there is usually only minimal swelling. Occasionally, some bruising and/or bleeding may be noted. More complicated extractions often result in more bruising, swelling and bleeding. However, your dental professional will provide you with post treatment instructions to minimize these side effects. Following an extraction, a condition called dry socket may occur. If the blood clot that formed in the extraction area becomes dislodged, it exposes the underlying bone. This condition is very painful, but usually resolves after a few days. It is preventable by following the post treatment instructions provided by your dental professional. The longer you wait and the older you get, there is the potential for more problems to occur. This is because as you get older, the bone surrounding the tooth becomes more dense, making the tooth more difficult to remove. The healing  process may also be slower.

Post Operation Suggestions

Do not disturb the wound - In doing so you may invite irritation, infection and/or bleeding. Chew on the opposite side of your mouth for the first 24 hours.

Do not spit. Do not suck through a straw - This promotes bleeding and may dislodge the blood clot, resulting in a dry socket.

Do not smoke - for at least 12 hours (preferentially, avoid smoking until the site heals completely). Smoking will promote bleeding and interfere with healing; it may also cause dry socket.

Following the removal of your wisdom teeth it's important that you call your dentist if any unusual bleeding, swelling or pain occurs. The first 8 hours are usually the worst.

Anti-inflammatory drugs such as Aspirin or Ibuprofen are used to control minor discomfort. Stronger pain relievers  may be prescribed by your dentist depending on the difficulty of the extractions and your level of discomfort.